Former CEO Linda Marzano speaks out on addressing “unsexy” patient realities

Friday, March 29, 2019

Linda Marzano

DOWNTOWN SEATTLE—In front of perhaps the largest gathering of Puget Sound health care leaders this year, Linda Marzano, former PacMed CEO and former Senior Vice President of Value Based Care for Providence St. Joseph Health, made sure the current wave of medical innovation does not wash away awareness of the difficulties facing patients in today’s health care market.

The eight panelists featured at Puget Sound Business Journal’s breakfast event, Health Care of the Future, held at the Fairmont Olympic hotel in Seattle, represented a cross section of health care providers and digital innovators. Dr. Naomi Diggs, of Swedish Medical Center, introduced “Health 2.0” as the advancement of tech and telemedicine for the convenience of a mobile-enabled patient population. Founders and CEOs of SEngine, BoxBar Vascular and Phillips Ultrasound expounded on the promises of personalized medicine, new device technologies, AI, machine learning and the “disruption”—for better or worse—emerging at the confluence of Big Data and electronic medical records.

On the human front, diversity and female leadership in medicine were spoken of as a promising developments. Marzano mentioned, for example, how 70% of PacMed’s leadership is women. When asked by the moderator how equitable health care is today, Dr. Kristin Conn, Medical Director of Diversity, Inclusion, & Equity at Kaiser Permanente, painted the positive picture of providers tracking data trends to monitor equity, and an array of local and national collaborations which represent “movement in terms of health equity, [and] people holding systems accountable.” Marzano, speaking from her experience as a clinical RN and as co-founder of Project Access Northwest, was quick to point out, however:

“Yes, we are seeing movement, but we are still challenged by access. Just because you have an insurance card or a Medicaid card does not mean you have access to very good health care. Even if you do have insurance—I think about our Medical Assistants… they’re a single mom with three kids—just because they have health care does not mean they can afford care and have access to it. So, equity and access, I think, have to go hand in hand. Because having health care does not ensure good access.”

Dr. Conn concurred, adding that “I think that we’re going to find that people in the past who’ve thought they’ve had excellent access to care will be less assured of that.”

The panel turned to addressing the strain of health care staffing (a topic on which Marzano recently penned an op-ed for the Business Journal), and some of the challenges faced by health care providers due to technology.

However, the real-world difficulties patients face in accessing care were still top of mind. When the panel opened to audience questions, one woman shared about her recent journey with cancer, describing herself as “one of the lucky ones” because she could afford the $7,500 out-of-pocket costs for three months of treatment. She wondered though,

“Should we not be starting to explain to patients, particularly where there are some incremental differences in treatment, that can have massive out of pocket cost differences, what those are? Because I can imagine the mental health stress on patients who cannot afford to pay those bills, going from being okay on one sort of semi-serious situation, to over the edge.”

At first, the question seemed to stump the panel.

“Financial toxicity is the term I’ve heard,” offered one panelist.

“I love the notion that we’ll have transparency around health care costs… that, day-to-day, is an entire black box for me and my practice,” said another.

Marzano, who is leading the transition from fee-for-service to fee-for-value model in her role as Senior Vice President of Value Based Care for Providence, had this to say:

“It starts with the care model… [As a doctor recently told me], ‘when I’m in an exam room, and I’ve got to talk to my patient about a treatment plan, that they could possibly not afford, but I can’t answer their questions and give them full transparency about the financial impact to them that will possibly change their life,’ he said, ‘that’s where the innovation needs to occur.’ But no one wants to address the stuff that’s not sexy, and really hard, so if someone could innovate around billing in the fee-for-service environment, I think that would truly advance us.”

Delivered as the closing remark of the event, Marzano’s call to action to dig in on behalf of the patient experience resonated through the audience, receiving the only spontaneous applause of the event.

Read former PacMed CEO Linda Marzano’s op-ed on addressing the staffing shortage among lower-paid health care workers.