Paul Markovich has worked in the healthcare industry for more than 30 years, and he calls the industry “dysfunctional” and in need of a major overhaul.
“The health care system is bankrupt and failing us. It requires systemic reform. That reform is unlikely to come from within the health care industry itself. So we need the federal government to step up and make it happen,” Markovich told a crowd of health care executives at an event in Manhattan in early March.
At that event, Ascendian, the parent company of Blue Shield of California, launched a new initiative called “Worthy” aimed at launching a bipartisan national health care reform movement. This initiative relies on industry stakeholders to propose bold, practical solutions to address long-standing problems in our health care system.
“Our efforts to get the federal government to do it are worth it. To do that, we need to appeal to a wide range of people, including employers, business stakeholders, industry, the media, and the general public, and create a critical collective voice that says this is not acceptable, the status quo is not acceptable. Bold, systemic reform is urgently needed, and that’s what makes it worthwhile,” Ascendian President and CEO Markovic said during the event.
The initiative’s name, “Worthy,” comes from the idea of building a health care system “that our families and friends deserve,” Markovich said. Worthy is centered around several strategic pillars.
- Delivering comprehensive, real-time digital health records to all consumers and patients
- Breaking away from the “do more, get paid more” fee-for-service model and start paying for health outcomes instead.
- Make prescription drugs more accessible and affordable by eliminating rebates in the form of rebates, commissions, and spread pricing.
- Keeping the entire health system on budget
“We need change, and Worthy is really trying to be the spark and the catalyst to create that forum and that energy to convince the federal government that we need to change health care and that we need to take responsibility for supporting change in health care,” he said in an interview with Fierce Healthcare in New York City after the Worthy event.
As part of this effort, Worthy creates and shares in-depth content on its website in the form of podcasts, issue analyzes (PDFs), videos, social media posts, media commentary, in-person forums, and more, with the goal of helping consumers and patients understand what needs to change and how to get there.
“Worsey will advocate for passing a series of laws and enacting regulations that will force all participants to prioritize patients over profits, forcing all participants to do the right thing on behalf of each patient, every time, in order to operate and earn money in the health care business,” Markovich said in a document explaining the Worthy initiative.
Markovich encourages healthcare executives to join the movement by signing the pledge on Worthy’s website.
“Every successful social and political movement in our history started with a certain number of people who decided and declared that the status quo was unacceptable and that bold change was needed,” he told an audience at an event in New York City in March. “And I’m asking you to do that.” “What I would ask of you is, when it comes to health care, don’t accept the unacceptable. Speak up for what it is. Set your standards to where they should be, not where they are. If you If you’re in the industry. Do it for yourself. When you do it, I would humbly suggest that we all set the standards for ourselves and the industry at a level that is appropriate for all of us.”
Regarding the involvement of corporate organizations in the medical sector, he acknowledged that participation and involvement depend on the issue.
“For example, I think pharmaceutical companies will be very interested in reforming the pharmacy distribution system. We’ve been advocating for the repeal of 340B. I have little doubt they won’t say ‘Hallelujah.’ In the coming months, we’ll see what needs to change in drug pricing in the first place. We’re going to publish an article about whether there is, and how we should reform it. I think that’s more of a question mark that some, even most drug companies are willing to support,” Markovich told Fierce Healthcare.
Markovich noted that the United States is facing a health care cost crisis because health care costs are currently too high for many people to afford health insurance. The industry also pays for volume, not value or compensation.
They value complexity over clarity and tolerate inefficiencies that leave patients frustrated and vulnerable.
Worthy will initially focus on prescription drug reform (PDF). The group proposes that Congress enact federal legislation to eliminate kickbacks. Over a two-year phase-in period, Congress should eliminate or fundamentally reform the 340B program by banning billing for services based on drug prices, differential payments based on prescription drug placement or quantity, and pricing above the actual cost of services, according to Worthy’s website.
Markovich points out that Blue Shield of California has been working in recent years to change its pharmacy care model and move away from traditional pharmacy benefit management structures. Under the new model, Blue Shield of California is partnering with Amazon Pharmacy, Mark Cuban Cost Plus Drug Company, Prime Therapeutics, and others.
Blue Shield has made a major shift in rethinking traditional paradigms, with the Pharmacy Care Reimagined model being a prime example.
“Back in 2019, we came to the conclusion that there was a fundamental flaw in the way medicines were sold and distributed. It was far from meeting standards. That’s when we created the first draft of what we are currently doing in that area. It was also at that time that we started talking about this and started advocating and lobbying for change. “What I was told at the time was, ‘You don’t understand how big and powerful the Big Three (PBMs) are and how entrenched their interests are,’ how much money and resources they have, how difficult it was to break through, and now it doesn’t seem so difficult,'” he said during an interview.
“You set that standard, you created a realistic path to get there, and we just lobbied persistently and really got a coalition around that. That’s what I want to reiterate,” he added.
Major pharmacy players are now moving to cost-plus, transparency, or fee-for-service models to combat high drug prices and regulatory pressures, and this shift is reverberating throughout the industry.
“The health care industry is very good at moving when needed,” Markovich said. “Right before COVID-19, we were told it would take more than a decade for clinicians to adopt telemedicine, and then it took days or weeks, and then all of a sudden telemedicine became popular. You get paid to do it. It’s amazing how quickly the rats go after the cheese when it’s moved. But I think that’s only going to happen when the federal government moves the cheese.”
Markovich argues that the Trump administration is taking steps in the right direction with initiatives such as drug discount site TrumpRx.
“When you look at what Mark Cuban (Cost Plus Drugs) is doing and what TrumpRx is doing, I think these are models and examples of how to take a lot of noise and potential costs out of the system,” he said.
When it comes to digital health records, Blue Shield of California has made progress in this effort by rolling out a digital health records program aimed at increasing care coordination and transparency and improving the flow of data to health care providers.
The Worthy movement is advocating for a new federal law that would require health care providers to share all patient data with each other and with their patients, giving patients access to comprehensive, real-time digital health records. “The principle of the problem is that it’s your data. You don’t have to ask permission,” Markovic pointed out.
He added, “If you could remove one word from the dictionary in healthcare, it would be interoperability, because it’s a journey without a destination. To me, it represents healthcare, where expectations are low and chronic diseases suffer. We always congratulate ourselves on being able to share a little more data.”
This month, Worthy released a 37-page plan (PDF) outlining steps to simplify health care, including streamlining all laws, regulations and norms for tracking care into a single national standard. The plan also calls for the use of technology, including the responsible use of artificial intelligence.
Automate anything that can be automated, including prior authorizations, billing, provider directory updates, insurance claims settlement, and even routine patient questions.
Markovich acknowledges that the Trump administration’s health tech ecosystem initiative is a step in the right direction, but argues that additional legislation is needed to significantly change direction.
Worthy’s strategic pillars of health care costs, drug pricing, access to medical records, value-based care, personalized care and affordable insurance coverage are all tied together, Markovich said.
“We want to personalize healthcare. We believe the clinical model is about shared decision-making. The idea is that if you have a digital medical record, it will tell you everything there is to know about you, but and other technologies, you can learn everything you need to know about medical care around the world related to your condition, and then lay out the pros and cons of different treatments. By exposing that information to patients, their loved ones, and the treating clinicians, you can have a dialogue and make decisions. Research shows that in general, when you put this process in place, costs are lower, patient satisfaction is much higher, and the quality of outcomes is better.” “What we want to do is create a system of truly personalized care.”
With midterm elections looming, it is unlikely the White House or Congress will take decisive action on health reform this year, Markovich acknowledged. However, public dissatisfaction with health care affordability continues to grow as many people struggle to pay their medical bills. Those feelings persist, he said, and could prompt elected officials to take action.
Worthy has long-term ambitions and progress cannot be measured in “weeks or months,” he said.
