(Yahoo!Finance) - Many health-care companies talk about addressing high costs and health equity, but too many fall flat in reaping impact, says one health-care CEO.
"We have to clean up our act. None of us is blame-free in this environment of ever-increasing health care costs," SCAN Group & Health Plan CEO Dr. Sachin Jain told Yahoo Finance at the 2022 All Markets Summit.
As an example of increasing costs, Jain pointed to Pfizer (PFE) CEO Albert Bourla's comments to Yahoo Finance about raising prices for COVID-19 vaccines. Pfizer confirmed a recent report that the vaccines, which had been sold at under $20 per dose previously, could be sold anywhere between $22 to $42 in 2023.
"We have to take a hard look at what companies are doing, why they are doing it, and holding them accountable ... to ensure that patients are protected. Because what I see time and time again is a lot of rhetoric that doesn't necessarily match the action of health care organizations," Jain said.
Even with increased investments in community partners and other equity strategies — which groups like America's Health Insurance Plans compile to showcase the industry's ongoing efforts — the combined impact can hardly be felt, Jain said.
"We've got organizations that have historically not necessarily given priority to these topics. You see a lot of talk ... coming from across the health care industries. Entities that are saying that they believe in health equity, saying that they believe in disparities reductions. But when you actually look at the real investments that they are making, they're small, and they're insignificant in the context of the broader challenges we face as a society," Jain said.
And more organizations need leaders willing to put in real investments, he added. "More than just the window dressing."
The industry has long found ways to justify higher costs, or engage in the blame game of pointing fingers at other sectors. Doctors blame pharmacy benefit managers (PBMs) for high costs and lack of access to drugs, drug companies also point to the PBMs saying they take too much of a cut and don't pass on the rebates they receive for favorable listing positions in formularies. Hospitals blame medical device companies and equipment manufacturers. The list goes on.
Even mission-oriented companies and non-profits share the blame, Jain said.
"What we often see is mission-oriented organizations hiding behind the rhetoric of 'no margin, no mission,'" he said, adding that it helps the industry feel justified in its profit-seeking behaviors.
"But ultimately (it) ignores the fact that the mission isn't organizational sustainability;" the mission is public and community health, Jain said.
SCAN has seen real results. For example, SCAN helped reduce disparities in vaccinations among Black, LatinX and low income individuals in the states it operates in. From February through August 2021, the gap between Black and white members reduced from 17% to 6%.
SCAN also recently launched an LGBTQ+ plan in four states that targets the group's specific needs and focuses on providing a health network that older LGBTQ individuals. The idea, Jain said, is to provide an increasingly tech-savvy older population with the tools they need to live healthier lives and address needs that have been exacerbated from when these individuals were younger and living in a less progressive world.
But how can the industry as a whole create results?
"I think we've gotten confused over the last number of decades and health care has evolved into this new normal where every sector of health care is trying to extract as much as it can," Jain said.
"And it's frankly unsustainable, and it's unethical," he added.
And now, with the passage of the Inflation Reduction Act, which will lower drug prices and enhance Medicare benefits, Jain sees an opportunity for the industry to find its way out of misaligned incentives.
"I think there's this interesting moment in time where there's an alignment of business interests as well as doing the right thing from a social justice perspective," Jain said.
By Anjalee Khemlani · Senior Reporter
