21% Of Medical Care Is Unnecessary. Here’s How We Prevent It.
"Healthcare has had no star score, there's been no reliable pricing. It's all been just a black box." - Will Bruhn
An estimated 21% of all medical care in the U.S. is completely unnecessary. My guest this week is Will Bruhn, CEO and Co-Founder of GAM (Global Appropriateness Measures), and he joins the show to explain exactly where that waste comes from and how we can fix it.
Will argues that we've been measuring quality wrong. Instead of just looking at outcomes (did the surgery go well?), we need to measure appropriateness (should the surgery have happened at all?). We discuss the perverse financial incentives driving this waste, using real-world examples like unnecessary spinal fusions and the statistical spike in C-sections on Friday afternoons.
But this episode isn't just about the problem; it's about the fix. Will breaks down how GAM uses data to identify high-value providers and how employers can redesign plans to guide members away from wasteful care, potentially saving millions while protecting patients from unnecessary risks.
Tune in for a blueprint on eliminating the 21% of healthcare spending that shouldn't exist.
Chapters:
(00:00:00) 21% Of Medical Care Is Wasteful. Here’s How We Prevent It.
(00:00:34) Why 21% of Medical Care is Wasteful
(00:01:57) The Missing Metric: Appropriateness of Care
(00:08:29) How Financial Incentives Drive Bad Medicine
(00:17:02) Case Study: Unnecessary Spine Surgeries
(00:24:06) How We Fix It: Identifying the Right Doctors
(00:31:22) Changing Plan Design to Stop the Waste
(00:33:52) The ROI of Steering to High-Value Care
(00:48:44) The Debate on Government Regulation & Drug Prices
(00:53:31) The Future of Healthcare Transparency
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