Kip Webb, MD, MPH, Managing Director and North America Health Provider Portfolio Lead
Dr. Kip Webb has a unique perspective on healthcare, combining a decade of clinical practice as a pediatrician, a public health background, and years of experience in provider consulting. We caught up with him a few days after he participated in San Francisco’s legendary Bay to Breakers race to get his take on healthcare today—and tomorrow.
How did you first get interested in healthcare?
I can vividly remember my first exposure to what people do when they grow up. I was a little boy, and I had a terrible headache. Thinking I might have meningitis, my doctor came to our house, gave me a shot, and made the pain go away.
I was so impressed. I wanted to be a pediatrician from then on, and became the first doctor in my family.
Tell us about your career journey.
When I started medical school in 1983, there were seismic shifts in US healthcare. At a molecular level, we were just beginning the human genome project. At a macro level, there were the first experiments with managed care and the new prospective payment (DRG) system.
I’d say that 98 percent of my medical school class was seduced by molecular biology. I was more interested in the macro issues of access and affordability, which ultimately shaped my career as a practicing physician.
When healthcare reform failed in 1994, I was devastated. I felt as though we had squandered an opportunity to address some of the excesses of our system and estimated it would be 20 years before we got another chance. Wanting to be part of the solution, I went back to school, earning a master's in public health with a concentration in health policy and management.
After earning my degree, my plan was to work as a consultant for a few years. Nineteen years later, I’m still a consultant. I love the work I do every day.
What motivates you in this work?
Being a consultant is hard work. There are long hours and a lot of time on the road. But as a patient and father of patients, I know we have to do better than we are right now.
The quality and safety of the care we deliver in this country is not where it should be. Costs are way too high. This inspires me to get to work.
What’s changed the most in healthcare and technology over the years?
There’s been a huge uptick in the use of electronic medical records in recent years, particularly in the United States and some other countries around the world. This is the first step in going from an analog, paper-based system to a digital healthcare system.
The process has been painful, but the foundation is now in place. We’re making progress using data to understand how we deliver healthcare today—what’s working and what’s not.
We’re getting insight to help make better decisions at the bedside, provide more affordable care and deliver better outcomes.
How has the shift to fee-for-value changed care delivery?
I went to medical school 15 years before I received my public health degree. So I grew up looking at healthcare through a medical lens, believing that modern medicine was the key to prolonging life.
While getting my master’s degree, I learned that only 10 to 20 percent of overall wellness comes from medicine itself. The other 80 to 90 percent comes from personal choices, social and environmental determinants and genetics.
Put this together and you realize that we can’t solve the value-based care problem by focusing solely on medical issues. We must look at the whole picture. We will need to build innovative relationships with non-medical organizations to address these other influences.
What do these innovative relationships look like?
Consider providers treating kids with asthma. It’s one thing to recommend mattress and pillow covers to reduce the harmful influence of dust mites in the bedroom.
But what if we could go a step further, getting into partnerships with home improvement companies that would replace that old carpet and drapes with hardwood floors and mini-blinds? While that may seem expensive, it is far less costly than a single trip to the emergency room, and it will improve long-term outcomes.
What’s your hot-button healthcare issue?
Access and affordability. My son got knocked out in a lacrosse game a few weeks ago and had to go to the emergency room. Even with insurance, our bill was almost $1,300.
For many American families, this would be economically devastating. Even after the passage of the Affordable Care Act (“Obamacare”), healthcare expenses are still the leading cause of personal bankruptcy in this country. We have to solve for this.
What should doctors understand about healthcare consumers in the era of digital health?
Doctors and hospitals both need to understand that patients want a consumer experience that rivals those they get from other industries.
Patients want convenience. They want transparency about cost and quality. They want tools that will help them better take care of themselves.
With these thoughts in mind, I think we are about to see a surge in the implementation of patient engagement and customer relationship management solutions. I also think that there will be a first mover advantage to those doctors and hospitals that implement them.
Do you think patients and doctors are aligned around the use of digital health technologies?
Definitely not! According to our most recent Consumer Survey on Patient Engagement, patient use of digital technology has doubled over the past two years. And those who have adopted digital technologies are using them to manage their own health and wellness. This is exciting news.
But when asked about accessing their electronic medical records, 93 percent of patients said that they wanted to access their entire medical record. Less than 20 percent of physicians agreed.
Alarmingly, this chasm is growing, with physicians being 30 percent less interested in sharing the complete medical record than they were just two years ago.
Why the disconnect between patients and doctors?
Good question. While we didn’t ask this question in our survey, I suspect that this is because the electronic medical record experience has not been what doctors had hoped for.
The industry hasn’t delivered enough tools that help them deliver care more efficiently or effectively. They may be cynical about having yet another dissatisfied consumer of electronic medical record data.
What does the doctor-patient relationship look like in five years?
When I started, medicine was very paternalistic. Doctors made the decisions, and patients followed. Over the subsequent 30+ years, the relationship has evolved to where doctors and patients both have valuable and unique inputs.
I frame it like this: Doctors can legitimately say that they know more about medicine. Patients can legitimately say that they know more about their own disease experience. Bringing both perspectives together can improve outcomes.
What digital health trends are you watching?
Part of why healthcare is so expensive in the United States is that we deliver care in the most expensive settings, using the most expensive resources. We need to move the locus of care upstream.
I’m excited about digital tools that allow us to deliver in the home and virtually, away from the hospital and clinic. And I’m most excited by digital tools that may help keep people from getting sick in the first place.
How do your experiences as a patient and a physician shape your views of healthcare delivery?
We go to doctors under times of great personal duress. As patients, we need to believe that our doctors and care teams are always acting in our best interests.
The truth is they are doing the best they can within a system that has evolved to treat the doctors as the primary customers, rather than the patients.
Take hospital rounds, for example. Doctors visit their hospitalized patients at the crack of dawn so they can back to the operating room or the office—where the majority of their income is earned.
By changing the incentive structure, my hope is that we can challenge some of these basic tenets about the way we do things—and create a more patient friendly and outcomes effective system.