Over a relatively short time, Bob Kocher, MD, has distinguished himself as one of the nation’s leading health reform thinkers. As Special Assistant to President Barack Obama and one of a handful of physicians in the White House, Dr. Kocher was a key architect of the Affordable Care Act. Now a Visiting Scholar at the Brookings Institution and a venture capitalist at Venrock, Dr. Kocher continues to contribute to national health care policy dialogue. He is a frequent editorial contributor to the New England Journal of Medicine and the New York Times.

Before serving in the White House, Dr. Kocher, a physician, served as a principal at McKinsey & Company, the management consultancy. An internist who trained at Harvard’s Beth Israel-Deaconess Medical Center, his breadth of experiences across government, clinical medicine, management consulting, and health entrepreneurship give him a unique perspective on the future of American health care.

I spoke with Dr. Kocher recently about his road from clinical medicine to the White House; his work on health care reform; health care entrepreneurship; and the future of American medicine.

What was your path from clinical medicine to the White House?

 
My path was serendipitous and made possible by many mentors! It stems from a tremendous desire to understand how our health system works in order to help make it become more affordable, consistent, and better for patients. My first step was to step out of direct patient care and join McKinsey & Company as a consultant to get an education in the business of US health care. At McKinsey, I was fortunate to work across most sectors of US health care, including hospitals, health plans, pharmaceutical and biotech firms, states and the federal government, and investors. Also, I worked in about 20 countries that helped me expand my perspective. A couple of observations really struck me:

• Hospitals and doctors are remarkably similar all over the world.
• Variation is everywhere, larger then you expect, and can be reduced to improve care quickly.
• Patients can get spectacular and disastrous care almost anywhere.
• Incentives matter more than people think and are seldom aligned with performance

These observations kindled in me an interest in improving the economic systems shaping performance of our health system and my ongoing research and policy interest. At McKinsey, I transitioned into a role where I could spend considerable time doing economic research at the McKinsey Global Institute (MGI). At MGI we set out to answer the question, “where does all the money go and why?” This gave rise to a series of reports, titled “Accounting for the Cost of US Health Care” and a series of suggestions for how policymakers could improve the economic incentives and performance of the US health care system to support expanded access to care, affordability, and better quality. I was fortunate that our work was widely read by health policy makers. When President Obama won the 2008 election, several members of the economic team were familiar with our work and this created an opportunity for me to join the economic team to work on health policy.

What was it like being one of the few physicians in the White House during the health care reform debate?

It was a privilege. Each day was fascinating, and when policies come to life that you helped to shape, it was also very exhilarating. I found it very helpful to be both a physician and experienced in the private sector, as well. This helped me to understand how policies could work in practice, predict and avoid unintended consequences, and to help prioritize the right policies to improve the practice of medicine for providers and affordability, quality, and the experience of care for patients.

What are you most proud of from your work on health care reform?

I think that we were able to galvanize opinion that the current system must change to become more affordable, more accessible for the millions of uninsured, and consistently higher quality. By doing this, we catalyzed a period of system change that will continue for years to come, regardless of changes in politics and federal policies. While people may not agree on the exact approaches for achieving these goals, I am encouraged by the progress and bipartisan support for bending down the cost curve, reducing unnecessary variation and errors, and improving the patient experience in our health system.

Today, we are seeing venture capital investment, talented entrepreneurs create new businesses, and incumbent payors, providers, and suppliers embrace new business models oriented around population health improvement and shared savings. We are also witnessing the wiring of American health care and the treasure trove of data that will be generated. These changes would not have happened as quickly without the Affordable Care Act and the HITECH Act. All together, I think more change has occurred in the past 2 years than the past decade!

There seems to be a lot of confusion among physicians about how health care reform will affect them. Why do you think this is?

 
Because it is complicated! Moreover, very few of the policies have been implemented, so it is no surprise that physicians are unsure on what to expect.

The impact of reform depends a great deal on the local market a physician is working in and their current practice model. The business models of hospitals and health plans, as well as changes in uninsured, will all shape how reform takes hold in markets and it will be different. In some markets, changes may be many years from being perceptible while others are undergoing tectonic shifts.

While the pace of change will vary, physicians should appreciate that reform will make it easier to focus on delivering great patient outcomes and clinical experiences. Once all Americans have access to high quality insurance with reasonable cost sharing and free preventative care, physicians will be able to focus on care delivery. Administrative burdens should also improve with standardization of payment processes. The widespread use of health information technology will streamline data sharing, translating evidence into practice, and coordinating care.

You are now working as a health care investor at a major venture capital firm. Where do you see the greatest promise among innovative new health care companies?

I am very enthusiastic about companies that reduce health care costs, improve delivery system productivity, reimagine insurance products, and demonstrably improve clinical quality and patient experience.

Huge opportunities exist to redesign care delivery to be more reliable, affordable, convenient, and fun for both patients and providers. Access to care is likely to become more retail in style and hours of services. It is encouraging to see the power of low-cost DNA sequencing and data analytics, too. We are on the cusp of being able to incorporate personalized risk-based treatment pathways and new diagnostic approaches that are better and cheaper. The trends toward defined contribution, mobile health monitoring, patient engagement, and integrated delivery all hold great promise from an investment perspective as well.

What do you see as the most important trends on which practicing cardiologists and other physicians should focus in the next several years?

Delivering consistently exceptional outcomes affordably should be the mantra. This should become the basis for competition. Providing very good care that is more affordable should lead to patient demand, growth, and better physician incomes.

Watch the exclusive CSWN interview with Dr. Kocher on our YouTube Channel at youtube.cswnews.org

Keywords: Sequence Analysis, DNA, Patient Care, Health Care Reform, Cost Sharing, Consultants, Medical Informatics, Health Care Costs, Patient Protection and Affordable Care Act, Entrepreneurship, Private Sector, Federal Government, Medically Uninsured, American Recovery and Reinvestment Act, Delivery of Health Care, Telemedicine, Information Dissemination, United States

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