Aaron Crane: It’s past time for a prescribed burn in the healthcare industry

Magnificent forests and the annual threat of fire are an integral part of my life as an Oregonian. In the Western United States, wildfires bring devastation annually. Last year, nearly 59,000 wildfires burned 7 million acres across the nation. And that’s just the beginning of the story as those fires also claimed both lives and structures. The economic impact of the 2021 wildfire season alone is estimated at $70 million to $90 million. The prior year was even worse.

But fire in the forest isn’t always destructive. In fact, it can be an intentional and positive tool. Such is the case with controlled or prescribed burns — fires set by professional firefighters to eliminate the intensifying effects of overgrown underbrush and deadwood. Such burns are managed in a manner that preserves and protects the health of the forest.

The U.S. healthcare system is like an unmanaged forest. It, too, is filled with deadwood and underbrush that serve as fuel to magnify our challenges, hinder innovation and improvement, and lead the United States to perform poorly when compared with other high-income countries. According to a recent Commonwealth Fund report, our avoidable death rate, for example, is 250 per 100,000 population, while other developed nations are at or below 150 deaths per 100,000. And that’s despite spending almost 20% of our gross domestic product (GDP) on healthcare while those same developed nations are investing only about 10% of their GDP in healthcare.

I believe the deadwood and underbrush contributing to these results fall into three primary categories:

• Perverse, misaligned incentives
• American lifestyle producing a population with a disease burden that’s 37% greater than the average of comparable countries
• Disparities in health and healthcare that are dramatically worse than those of other developed nations

It is past time for us to manage this ecosystem and cultivate a healthy forest. We need to improve our value and transform into a cost-effective, world-class example of sustainable population health. In short, it’s time for a prescribed burn. And that is why I have selected “Ignite the Spark” as the theme for my year as HFMA National Chair. 

I plan to use this column to explore some of these issues and to encourage you to identify those things that keep your own organizations from being as healthy and thriving as they were meant to be. I’m also going to challenge you to take that next step — igniting the spark that sets the fire to bring about necessary change and innovation.