Normally, I do a decent job turning my work switch off during the holidays. However, this time, as the holidays approached, I couldn't help but reflect on the state of our healthcare system, given the events of the last month. It's a fact of American life that we are frustrated with our healthcare system.

Interestingly, the last time we as a society had a sincere discussion about our healthcare system was when the Affordable Care Act was signed in 2010. It had many flaws, but it did propel the value-based care genie out of the bottle, making it possible for a number of companies to emerge and help address some of those flaws. Nearly fifteen years later, we are again collectively talking about the state of our healthcare system, which is reaching a breaking point with nearly five trillion dollars in spending. On one hand, most people can't access the care they need, and when they can, it costs us an arm and a leg, quite literally. It's tragic that it takes a shooter, aggravated by his back pain and frustrated with the healthcare system, to spark a necessary conversation about healthcare.

I have personal perspective to add to this conversation. Five years ago, I experienced a period of debilitating chronic back pain. The pain was so severe that I was unable to even lift my newborn daughter. Despite trying a variety of treatments, including physical therapy and acupuncture, I found myself on the verge of undergoing back surgery. After much deliberation, I chose not to go through with the surgery and eventually recovered. I was fortunate to have access to top-tier spine surgeons who advised against surgical intervention. However, not everyone has the same access to quality care or the benefit of such sound advice, and this proved tragic in the case of Luigi Mangione.

To say that the American healthcare system is complex would be an understatement. If only there were a single party to blame. The structure of our fee-for-service PPO network model creates a zero-sum game, pitting purchasers, insurers, pharma companies, providers, and patients against one another -- leaving patients, their families, and our collective bottom lines as collateral damage.

While insurers are often criticized for denying coverage, the rest of the healthcare system incentivizes overtreatment. In America, we are overdiagnosed, overprescribed, and overtreated. The opioid crisis is just one example of it.

Even more concerning is the widespread practice of providers overcharging for services. I know this firsthand, having worked for one of the hospital revenue cycle companies, which primarily exist to help chase patients and insurers to maximize their reimbursement. This further contributes to our bloated healthcare expenses as both providers and insurers hire an army of people to duke out procedure payments. If we aggregate the revenues of all middlemen in healthcare, it will be well north of one trillion dollars or nearly 4% of our entire GDP. All these dollars are primarily spent on moving money from one pocket to another, and none of this reduces costs, improves the quality of care, or enhances the patient experience. Tools like prior authorization and revenue cycle management are poor attempts that ineffectively scratch the surface of a much deeper problem.

What we need is a system where all stakeholders are aligned in their goals, with a focus on delivering the right care and reducing cost while inspiring confidence among patients that the system is working for them rather than against them. This requires a lot of deep plumbing, starting with shifting our payment model from PPO networks to value-based care, a model that has been proven to work.

We are seeing in real-time how effective it can be to incentivize providers to deliver only appropriate care and prioritize value over volume. This also simplifies the administration of our healthcare system by reducing the back-and-forth that happens among providers, pharma companies, insurers, and pharmacy benefit managers related to reimbursement and care coverage. To successfully disrupt the status quo and bring about real change, we have to follow the flow of the dollar and course correct it. It's high time we stop kicking the can down the road on value-based care and get to work.

Photo Credit: Big Stock Photo

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