Bill Frist: 'There will likely be a public plan as a backup'

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Bill Frist has been keeping busy these days. Between chatting up former colleagues on both sides of the aisle about healthcare reform and heading up the acquisitions, divestitures and portfolios for his Nashville-based investment firm, Cressey & Company [2], the cardiac surgeon and former Republican Senator from Tennessee is also promoting awareness of atrial fibrillation [3]. He has also been an advocate for children's health around the world, pushing for investments in such resources as clean water and vaccines.

FierceHealthcare caught up with the ex-Senate Majority Leader yesterday and asked him to elaborate on some of his efforts, as well as his views on healthcare reform.

FierceHealthcare: On a scale of one to 10, with 10 being an absolute certainty, what do you think are the chances of a reform bill getting passed with most of its objectives in tact? 

Bill Frist: Ten. A reform bill will be passed. It will be significant. It will be in the range of $900 billion. It will have a very positive insurance reform. It will address issues of pre-existing illness so that people are not unfairly denied insurance. It will not go so far as to allow people to shop across state lines for insurance, unfortunately, but it will have very good reform in there that will make the way we get our insurance much, much fairer. 

With the sort of end goals in tact, those people who want to get 46 million people insured who are uninsured today--they will not be able to do that. I predict maybe 20 million of the 46 million people will be insured or have access to an insurance policy. We don't have enough money to do 46 million people; 10 million to 11 million of those 46 million are immigrants from other countries, many of whom are illegal. Fifteen million of them already have an insurance policy, but they just haven't signed up for it, so we'll have about 20 million people who will be insured. 

There will not be a public plan on the forefront, but there likely will be a backup public plan if the private sector doesn't step up in that area. There will likely be a public plan as a backup, and they haven't put that out yet, but I predict at the end of the day that that will be part of the plan. 

FH: Are you, yourself involved in any political efforts with regards to reform? 

BF: No political efforts, but a lot of policy efforts. I am no longer in elected politics, and so most of my work is focusing on substantive policy. I speak to both the Democratic leadership and the Republican leadership from the standpoint of someone who's spent over 20 years in medicine as a practicing physician, as a scientist who has written 100 peer-reviewed papers, and as an interested party, having been a United States senator. I've stayed active there, continued to speak and debate the issues themselves, and continued to write on the issues themselves in domestic healthcare policy. 

I also do a lot of global healthcare policy focusing on children, women and maternal mortality around the world. 

FH: Speaking of which, I noticed that earlier this week you asked for world leaders to put children's health on the agenda for next week's G-20 summit in Pittsburgh. 

BF: Yes. The linkages between health productivity, quality of life, cost, access, all of these issues, in many ways come back to the healthcare of our children both here in the United States and around the world. Today we know that about 10,000 children around the world die every day, two-thirds of which die of easily preventable causes--not high-tech problems, not expensive problems, not [things that are] sophisticated to hospital and to care units, but of simple things like lack of a vaccine, or lack of clean water, or lack of a penny's worth of antibiotics to treat pneumonia. And a lot of people don't realize that, because they think the investment is going to be very heavy. So, one of the things that I'm encouraging nations to do--because the future of these countries who are in Pittsburgh this week very much depends on a healthy, productive workforce--is focus on things like clean water, like vaccines, like oral re-hydration for treatment of diarrhea, etc., to encourage them to invest there. We know that the payout is huge for promoting a productive, healthy workforce in the future. 

FH: I understand that both your older brother and your brother-in-law have struggled with Atrial Fibrillation, a cause that you currently are trying to raise awareness for; why do you think that AFib is becoming so important in this day in age? 

BF: Atrial Fibrillation is understood by medical professional teams as well as individuals [as a] condition in which the upper chambers of the heart, they beat in a really uncoordinated and disorganized fashion. It can come and go, it's a little bit difficult to diagnose; different people diagnose it different ways. Therefore, a lot of people who have it don't know it, and it decreases their productivity in life. It makes [those affected] much more prone to stroke, much more prone to accelerate other types of heart disease like cardiovascular disease, heart failure and the like. This particular initiative--it touches, as you said, two people in my immediate family, [people] above 60 years of age [and] about one out of 10 people--it's a growing problem and a growing challenge because the older people get, the more they're likely to get it. By the time somebody's 80, their chance of getting it has doubled, compared to people who are 60 years of age. 

The overall instance of it is going to double over the next 30 years--in terms of the numbers of people it'll go from about 2.6 million people to 5.2 million people--so it's a growing problem, and it's an expensive problem. It increases the incidences of stroke by five times, and stroke as you know is very, very expensive to manage. If we can diagnose atrial fibrillation earlier and treat it more appropriately, we prevent that stroke, and by preventing that stroke and the re-hospitalizations associated with that, you lower the cost of healthcare. 

FH: How much do you anticipate this actually lowering the cost of healthcare? 

BF: If you sort of walk through it, morbidity-wise, we know [there would be] a huge impact because people with atrial fibrillation had five times the incidences of stroke [as people without atrial fibrillation]. In terms of mortality, people with atrial fibrillation had twice the chance of dying at any point in time compared to somebody without atrial fibrillation. In terms of quality of life, a lot of people go around with depression, with mood swings and being dispirited because they don't really realize they have atrial fibrillation....The medical costs for an atrial fibrillation patient end up being about five times what they are for somebody without it (currently, the annual cost for treating the disease is $6.65 billion, with the potential to reach $15.7 billion per year). If, through aligning the interests, bringing all the people together we are, establishing the protocols, making sure that both patients or potential patients as well as the caregivers adhere to those protocols, we can probably cut that cost in half over time. That's a huge cost savings for a particular chronic disease, and we know that 75 percent of all the spending in healthcare today is on chronic diseases. 

FH: What sort of a message would you like to try to get across to our readership, in particular? 

BF: First of all, just so I can mention it up front, I would like to encourage all of them to go to the website, which is AFStat.com [4]. The overall goal of this initiative that we have underway is to improve patient outcomes; to improve the quality of healthcare by promoting this change and understanding in attitudes, ultimately to change behavior to enhance atrial fibrillation understanding and management. So it's an educational process, both for the care providers, as well as the general population. We want to facilitate atrial fibrillation education among patients and others, and that's going to require dissemination of important information that people can't get to. 

We've found very early on that people say 'well, I have atrial fibrillation and I go to the web and I hear all sorts of things, but I can't tell what's real and what's not; what's good for me, what's not. I've tried this, I've tried that.' What we want to do is make that process much easier. We want to be able to say 'these are the things that need to be done; these are the people you need to see; this is the team of people that is available for you.' So you align everybody's interests around improving the quality of life of that patient with atrial fibrillation....What that accomplishes is pulling together resources to support those patients. When you have so much waste, so much misuse, so much misdiagnoses, so many missed cases out there-it ends up costing the healthcare system a huge amount of, not fraud, but waste and abuse. That money clearly can be captured so that the resources that are out there, as well as new resources, can be directed at that individual patient who is either at risk for atrial fibrillation or has it already. It really boils down to the starting point of having a disease, a condition, that is really misunderstood both by the healthcare profession and the population, at large. 

FH: You've been a partner with investment firm Cressey & Company since 2007-in your opinion, what are the most lucrative healthcare investments to make these days? 

BF: I approach systems change in the following way: Government sets the framework, and that's what we're going through right now--what are the rules going to be around healthcare, healthcare delivery?--that's being defined right now by Washington, DC, and then it will be implemented over the next two to four years (very similarly to what we did with the prescription drug bill in 2003). The real important aspect of the implementation is not government, it is the private sector. It's real people out there creating answers in a creative dynamic constantly adjusting away, always looking for quality, always looking for value-and that can only be done by markets; it can only be done in the private sector. So where I focus in terms of my current fund with Cressey is on health services delivery, where we can improve access for individuals, where we can improve quality--especially value--and where we can lower costs for the consumer. The private sector can do that because in healthcare there's so much waste, there's so much abuse. Coming back to atrial fibrillation, there's a lot of mistreatment because people don't know exactly how to treat it. There's over treatment. There's under treatment. People are getting oblations when they should be on medicines. People are getting the wrong medicines. But once you look at that, you realize that all of that waste just churns out extra money that you can invest. So in the private sector, just as a quick example, we're looking today at this problem of re-admissions after Medicare. About 20 percent of people who've been hospitalized for Medicare end up back in the hospital within 30 days. It also happens with atrial fibrillation, and it's a big part of our AFStat conference, to focus on that to make sure we're getting appropriate care. 

What a company can do is set care coordinators up. They start in the hospital; they follow through the patient's transition out of the hospital; they transition and interact with the home healthcare people; and they continue for about two months. So a whole company can be set up to focus on that. It's efficient, they can cut those readmissions from 20 percent down to 3 percent, and they do so by making a reasonable return on their investment. So that's where the private sector comes in, is to create more value in a healthcare system. Not more volume, but more value, and that's where our focus is.