David Cook talks about new “quadruple aim” for health care

Published 12:00 am Friday, April 20, 2018

SALISBURY — David Cook compares America’s health care system to a bridge built in Ecuador in the early 1990s.

Cook, who works at Novant Health, spoke Thursday at the April Power in Partnership breakfast sponsored by the Rowan County Chamber of Commerce.

Cook said the bridge was built to cross a river that would frequently flood.

“So what they said is, ‘Hey, let’s spend more money than ever spent in Central America to build a bridge. Let’s build a bridge that will never go away,’” Cook said. “’It will always be there and will be standing even if we have a nuclear blast.’”

Cook said several companies went bankrupt as the bridge was built. He showed a photo of the bridge years later, and it looked the same — but the river had shifted from under it.

“There’s the bridge. It’s not going to go away. Millions and millions of dollars,” Cook said. “It the most amazing slide to say what health care is doing now.”

Cook is senior vice president of business strategy and innovation with Novant Health’s corporate office.

He said the metaphorical bridge of American health care was built in 1945, when the country “decoupled” health care from consumers.

“People got health care insurance through their employers. No other country in the world did that,” Cook said. “So all of the sudden, people coming back (from the war) got this benefit. They didn’t know what it meant. They didn’t know how much they were getting.”

He said that differs from the way consumers think about other major investments, like buying a car.

“When you buy a car, you shop for everything. You know how much money you have in your bank account. You know how much you want to spend on a car, and you compare and you shop,” Cook said.

He said in the years since 1945, the “fee for service” method has remained popular. But he said he sees a different future for health care — the “quadruple aim.”

“If you don’t see this as the future of health care, you’re going to be building that old bridge again,” Cook said.

The four tenets of the quadruple aim are enhancing patient experience, improving population health, reducing costs and improving provider work life.

To explain patient experience, Cook told a story about a colleague who was upset with a patient.

“He said, ‘Can you believe this? This 23-year-old girl walked into my office just for a new visit and wants me to do a Pap smear. … She hasn’t scheduled anything,’” Cook recounted.

Cook said the average millennial expects to wait 36 hours for an appointment, rather than the more traditional six-month wait time.

“So I told him, ‘In the time you’re sitting in here and complaining about your schedule, you could have not only done a Pap smear, you could have talked to her (about) all kinds of things about her health care,’” Cook said. “’You could have bonded with this person for the next 20 years and created a generation of health.’”

Cook said technology could help improve the general health of the population and that the health care industry needs to spend less than the nearly $4 trillion it’s now spending annually.

“But the reason we’re innovating is to improve the human experience, not just to lower cost,” Cook said.

The April Power in Partnership breakfast was sponsored by Novant Health Rowan Medical Center.

The next Power in Partnership breakfast will be May 17, when the 25th Leadership Rowan class will graduate.

Contact reporter Jessica Coates at 704-797-4222.