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Improving Care From Within

The astronomical cost of health care creates a challenge for even the most financially savvy patients.

Dr Jay Moore, Paytient

On a hot July morning in 2015, my phone rang at 4 a.m. No good news ever comes at 4 a.m., so I answered with a sense of dread. My brother was on the other end of the phone, breathless.

“We’re in the car following the ambulance,” he said. “Dad’s heart stopped. They’re doing CPR. They’re headed to the ER.”

I’m a doctor. My brain snapped instantly from “son mode” to “clinical mode.”

“How long was he down?” I asked.

“I don’t know … 15 minutes?” he recalled. “Is that a long time?”

My silence told my brother everything he needed to know.

“I’ll call you when we know more,” he said. “Get down here as fast as you can.”

It’s a two-hour drive from my home in St. Louis to the hospital where they were taking my dad. I was on the road by 4:15 a.m. As the Missouri countryside slid past my window, I had a lot of time to think. My family needed me. I am the oldest son, the first in my family to go to college, and the only person with medical training in the family. I knew they’d need a lot of me over the next few days.

Somewhere in the middle of Missouri, I got the phone call that I had been dreading. My clinical training wasn’t needed as my dad had passed away in the emergency room. My brain snapped back into being a son. I pulled the car off to the side of the road and took a few moments to cry. Then I got back on the highway and kept heading deeper into the Ozarks.

How Did We Get Here?

I grew up in a double-wide mobile home in the little town of Dixon, Missouri, in the 1980s. We lived simply, but we had a lot of pride. When I started kindergarten, I brought home a letter telling my family that we qualified for free lunches.

“We don’t need that,” my dad said. “We aren’t poor. Others need that more than we do.”

My dad was trained as a land surveyor by his father, and he worked for much of his career for a telephone company in Missouri. My mom stayed home to take care of my brother and me, but we always managed to make ends meet on my dad’s salary. After I started college, my dad finally felt the financial freedom to pursue his lifelong dream: In 1995, he cashed in his pension and opened a restaurant. He was a fantastic grill master—he was always in demand at company picnics and church events to cook up hamburgers and steaks, which he would season with a secret family recipe that he had invented using simple ingredients that he could buy at the grocery store.

The restaurant sat on a bluff overlooking the Gasconade River in Pulaski County. I was a sophomore undergraduate at the University of Missouri when he opened it, managing to get by on scholarships and student loans. I was worried that he was gambling his future, but the bet seemed to pay off; he was busier than he had ever expected. He could afford to buy a motorcycle and take some trips out West, where he’d ride his bike through the desert and imagine he was a cowboy from one of the westerns he’d grown up watching. Things seemed great.

But trouble was brewing. The stress of running his own business was getting to him. His blood pressure was too high, and the town doctor who we’d been seeing since I was 3 years old noticed his blood sugar was creeping up. My dad couldn’t afford health insurance, and seeing specialists was expensive. He’d get by with a few cheap generic prescriptions. He felt good, so what could go wrong?

In 2008, the economy tanked. The catering jobs and big parties that the restaurant depended on to stay afloat dried up. Soon, my dad was skipping bills and dodging calls from the bank. His blood pressure worsened. His high blood sugar blossomed into full-blown diabetes. By that time, I had finished medical school and was in practice. I knew what my dad should do, but he was stubborn and didn’t want to follow my advice. “You need to see a specialist,” I said. “Come to St. Louis, and I’ll get you set up here.”

His answer was always the same: “Too expensive.” When I offered to pay for his care, he’d mutter that this wasn’t how this was supposed to work. My dad was a proud man who wanted to take care of himself. I did what I could, but it wasn’t enough.

“Don’t worry,” he said. “Your mom andI will be fine. Take care of yourself and your kids. Go someplace nice for vacation. We can get by.”

The restaurant shuttered. My dad finally relented and let me send him money so he could pay the mortgage and heating bill. I convinced him to see some colleagues who got him on some reasonable medications. But the damage had been done. Years of ignoring his health—largely driven by an inability to pay for it—had led him to chronic kidney disease, heart failure, and diabetes. The stage was set for the call I received that fateful July morning several years later.

How Can We Make the System Better?

I eventually decided to leave full-time medical practice and go into health care administration. Watching my dad and his plight—and hearing similar stories from countless patients—had a major effect on me. I was determined to make the system better.

As a physician seeing patients, I could care for one person at a time. As a leader in health care, I could make the system better and help hundreds or even thousands of patients. I started in administration with a hospital, where I created quality programs that ensured each patient received a recommended treatment plan for any condition they had. I also worked with the hospital’s foundation on charity care options to help folks who didn’t have money to get the medications and care they needed.

I then transitioned to a role with Anthem, one of the largest health insurers in the U.S. While with Anthem, I built a program with the state of Missouri to ensure Ryan White HIV/AIDS Program patients received medications to keep their virus counts at zero. My time with Anthem also saw me partner with paramedics to create community health programs that delivered care in patient homes.

At every stage, I worked tirelessly to help others avoid my dad’s tragic fate. There’s no way to know whether his life would have been saved had he gotten the preventive care he needed much earlier in life, but it certainly couldn’t have hurt.

There are so many people in this country who are in the same position as my dad—proud men and women who want to do what’s right and take care of themselves. But the astronomical cost of health care makes for a challenge for even the most financially savvy patients. We need services that allow people to get the care they need even when it’s hard to access or afford. We need answers when they aren’t sure how to pay for a sudden medical bill. We need to solve these ongoing problems while treating patients with dignity.

Thankfully, there are plenty of organizations working to change things for the better. I’m talking about companies like Flossy (featured on Page 14 of this magazine), which provides top-quality dental care at affordable prices for folks who lack dental insurance. There’s also Ro, a health care technology company building a patient-centric health care system that brings together telehealth, diagnostics, and pharmacy services to provide high-quality and affordable health care without the need for insurance. And I’d be remiss not to mention Paytient, my current employer. We partner with employers, brokers, hospital systems, and others to help people access care earlier without financial harm via a buy now, pay later option for out-of-pocket costs.

I’m optimistic that together, we can do this. Whether you work for an insurance company, see patients in a practice, design health care benefits for your employees, are about to launch a healthcare startup, or just have an interest in making things better, you have an important role to play as we meet this challenge. We will explore problems together and find solutions that help everyone, all in honor of my dad and the many patients in similar predicaments.

Let’s get to work.

Dr. Jay Moore is Paytient’s chief clinical officer. He did a combined internal medicine and pediatric residency at the University of Missouri, and maintains board certification in internal medicine. Jay has worked as a hospital administrator and an insurance executive, where he managed a team of physicians and evaluated startups for partnership opportunities. He lives in St. Louis with his wife and a way-too-large collection of hobby games.

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