Paul Markovich has spent more than three decades working in healthcare, an industry that he calls "dysfunctional" and in need of a major overhaul.
"The healthcare system is bankrupting and failing us. It requires systemic reform. Those reforms are unlikely to come from the industry itself. Therefore, we need the federal government to step up and make those reforms happen," Markovich told a crowd of healthcare executives at an event in Manhattan in early March.
At that event, Ascendiun, the parent company of Blue Shield of California, launched a new initiative called Worthy that aims to kickstart a nonpartisan national healthcare policy reform movement. The initiative leans on industry players to bring forward bold, practical solutions to address long-standing problems in the healthcare system.
"Worthy is our attempt to get the federal government to do just that. In order to do so, we need to appeal to a broad set and create a critical mass of voices—employers, corporate figures, industry, media, the general public to say, this is unacceptable. The status quo is unacceptable. We need bold, systemic reform urgently, so that is what Worthy is," Markovich, the president and CEO of Ascendiun, said during the event.
The initiative's name, Worthy, stems from the idea of building a healthcare system that is "worthy of our family and friends," Markovich said. Worthy is centered on several strategic pillars:
- Providing every consumer and patient with a comprehensive, real-time digital health record
- Breaking the "do more, get paid more" fee-for-service model and instead start paying for health outcomes.
- Make prescription drugs accessible and affordable by eliminating kickbacks in the form of rebates, fees and spread pricing.
- Put the entire healthcare system on a budget
"We need change, and so Worthy is really attempting to be a spark and a catalyst to create that kind of forum, that kind of energy, to convince the federal government that you got to change healthcare and you need to take responsibility for helping to change healthcare," he said during an interview with Fierce Healthcare in New York City following the Worthy event.
As part of this initiative, Worthy produces and shares deep-dive content on its website in the form of podcasts, issues analysis (PDF) and videos as well as social media posts, media commentary and in‑person forums aimed at helping consumers and patients understand what needs to change and how to get there.
"Worthy will be advocating for passing a series of laws and enacting regulations that will force all the players to put patients over profits, that is, to do the right thing on behalf of each patient, every time, in order to have a health care business and to earn an income," according to Markovich in a document that explains the Worthy initiative.
Markovich encourages healthcare industry executives to sign a pledge on the Worthy website and to get engaged in the movement.
"Every major successful social-political movement in our history has started with a critical mass of people who've decided and declared that the status quo is unacceptable and that we need bold change. And I'm asking you to do that," he told the crowd at the New York City event in March. "I'm asking you to say, when it comes to healthcare, don't accept the unacceptable. Call it out for what it is. Set the bar at the level it should be, not where it is. If you're in the industry. Do that for yourself. Do that for your organization, and I'd like to humbly suggest, when you do that, that we should all set the bar for ourselves and the industry at a level that is worthy of us all."
When it comes to engagement from corporate organizations in healthcare, he acknowledged that participation and engagement will depend on the issue.
"For example, pharma, I would think, is going to be really interested in reforms in the pharmacy distribution system. We've advocated for the repeal of 340B. I have very little doubt that they wouldn't say 'hallelujah'. In the next couple of months, we'll be putting out a piece on what needs to change with pharmaceutical pricing in the first place and how it should be reformed. On that, I think it's more of a question mark about whether that's something that some or even most pharmaceutical manufacturers would be willing to support," Markovich told Fierce Healthcare.
The United States is facing a healthcare cost crisis as it's currently too expensive for many to afford health insurance, Markovich noted. The industry also pays for volume instead of value, rewards
complexity over clarity and tolerates inefficiencies that leave patients frustrated and vulnerable.
Worthy will initially focus on prescription drug reform (PDF). The organization proposes that Congress should enact federal legislation to eliminate kickbacks. Over the course of a two-year phase-in period, Worthy proposes that Congress should prohibit services charged based on drug prices, differential payments based on formulary placement or volume, spread pricing beyond actual service costs and repeal or radically reform the 340B program, according to the Worthy website.
Markovich points to Blue Shield of California's work in the past few years to change its pharmacy care model and move away from the traditional pharmacy benefit management structure. Under the new model, Blue Shield of California partners with Amazon Pharmacy, Mark Cuban Cost Plus Drug Company and Prime Therapeutics, among other companies.
Blue Shield has taken some big swings in rethinking the traditional paradigms, with its Pharmacy Care Reimagined model as a prime example.
"We started back in 2019 and we came to the conclusion that how pharmaceuticals are sold and distributed was just fundamentally flawed. It didn't come anywhere close to meeting the standards. That's when we developed our first draft of what we are doing now in that space. It's also when we started to talk about this and started to advocate and lobby for changes. What I was told at the time is, you don't understand how big and powerful the big three [PBMs] are, how entrenched the interests are, how much money and resources they have, how hard it was going to be to break through. Now it looks like it wasn't that difficult," he said during the interview.
"You set that standard, you create a pragmatic path to get there, and then we were just persistent in lobbying and really gaining a coalition around it. That's what I'd like to repeat," he added.
That shift is resonating in the industry as major pharmacy players are now moving to cost-plus, transparent, or fee-for-service models to combat high drug costs and regulatory pressure.
"The healthcare industry is remarkably good at moving when it has to," Markovich said. "Just before COVID, people said it was going to take a decade or more to get clinicians to adopt telemedicine, and then it was days or weeks, and all of a sudden it was ubiquitous, because that's how they got paid. When the cheese gets moved, it's amazing how quickly the mice go after it. But it's only going to happen, I think, with the federal government moving the cheese."
Markovich asserts that the Trump administration is taking some steps in the right direction with efforts like TrumpRx, a discount pharmaceutical site.
"Seeing what Mark Cuban [Cost Plus Drugs] is doing, seeing what TrumpRx is doing, I think those are models and examples of ways to cut a lot of noise and potentially cost out of the system," he said.
With regard to digital health records, Blue Shield of California has made strides in this effort as it rolled out a Digital Health Record program, aiming to boost care coordination and transparency as well as improve the flow of data to providers.
The Worthy movement advocates for a new federal law that requires providers to share all patient data with each other and with patients to give patients access to a comprehensive, real-time digital health record. "The principle of the matter is, it's your data. You shouldn't have to ask permission," Markovich noted.
He added, "If I could expunge from the dictionary any one word in healthcare, it would be interoperability, because it's a journey without a destination. To me, it's the poster child for healthcare suffering from the chronic illness of low expectations. We're constantly congratulating ourselves over sharing a little bit more data."
Worthy published this month a 37-page plan (PDF) that outlines steps to simplify healthcare, such as streamlining all laws, regulations and norms for tracking care into a single national standard. The plan also calls for using technology, including the responsible use of artificial intelligence, to
automate everything that can be automated, including prior authorization, billing, provider directory updates, claims settlement and even routine patient questions.
Markovich credits the Trump administration's Health Tech Ecosystem initiative as moving in the right direction but asserts that additional legislation is needed to substantially move the needle.
Worthy's strategic pillars—healthcare costs, drug pricing, access to health records, value-based care, personalized care and affordable insurance coverage—all tie together, Markovich noted.
"We want to personalize healthcare. We think the clinical model is shared decision-making. It's the idea that if you have the digital health record, you know everything there is to know about you, but you can use AI and other technology to learn everything there is to know about healthcare in the world related to your condition, and then you can sort of lay out the pros and cons of different treatments. If you make that information available to patients and their loved ones and treating clinicians, then you have a dialog and make a decision. Research has shown that generally the costs are lower, the satisfaction is much higher for the patient and the quality outcomes are better when you have this process in place," he said. "What we want to do is truly get to a system of personalized care."
With the mid-term elections looming, it's unlikely the White House or Congress will take decisive action on healthcare reform this year, Markovich conceded. But public frustration over the affordability of healthcare continues to grow as many people struggle to pay for medical care. That sentiment is not going away, which could spur elected officials to take action, he said.
Worthy has long-term ambitions, he said, and progress won't be measured "in weeks or months."