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The Keckley Report

The Sacred Cows in Healthcare

By January 19, 2015March 1st, 2023No Comments

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article.

In the President’s State of the Union address this Tuesday, he is expected to address an important theme: how to address growing income disparity in the U.S. It’s a much discussed and well-documented trend among economists, demographers and academicians. The rub is how to address it. That’s where opinions split and sacred cows moo loudly.

Last week, I participated in a Western Governors University (WGU) Advisory Board meeting where the focus was curriculum design for a two-year, 17 course master’s degree program focused on integrated health system management. Since former Secretary of Health Mike Leavitt asked me to join the group years back, I have become keenly sensitive to the parallels between higher education and healthcare, and the vexing questions both face. The challenge that’s shared is value—what’s the return for the investment of a person’s time and money. Change-agents, disruptors and innovators in both industries face sacred cows as we attempt to chart a new course.

WGU is a disruptive innovator in higher education. Its answer to the question of “how” is straightforward: competency-based online education that’s affordable to those seeking baccalaureate and advanced degrees. Tuition is $6,000 per term, unchanged since 2008 with average graduates spending less than 3 years in their programs. Its 1,600 faculty are full-time. It is a non-profit that’s financially stable. And its results speak for themselves: placement rates, licensing of grads in professional aptitude tests, employment rates and employer satisfaction are top quintile across all degree programs exceeding their higher priced competitors. In 2014, the National Council on Teacher Quality (NCTQ) ranked WGU’s secondary math education program first in the nation:  its goal is to prepare 100,000 science, technology, engineering, and math (STEM) teachers by 2021 and to be a forceful contributor to the future of the healthcare workforce.

In higher education, sacred cows are many: the tenure system for faculty, huge investments in bricks, sticks and programs like athletics that drive volume and revenue, and degree programs requiring one-size-fits all 2, 4 and multi-year participation. When Mike Leavitt started WGU in 1997, the sacred cows were mooing, but 40,000 graduates and superior outcomes later, they’re not heard.

In healthcare, there’s widespread consensus more should be done to increase access to affordable insurance coverage, discourage unhealthy lifestyles, encourage access to preventive and primary care, eliminate waste and fraud, simplify the system, align incentives with desired behaviors and results for producers (doctors, hospitals and other providers) and consumers, and do all this at a substantially lower costs. The rub is how, at what cost, who will take the lead and how to address our sacred cows.

Healthcare’s sacred cows moo loudly.  We are suspicious consumers are incapable of making good decisions about their health and costs and therefore dependent on “us” to make decisions on their behalf. We imagine the science of diagnosis and treatment too complex to be digitized via gadgets and online tools. We tiptoe around physician sensitivities fearing retribution if we engage them directly as adults who are rational decision-makers and business partners. We dismiss alternative health as non-scientific and self-diagnosis as problematic. We mark-up and pass-through costs for services which may or may not be necessary using medical liability as the excuse. We presume cost-containment is at best incremental and “low-price, high quality” an oxymoron applicable in every industry other than ours. And we sleep well believing we’re better at defining value in healthcare for our patients, enrollees, clinical trial subjects and users than they can on their own. After all, they need us, value our relationship and are not likely to ditch us to save a few bucks or chart an alternative course without our blessing. Our sacred cows mooo loudly, especially at feeding time.

There are WGU’s in healthcare’s future—an organization that will step out with a new vision, leadership that’s effective, a team that’s committed and business operation that’s not paralyzed by sacred cows or fear of failure.

In addressing the issue of income disparity or the paths to accessible, affordable higher education and healthcare, the sacred cows moo loudly.  They need not define our responsiveness nor limit our solutions to these three challenges unless we choose to hear them.


Sources: Sacred cow: ‘A figurative sacred cow is something else that is considered immune from question or criticism, especially unreasonably so’ The Phrase Finder (The meaning and origin of the expression: Sacred cow. (n.d). Retrieved January 18, 2015, from; “2013 Annual Report” Western Governors University

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

© 2015 Navigant Consulting, Inc.