Reflections on Contemporary Healthcare

Care Delivery, Innovations, and What We Risk Leaving Behind

-by Dr. Sharon Hibay, CEO of Advanced Health Outcomes

As I sit and reflect today, I find myself considering the current state of healthcare—where it’s been, where it’s going, and what we’ve gained or lost over the past two to three decades.

There’s no doubt that healthcare has made remarkable strides. We’ve seen groundbreaking innovations in medicine, research, technology, equipment, and enhancements in healthcare leadership. More recently, genomics, artificial intelligence (AI), and data interoperability promise to revolutionize the field exponentially. These advancements are awe-inspiring and may radically the change healthcare landscape as we know it, eradicating and drastically reducing once incurable diseases and conditions.

And yet, I can't help but wonder how, despite all this progress, healthcare has also declined in critical ways.

We’re running so fast toward what’s possible that we may be ignoring what’s necessary.

As a breast cancer survivor, I truly understand and have experienced what high-quality, well-coordinated, compassionate, and cutting-edge care looks like. From medications to chemotherapy, immunotherapy, and targeted treatments, every discipline working seamlessly together with a single purpose: me, the patient. I remember my first cancer treatment team meeting—it happened just days after my diagnosis—not weeks, but days. My entire care team of providers, pharmacists, nurses, and navigators all assembled to listen to my needs, my concerns, my barriers. That’s what true patient-centered care is, actively listening to identify and eliminate potential treatment disruptors that could jeopardize positive outcomes.

I say this not because I was treated as someone special—this was standard practice for every patient newly diagnosed breast cancer. The level of commitment, the time, the coordination—it was all there. I deeply appreciated the collective eyes and ears on me, knowing my case was important. As a previous hospital administrator, I recall thinking how expensive that meeting was if I was to add up all the billable hours sitting around that large conference table almost seven years ago.

Professionally, I’ve spent over 20 years in healthcare—as a clinician, healthcare leader, health policy expert, and national clinical measure developer. I’ve worked across diverse settings and always believed in putting patients first. So many times I had to fight for that principle, albeit primary care, cardiology, gastroenterology, community practice, or graduate medical education care. Because far too often, the system prioritizes something else.

Today, we see fragmented, disjointed healthcare, built around high cost services, value-based care, accountability metrics, and other innovations that do not always deliver what they claim—better outcomes and smarter spending. Access to care—true access—still depends far too much on a person’s ability to pay. We design systems for the insured or those able to pay out of pocket, and hope these practices trickle down to the uninsured and under insured. Sadly, we don’t truly monitor the latter.

Primary care—arguably the backbone of our nation's healthcare system—is overburdened, underpaid, and expected to continually do more with less. We ask them to produce miracles without the tools or time to deliver anything near what I received during my cancer journey.

Recently, I underwent neck surgery (C6-7 and C7-T1 Anterior Cervical Discectomy and Fusion, Allograft, Plate & Screws... good times!). While my surgeon was excellent, I experienced an evident disconnection among inpatient teams in 2 hospital stays and between inpatient and outpatient services. I was often left begging for guidance and pain relief post surgery while struggling with ongoing symptoms. When I approached clinical and hospital leaders, they simply stated they already knew these problems existed. I am a quality improvement expert and it baffled me that known fragmented processes were not fixed. Why did I or other patients not matter? How could this possibly be? Back in my clinical days, my paper hospital chart would have had one of those hideous signs taped to the chart cover, "nurse", or "quality consultant", or "PIA" on it. It was unfathomable that my beautiful cancer hospital cured my very aggressive cancer and did not address such apparent and easy fix care delivery gaps. Again, I'm nothing special, so if this is done to me it is done to everyone. If I really didn't matter, does that mean that no one really matters? My story is not new, instead is quite common.

After six months of continued symptoms and pain, I experienced repeated delays with payer prior authorization requirements that allow 15 business days (that's 3 weeks!) for a treatment approval decisions. Denials were accompanied with new requirement requests and the 15 business days started anew. It was exhausting and painful... do you know how hard it is to get pain medicine during an opioid epidemic? Day 3 at home, I was already rationing medications because I feared I would never get any refills. My poor PCP was left to coordinate pain management for services she did not perform. What do patients do when they do not know how to negotiate these barriers and blockers? When there is no one there to help?

That’s what haunts me: how difficult it is to be a patient today without knowledge and a voice, or an advocate. During my cancer journey, I was lucky to have my husband—without him, I may not have survived and now be cancer-free. Have we forgotten that being a patient can cloud your judgment and memory, and can overwhelm even the most savvy among us? We know that the brain just doesn’t work the same way when you’re sick or scared. Did we forget, didn't we?

To cut expenses, so much of healthcare occurs without direct clinical support—major outpatient surgeries (e.g., hysterectomy), self-injected medications rather than infusions, home dialysis, acute-level at home monitoring are all happening outside the hospital walls. As care moves outward and our support systems further erode, reimbursements continue to shrink, and fragmentation between patients, providers, and specialists grows. All while uninsured and underinsured populations are rising. If you cannot pay, then what?

I envision a tug of war as progress and innovation are speeding away from us—advances accelerating exponentially while compassion, essential care, and infrastructures falter.

We’re running so fast toward what’s possible that we may be ignoring what’s necessary.

Sadly, healthcare often feels more like a production line—each person doing their part without seeing the whole person or process. Two ends of our healthcare system—care delivery and innovation—are pulling away from each other. Are we asking: who is being left behind? Because in chasing what's exciting, we might be loosing sight of what is important... the patient.