Healthcare costs in the U.S. are growing faster than inflation, and the U.S. spends significantly more than other comparable nations on healthcare. And according to one healthcare executive, this is unsustainable.
“The healthcare system is bankrupting and failing us. It requires systemic reform, and it’s not going to come from inside the industry,” said Paul Markovich, president and CEO of Ascendiun, in a recent interview at the AHIP 2026 conference. Ascendiun is a nonprofit and parent company of Blue Shield of California, Blue Shield Promise Health Plan, Altais and Stellarus.
That’s why Markovich recently launched a national policy reform movement called Worthy, which aims to lay out “compelling, but also pragmatic and nonpartisan reforms,” he said. He shared four key policy efforts that Worthy is promoting:
1. Digital health records: Markovich is proposing getting every American a comprehensive, real-time digital health record that can personalize their care. He said this would save over $300 billion in administrative costs throughout the system. Much of the healthcare system is currently run on outdated technology and fax machines.
“Technologically, this is easy to do. It’s not complicated,” he said. “Everyone wants to make sure their information is secure and private, and we’re following all of the privacy and security laws and regulations that are out there. But that’s all doable today. The part that’s hard is that there are business and financial self-interests that potentially get threatened by making this information more ubiquitously available in a usable format.”
2. Change the way healthcare is paid for: The healthcare industry needs to transition to paying for outcomes versus the fee-for-service model.
“Reward physicians, hospitals, everybody for making you feel better and improving your health outcomes, not for just doing more,” Markovich said. “Because when you reward all these players for doing more, they just do more, but it’s not necessarily better.”
3. Make prescription drugs affordable: The price of pharmaceutical drugs has been growing at levels that aren’t sustainable for the public, Markovich said. He called for efforts to ensure intermediaries aren’t rewarded for selling a higher volume of more expensive drugs.
“[This] is the way it works today for pharmacy benefit managers [and] their affiliated companies like group purchasing organizations and specialty pharmacies, but it’s also true with hospitals and physicians when they do what’s called spread pricing or buy-in bill, like with 340B for hospitals,” he stated.
4. Put the healthcare system on a budget: Markovich is calling for putting healthcare organizations on a budget and implementing financial consequences for missing budget targets. He argued that hospitals, in particular, are paid more to do more, incentivizing them to conduct more tests, scans, keep people overnight, etc. This eventually leads to more inflation. Instead, Markovich proposes reimbursing hospitals a fixed amount on a monthly basis and adjusting it for the risk of the population and the size of the population.
“We’ll pay you more if and when your quality improves, and if you get good service feedback from your patients, but basically it’s a high fixed cost to manage this hospital. We’re going to pay for it whether people come to your facility or not, and so then their incentive is to figure out how to serve a bigger population without expanding. … I’m going to ask you to do what every average American family has to do, which is make ends meet with a modest increase in your pay every year. That hardly seems like an unfair expectation,” he said.
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