Comparing March Madness to Health Care

The time of year is upon us again. A time many sports fans wait all year long for. That’s right, it’s time for March Madness. March Madness is the NCAA’s single elimination basketball tournament that will crown the best team in the country. The included teams are split into four regions and ranked one to sixteen. This is a time many fans spend watching, researching, and even gambling on teams they would never have otherwise paid any attention. People spend countless hours investing into March Madness, what if they spent that same amount of time thinking about their own healthcare? There are many things that can be learned from March Madness, things that could be similarly applied to understanding our own healthcare.

Selection Sunday/Rankings

The first big item of March Madness is Selection Sunday; this is where a panel of experts come together to rank every team in the country. Ultimately the top teams (along with automatic qualifiers) are selected and placed into a bracket with four regions where each team gets a seeded position from one to sixteen (along with a few play-in games). The teams that have performed the best throughout the regular basketball season will get the top seeds (one to four); whereas the teams that barely made it in or got an automatic qualification will get a lower seed (thirteen to sixteen). Experts spend many hours, days, weeks, and even months trying to predict where each team will be seeded.

What if there were an equal amount of time spent on ranking and seeding of health care providers? Why should we spend so much more time analyzing whether we think a top seeded basketball team deserves their ranking but not research whether our own primary care physician would be ranked highly? If there were a published ranking of all providers in your area would you take the time to read it, scrutinize it? Would it change how you view your own provider? Would you be prone to ask more questions or seek more transparency? An example of an advanced ranking system we believe has the potential to become a gold standard of ranking healthcare professionals is MPIRICA (https://www.mpirica.com/). They have created a user-friendly, formula driven scoring platform based on outcomes.

Filling Out Your Bracket/Selecting Your Provider

As soon as the March Madness brackets are announced on Selection Sunday people begin filling out how they think the tournament will play out. Which twelve seed is going to upset a five seed? Because it happens every year. Which of the experts do you agree with? How far do you think your favorite team will make it? There is a lot of time spent filling out March Madness brackets and a lot of money gambled to support these brackets.

When it comes time for you to see a doctor, how do you decide whom to see? Some health insurance carriers will assign a doctor, but is that doctor a high or low ranking professional? The insurance carrier may have a proprietary tool used to score the doctor, but do you ever ask to see how good your assigned doctor scored? If a ranking of healthcare providers existed in a similar fashion, how much time would you spend deciding who you think is the best for you? There are already many publicly available tools for reviewing doctors (https://www.ratemds.com/ is one example). Do you spend time reading about your doctor prior to selecting a healthcare provider? Would you pick a low seeded or lower reviewed primary care doctor to outperform a top ranked one? How willing would you be to bet your own money, or health, on picking a lower ranked provider as your champion?

Tournament Play/HealthCare Performance

One of the more exciting things during March Madness is watching a lower seeded team knock out a top ranked team. It’s a historical feat for a sixteen seed to be competitive with a one seed (only once has the sixteen seed beat a number one seed). It’s even more exciting to watch a lower seeded team win multiple games to go on a “Cinderella run”. The length of a lower seed’s run often adds to the excitement, however these runs usually come to an end though.

Would you be willing to select a lower ranked healthcare provider hoping that they go on a high performing run when you need care? It’s possible they would outperform the top ranked providers for a short period of time and give you outstanding care; they are all medically trained professionals. How long would that high performance run last? Long enough for a deep tournament run? Long enough to win it all? Perhaps the lower ranked provider would be a cheaper option, would you be willing to gamble the quality of care for a lower cost?

Top Seeds Usually Win/High Performers Usually Outperform Lesser Performers

During March madness the most commonly picked winners of the tournament are the top seeds. It makes sense to say that the teams who have performed the best throughout the year would be expected to perform the best in the final tournament. The number one overall team might not always win the championship but a top four seed will win it over 90% of the time (according to www.NCAA.com a team with a four seed or better has won the tournament 31 out 34 times since 1985, or 91.4% of the time). This doesn’t come as much of a surprise, as a good predictor of future performance is the recent past performance. The top seeded teams got their high ranking due to performing better during the regular season play.

Knowing this, would you be willing to bet on a lower ranked healthcare provider? If a lower ranked provider offered a substantial discount on cost this would entice some people to select them. How much money would you have to save to gamble on a lower ranked provider? It is possible for a lower ranked provider to outperform the top ranked ones, but is it probable? March Madness has even seen an eight seed win it all once. Would it be best for members to just make sure that their doctor is at least equivalent to an NCAA eighth seed, which would be middle of the pack? Or should we always feel the need to only support one and two seeds, the top ranked providers?

Outperforming Seed/Becoming Aware of Rank

During the NCAA tournament every year there are teams that believe they should have received a higher seed than they did (or teams that believe they should have been included when they weren’t). These teams that believe they were poorly seeded often say they are playing with a “chip on their shoulder”. The lower seeding is used as motivation during the tournament to outperform the high seeded teams and potentially win some games they wouldn’t be expected too.

Would a provider that saw a lower ranking have a similar reaction? Offering an insight they potentially have not seen before could motivate these lower ranking providers to become more efficient and offer a higher quality of care. Even aware of a lower ranking, some providers might choose not to change. They’re happy to take the members assigned to them and continue business as usual. Would you want to go to a business as usual provider or one motivated to improve (or continue) their high performance?

Conclusion

Many people love the time of year known as March Madness. There are countless hours and a lot of dollars invested in the tournament and individual games. If healthcare providers were ranked in similar fashion would people be as interested in doing research and potentially take a risk on a lower ranked professional? If rankings existed, would some providers become more cognizant of the quality of care they are providing? The March Madness basketball tournament and our healthcare system have many differences, but also have some key similarities. As tournament time is upon us, I challenge us all to look at our own healthcare, who is on our team, and if we really believe they are good enough to be considered the best around.

Zachary Westphal, ASA, MAAA is an Actuary at Axene Health Partners, LLC and is based in AHP’s Temecula, CA office.