Convenient Care: Consumers as Partners in Healthcare Decision-Making?
Are health care consumers being empowered and positioned for success or manipulated and positioned for failure? How consistently and how fairly do we deliver quality care to all parts of our population?
What are the appropriate and changing roles of health care providers, such as physicians, nurses, PAs, nurse practitioners, office assistants. Medicine is a team sport, all working on behalf of the patient. How does this team work together on behalf of the patient?
Consumers need credible sources of information. How does the medical community validate credible sources of information? We need more head to head trials between drugs that treat the same conditions and medical devices that treat the same conditions.
The more patients self-manage, the more they are going to need contact with their physician and their physician’s office. That will create strain on the system.
In medical care, we value procedures and interventions over advice and diagnostic thinking.
American medicine has never been better, yet the frustration with American health care has never been greater. Patients are becoming consumers. They are asking tough questions, shopping for services. However, health care is the most consumer unfriendly segment of the economy. But this will change. When you have an information void, companies rise to the occassion.
Cost containment and improving quality and access are both valid goals. However, they can be competing goals. Will minorities and low wage workers be less or more empowered? Greater cost sharing for low wage workers will reduce access and negatively affect health outcomes.
Health literacy: Nearly half of all american adults have difficulty understanding and acting on health information. Patients with limited health literacy face higher consequences, such as poor health and increased hospitalization.
Cost containment is a goal that can sometimes clash with the need to increase access to services for underserved populations. It is possible that the consumer directed health model may promote less empowerment, not more empowerment, for vulnerable consumers, particularly for minorities and low wage workers.
Affordability, health information, and health literacy are key factors that must be taken into account when designing and evaluating consumer directed health programs. How will this model address existing disparities in health care access? How will it address the national challenge of poor health literacy? What is the effect of this model on health outcomes?
The health care system is the largest segment of the economy, but it is totally fragmented and confusing to patients and consumers. It is an industry of millions of independent players who are unconnected through information systems and management processes. And for a patient, whose typical care process may involve from 1-5 to up to 25 different providers, it is a labirynth to navigage.
40% of all initial referrals to specialists are from the patient themselves. And 60% of those referrals are to the wrong specialist. And to specialists, when you’re a hammer, everything looks like a nail, so specialists then do 3-5 months of rule out diagnostics only to come to the conclusion that there is nothing they can do for the patient.
When patients self-navigate they get lost in the system. 18-20% of health care events never needed to happen. They are not occurring to help the medical outcome, or the diagnosis or the treatment. They are due to the fragmentation in the system and lack of coordination among the many players. Duplicated MRI’s, extra days in the hospital and unneccessary delays are causing cost, confusion worse health outcomes just because of the confused process of health care.
To make health care work, patients and providers need assistance with the process of health care. Good health care requires more than just good medicine. What happens when the patient leaves the treatment room? They do all sorts of crazy things outside the doctors office. Doctors are not paid to coordinate care. 50% of patients leaving the physicians office are confused about what they just heard and what they are supposed to do.
To make health care work more efficiently and effectively, there have to be functions that create coordination of the health care process on behalf of the patient and under the direction of the physician. There are a variety of ways to do it. American health care has to figure out how to adopt coordination of care functions and help patients navigate through this very complex system. We need to reestablish the importance of primary care physicians. Patient education, incentives and benefit designs should have as a goal to push patients towards primary care physicians.
The issue is about access to information. Everybody sees consumers as partners in health care decision making unless it threatens their bottom line or institutional interests. Then they don’t want information to be free and public.
Consumer Directed Health Care is working for some people, and not for others. What populations are well served by CDHPs and what populations are not?
Speakers
Nancy Nielson, American Medical Association
David Gratzer, Manhattan Institute
Randall Gebhardt, Quantum Health
Peter Lurie, Public Citizen Health Research Group
Paul Antony, PhRMA
Sandra Gadson, National Medical Association
Moderator: Michael Magee, Health Politics, Pfizer
This convenient care panel discussion was a part of the Consumer Direct Access to Healthcare and Retailization event at the Consumer Health World Conference in Washington DC. If you are interested in purchasing audio from the entire Consumer Health World Conference, please visit our online conference multimedia store.
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Discussion
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