Knowledge, Standards, and the Healthcare Crisis

There is widespread acknowledgement that our healthcare system needs radical transformation since:

  • All patients are at risk for receiving poor health care, no matter where they live; why, where and from whom they seek care; or what their race, gender, or financial status is[1]
  • Healthcare is increasingly more expensive and less accessible[2], with more than 46 million uninsured in the U.S. from every age group and at every income level, 8 out of 10 being in working families[3]
  • There is a knowledge void – the healthcare community is drowning in oceans of information, yet doesn’t know the best ways to prevent health problems and treat them cost-effectively.[4]

In this next series of posts, I will offer an answer to this daunting question: What can be done to drive continuous improvements in care safety, quality and efficiency, which would enable people to remain healthy longer, manage chronic conditions more effectively, and receive the best possible healthcare delivered in the safest and most economical way?

My answer focuses on the creation, use and evolution of valid health knowledge. Why? Because, I contend, the quality of care would improve dramatically and costs would drop precipitously if everyone:

  • Knew the best ways to prevent illness, to avoid complications of chronic diseases, and to treat health problems in the most effective and efficient manner
  • Used this knowledge to promote wellness, self-management, and recovery
  • Participated in evolving this knowledge to make it ever-more useful and effective.

So, what would it take to foster widespread knowledge creation, use and evolution in our healthcare system?

Well, since knowledge emerges from information,[5] it is essential that both consumers/patients and providers have access to useful health information, including patient health data, care outcomes, and evidence-based guidelines. Furthermore, the information must be presented in a way tailored to each persons needs and be made available whenever it’s needed. Unfortunately, this is much easier said than done for many reasons.

One daunting core problem involves exchanging patient data between disparate electronic record systems. After all, knowledge can’t grow and care can’t improve unless patients share their health information with their providers, providers share patient information with each other, and researchers have access to this information to develop evidence-based guidelines. And this must be done in a convenient and secure manner that protects patient privacy.

With cost estimates for developing a national health record system enabling patient data exchange being between $100-276 billion,[6] the question is, why must it be so expensive? Aren’t there any easy, inexpensive ways to do it? Let’s examine these questions.

One way to reduce health information exchange costs is by developing and using standards that promote interoperability between disparate health record systems.

Standards are models, principles, policies, or rules that provide an agreed-upon framework for doing and understanding things. When it comes to health information exchange and knowledge growth, at least two types of standards come into play: data and technology standards. These standards describe how health data are categorized and defined, how health outcomes and healthcare performance are measured, how healthcare knowledge is used, and how different software systems communicate with each other when exchanging data.

In my next post, I examine this double-edged sword of standards, pointing out their benefits and the thorny problems they create.

References:

[1] The First National Report Card on Quality of Health Care in America by RAND Corp (2006)

[2] Health Care Coverage in America: Understanding the Issues and Proposed Solutions by The Alliance for Health Reform (March 2007)

[3] The Current Situation – WellnessWiki

[4] The Knowledge Void – WellnessWiki

[5] DIKUW Blog

[6] Linking Providers Via Health Information Networks by The Alliance for Health Reform (2006) and
Dying for Data by R.N. Charette (2006)

Steve Beller, PhD

Step-by-Step Blueprint for Employers to Achieve Healthy Company Status: So What? Return on Investment

Chris Kersey, MD, of RediClinic: Michael Samuelson, The Health & Wellness Institute, David E. Wilson, Wilson Partners, LLC, and Moderator Jerry Reeves, MD, Health Innovations, LLC speak about Return On Investment at Consumer Health World.

This video is from Consumer Health World.

Register now for future Consumer Health World conferences.

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.

Register today for the upcoming Consumer Health World Conference.

Convenient Care: Retailers Providing Healthcare Services

One of the newest and most talked about trends in consumer health is the merging of retail locations and health centers. The attributes of choice, convenience and control are now called Convenient Care.

Convenient care has enjoyed rapid growth in the past year. The most important constituent is the consumer, and convenient care clinics have been monitoring patient satisfaction, one metric they should be judged by.

There are three reasons why consumers are embracing convenient care:

1. There is an opportunity for the consumer to take control of their health and wellness;
2. It provides convenience;
3. It provides time efficiency.

The transparency of price that consumers experience at convenient care clinics should be embraced throughout the healthcare system.

There are three reasons why retailers are embracing convenient care:

1. Extend the retail brand in terms of loyalty and trust;
2. Drive traffic to retail locations;
3. Increase sales of OTC, Pharmacy products, etc.

It is important for convenient care clinics to set a standard for quality. They are not meant to replace primary care facilities, but rather to fill a void in the system. Convenient care clinics can bridge a socio-economic divide that exists in America.

Speakers

Hal Rosenbluth, Convenient Care Association and Take Care Health Systems
Web Golinkin, ReadiClinics
Mark Goodman, Sam’s Club
Mike Marolt, Eq-Life / Best Buy
Joseph Calomo, Walgreens Health Systems
Moderator: Wendy Borow-Johnson, Healthy Living Channel

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.

Register today for the upcoming Consumer Health World Conference.

Interview: Philip Polakoff, ACS Healthcare Solutions

Health is a sense of complete physical, emotional, and social well-being, not merely the absence of infirmity and illness.

Interoperability, quality, and transparency are all important. On the prevention side, we are not putting enough energy into the issue. Smoking and obesity are on the rise. Our system is innefficient, inneffective, and no one is happy. Government can play a role as a bully pulpit.

Hopefully in the upcoming elections we will have an in depth discussion on health care, which we have not had in the past decade.

Phil Polakoff’s career in health and disability span thirty years and includes product development, network development, care management, organizational development, policy formulation, communications and finance. Prior to joining ACS Healthcare Solutions, Phil spent two years as a principal with Buck Consultants. Phil was previously CEO and President of Total Health Advocacy Partners, a venture backed health and productivity company.

Phil’s areas of expertise include the design, implementation and assessment of integrated health and productivity initiatives, quality assurance, workers compensation and disability plans, consumer driven health care plans/HSAs, and communications / public relations. In addition, Phil lead the Buck team that developed Lifetime Health, a state of the art online health and wealth resource center.

Interview: Greg Scandlen, Consumers for Health Care Choices

The Commonwealth fund recently came out with a report that was based on an online survey that, according to Greg Scandlen, founder of Consumers for Health Care Choices, was not very accurate. The Commonwealth Fund and EBRI surveyed about 3,000 people and found 28 people who had Consumer Driven Health Plans and concluded that there are only about 1 million people who have CDHPs nationwide.

According to Greg, the vendors, health insurance companies, employers, and HSA administrators who have counted, have said that a little over 13 million people have CDHPs, or 10% of the benefits market. That a survey could be that far off suggests that the rest of the findings in the survey cannot be that accurate.

Greg Scandlen started Consumers for Health Care Choices because too many health care conferences and industry organizations are focused on the interests of the insurance companies, the technology vendors, etc. Everyone is a health care consumer and the goal of Consumers for Health Care Choices is to represent the voice of the consumer.

Greg was the chair of the Consumer Directed Health Care Conference consumer awareness track called How Consumers Can Cope in a Consumer-Driven World.

Interview: Robin Felder, Medical Automation Research Center, University of Virginia

Robin wants to eliminate health insurance companies and create a single payor system combined with Health Savings Accounts. The government would act as a safety net for catastrophic situations.

Technology will only be useful if it applies to the proper financial infrastrure. Why not create Health Savings Plans and incentivize people to judiciously manage their health care dollars. Consumers would be empowered.

The Blogging Revolution: Why Healthcare Will Be Transformed and How Other Industries Show the Way

Steve Rubel of Edelman talks about trends in technology, search and social networking. There is an erosion of trust in institutions such as the church, corporations, major league baseball. People do want to trust each other and turn to other individuals for credible information. People can use technology to bypass institutions to disseminate information to each other.

Power is now distributed from institutions to individuals. Individuals have launched blogs with open source software that are now read by millions.

How does all this apply to healthcare? Watch and learn…

This healthcare blogging keynote was a part of the Healthcare Blogging Summit 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.

Register today for the upcoming Consumer Health World Conference.

Interview: Michael Samuelson, Blue Cross & Blue Shield of Rhode Island

Michael Samuelson, Blue Cross & Blue Shield of Rhode Island, chair of the Health, Wellness and Prevention track of the Consumer Health World conference thinks a a paradigm shift is inevitable – the recognition that whether you want the system to change or not, it will change because it is broken.

The current treatment model, which is designed to fix people once they have a problem, will no longer work. The health care system only kicks in once there is a disease or a problem that needs treatment. We need to focus on prevention. By spending a little time, effort and energy up front, to reduce long term problems and costs to both individuals and the system, the healthcare system can avoid the serious medical costs that are currently crippling the system.

Insurance companies will start to offer wellness and prevention services because employers are demanding them.