Category Archives: Consumers

Interview: Greg Scandlen, Consumers for Health Care Choices

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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.

Convenient Care: Who is the Primary Healthcare Provider?

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Who owns the patient? In terms of health care delivery, where does the spectrum of care begin and end? Retailization and convenient care (store-based clinics) bring this question to the forefront.

The American Medical Association (AMA) believes that if convenient care clinics exist, there are certain guidelines that should be followed that are beneficial to the patient. The AMA issued a 9 page report entitled Store-Based Clinics that offers guidelines for convenient care.

The AMA Council on Medical Services (CMS) issued Report #7 dealing with Retail Health Clinics. This report outlined the development of store-based clinics and their use of medical protocols. This report highlighted the activities of the AAFP in this area and outlined the AAFP’s desired attributes for store-based health clinics. The recommendations adopted by the House of Delegates are the following:

a. Store-based health clinics must have a well-defined and limited scope of clinical services consistent with state scope of practice laws.

b. Store-based health clinics must use standardized medical protocols derived from evidence-based
practice guidelines to insure patient safety and quality of care. (Some may disagree with this statement because they think it replaces physician judgment).

c. Store-based health clinics must establish arrangements by which their health care practitioners
have direct access to and supervision by MDs/DOs as consistent with state laws.

d. Store-based health clinics must establish protocols for ensuring continuity of care with practicing
physicians within the local community.

e. Store-based health clinics must establish a referral system with physician practices or other
facilities for appropriate treatment if the patient’s conditions or symptoms are beyond the scope of
services provided by the clinic.

f. Store-based health clinics must clearly inform patients in advance of the qualifications of the
health care practitioners who hare providing care, as well as the limitation in the types of illnesses
that can be diagnosed and treated.

g. Store-based health clinics must establish appropriate sanitation and hygienic guidelines and
facilities to insure the safety of patients.

h. Store-based health clinics should be encouraged to use electronic health records as a means of
communicating patient information and facilitating continuity of care.

i. Store-based health clinics should encourage patients to establish care with a primary care physician to ensure continuity of care. There should be a mechanism to ensure continuity of care if the convenience center is not going to do the follow-up care.

When physicians make a decision to get involved and supervise care, the AMA urges them to follow these guidelines.

The American Academy of Family Physicians believes, in addition to the AMA’s guidelines, that the most valuable commodity that anyone can have in health care is a medical home, where their medical history resides, and where they can get most of their primary care, that coordinates their care, and where they can always come back to.

Part of provinding a medical home is a team-based approach to care – physicians, nurse practitioners, dieticians, physical therapists, etc. Everybody has a role in patient care. There has to be an electronically coordinated center of care to effectively take care of the patient and coordinate the activities of all the providers.

The American College of Nurse Practitioners supports the concept of convenient care clinics. The system is broken, and retail clinics think that they can provide a service. The retail clinics are filling a need that wasn’t filled before. There are not enough family care physicians graduating each year to meet demand. It can take a long time to see a family practice physician. How do we solve it? Look at the numbers. 2.5 family nurse practitioners are graduating for every one family practice physician. They can play a role.

There are a number of reports that show that the quality of care that nurse practioners provide is equivalent to that provided by family physicians. They can do about 70% of what MDs can do. Unlock the regulations and restrictions to allow NPs to do what they are capable of doing. Retail clinics are using nurse practitioners as a primary care provider. The primary care provider is the person seeing the patient at that point in time.

Minute Clinic thinks there is patient value to retail clinics. The retail clinic model is to provide services as an adjunct to the medical home. The medical home relationship is a critical one, and retail clinics should facilitate that relationship. Most patients don’t currently have a medical home. Retail clinics cannot provide the full breadth of services because of the businesss model. Retail clinics are there to be supplements to the medical home. Can they help in, for example, disease monitoring, not necessarily disease management.

How do you measure and demonstrate the quality of retail clinics? Minute Clinic has been working with the Joint Commission on Accreditation of Healthcare Organizations to set these standards of measurement.

Little Clinic also sees itself as a compliment to the family practice. But the question we should ask is what do consumers want? How do they want to deal with their daily medical needs? Do they always need to see their family practitioner, who might not always be available? Maybe not. The primary care physician is responsible for integrating all the patients health care information, but PCPs are in decline. There are less of them than in the past. They can’t keep up with demand. So convenient care clinics can serve as a compliment to help ease the burdon on the system. Let the retail clinics deal with the low risk issues if the consumer so desires. If it brings value to the consumers, this model will be successful. If not, it will fail.

Teladoc believes that when people move, it is difficult to drag the doctor with us. More likely, our medical record will go with us in the form of an electronic medical record. When a continuity of care record is working, a patient can bring their record to anyone providing their care. Patients, at 2am, can access their medical record and deliver it anywhere. CCRs will be a huge part of the solution.

Register today for the upcoming Consumer Health World Conference.

Health Trends: eHealth Consumers

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In this episode of Health Trends we sit down with Meredith Abreu of Manhattan Research. Manhattan Research just released their annual Cybercitizen® Health report.

Cybercitizen® Health is a syndicated consumer study and marketing data set of Manhattan Research, primarily focused on key research topics and trends impacting the ehealth market. The study objectives are to identify and analyze the behavior, attitudes and demographics of the consumer population using technology for health purposes. It is clear that ehealth is “going mainstream” in the U.S. with 116 million consumers using the Internet for health information and services. Along with this growth comes the need to further segment the population into relevant sub-segments, such as condition groups, utilization and motivation.

Cybercitizen® Health explores topics such as the Internet, email communication with physicians, DTC advertising, health ecommerce, plans and providers, use of pharmaceutical information online, health information seeking methods and more.

Key points:

  • Consumers are becoming increasingly empowered and responsible for their healthcare decisions
  • They are exercising this power by going online for additional information in droves, and in many cases challenging their physician
  • In the past 2 years, consumers have become much more satisfied with the health information they find online – while becoming less satisfied with the information they get from their physician.
  • Consumers are becoming very comfortable with researching health information online – perhaps too comfortable. Nearly half of consumers researching health info online are almost exclusively reliant on search engines to find that information – and without editorial oversight of search results, consumers are left to be the expert and sort through the information they find.
  • Despite being comfortable with using the Internet for health information, consumers have a certain degree of wariness about health IT initiatives such as electronic medical records, with two-thirds of U.S. adults reporting they are “not at all interested’ in having their health information stored electronically.

2007 Consumer Health Trends

As Time magazine noted in voting “You” the person of the year, we, the collective body of consumers, are more and more in control of the media we consume, the information we’re exposed to, and the decisions we make. Nowhere is this more apparent – for better or for worse – than when it comes to healthcare.

Like it or not, today’s consumers are bearing increasing responsibility for their healthcare. The trend toward “consumer driven healthcare” has put difficult financial and treatment decisions in the hands of the consumer – forcing today’s consumers to take ownership of the business of their healthcare.

The Internet has emerged as a critical tool for consumers as they seek to navigate their healthcare choices, with over 116 million consumers go online for health information today. With this increase in empowerment comes a certain wariness – consumers are also less likely today to be satisfied with the information they receive from their physician, and more likely to challenge their physician if they do not agree with a diagnosis or treatment decision. This wariness also extends to health IT initiatives – despite overall consumer interest in researching health topics online, consumers are less-than-enthusiastic about things like electronic medical records – a technology which, paradoxically, consumers might feel permits them less control over their personal health information.

With these forces in mind, here are some of the key trends among today’s empowered health consumer:

Today’s Savvy Consumers are Less Satisfied with Their Physician

Over the past few years, there has been a drastic increase in the number of consumers going online for health information. In fact, “eHealth Consumers” are the new majority – with more than half of U.S. adults reporting that they have gone online for health information.

Additionally, consumers today are more satisfied with the health information they find online than they were even just two years ago. However, if we look at the historical data, we see that as the Internet has increased both in reach and relevance as a health information source, consumer satisfaction with information from their physician has decreased. As today’s physicians are pressed for time, consumers are finding that it’s easier to go online for information than it is to find the information they need during a brief 5-minute visit with their doctor.

Consumers are Increasingly Comfortable Fending for themselves when Finding Health Information Online

A few years ago, when consumers were asked how they typically go about finding health information online, on average they reported that half of the time they used a search engine to find the information they were looking for, and half the time they went directly to a website they were familiar with. This was understandable – in the early days of navigating online content, it was difficult to know which information was trustworthy — so consumers were perhaps more likely to trust the big-name sites that contained accredited content

Over the past two years, however, there has been a substantial shift in consumer behavior in this regard. Today’s eHealth Consumer uses a search engine to find health information more than two-thirds of the time on average – and nearly half of consumers looking for health information online report they use a search engine first more than 90% of the time – making a large portion of the health information seeking population almost entirely reliant on search engines to bring them to the information they seek. This type of search engine reliance requires a high degree of Internet savvy – as well as a large measure of health knowledge in order to sift through results that are trustworthy and reliable. While there are some filtered health-specific search engines (such as Healthline.com) beginning to emerge – for the moment, convenience seems to be king when it comes to the driver behind search engine reliance – so the sites consumers are primarily using for health searches are the same ones they use to track down the latest gossip about Britney Spears.

And, of course, the degree to which consumers are successfully sorting through health information online remains to be seen. As consumers become increasingly comfortable with the “Web 2.0” means of online communication and content generation – through blogs, community messageboards, and social networking sites – there is likely to be an abundance of misinformation being passed around unchecked.

Electronic Medical Records – Who Cares?

But for all their tech savvy when it comes to researching health information online, consumers are noticeably lackluster in their interest in health IT initiatives such as electronic medical records.

When asked about their interest in accessing health records electronically, only 1% of U.S. adults report currently using electronic medical or health records, while 64% report they are “not at all interested in using” an EMR.

Given the lack of consumer interest, can we expect EMR adoption will instead be driven by physicians? The story there is not any more encouraging: only 26% of primary care physicians use electronic medical records in their office, and almost one-third of PCPs have no interest in using electronic medical records in the future.

What does this mean for the future of the health IT movement? Adoption of electronic health records will clearly not be driven by consumers, who are not convinced that electronic health records are necessary; nor will adoption be driven by physicians, who in many cases, are unwilling to foot the bill or invest the time and resources required for such a substantial change in practice management – and especially heavy burden for smaller practices.

Instead, the electronic medical record movement will have to be driven by government legislation or by incentives from payers, who stand to benefit from the vast opportunities for data mining that could be made available through electronic medical records.

The current administration is beginning to recognize the necessity of electronic medical records for cost containment, outcomes measurement, and a myriad of accessibility reasons highlighted by the Hurricane Katrina disaster – and has set a national goal of making EMRs the norm within the next 10 years. But is this an achievable goal? While EMRs are a critical next step for our country’s healthcare system – don’t expect there to be vocal public outcry if these goals aren’t met.

Source: Manhattan Research Cybercitizen® Health v6.0, Taking the Pulse® v6.0