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Remember Who the Customer Is

By Kim Bellard, October 17, 2012

An organization called OpenNotes – primarily funded by the Robert Wood Johnson Foundation – recently released a very interesting study that supports the concept that patients do want to participate in their care with their physicians.  This probably doesn’t surprise patients, but may surprise many physicians. 

In brief, the study allowed patients of three geographically disparate primary care practices to access their doctor’s notes (electronically).  The study included over 13,000 patients from 105 physicians.  The vast majority of patients did view at least one note, and survey results indicate that such viewing notes made them feel more in control of their health and improved their medication adherence.  Contrary to physicians’ concerns, such viewing did not lead to longer visits or to more questions outside of visits.  About 60% of patients wanted the ability to add their own comments to the notes, while one-third wanted to approve the notes’ content (something adamantly opposed by the physicians).

It goes back to one of what I think is one of the central problems in health care: those in the business of health care are doing things about patients, but not necessarily for patients.   

Health records are the case in point.  They are maintained about patients, but are written in a jargon that is virtually unintelligible to lay consumers (and, in the case of paper records – often illegible as well!).  The concept that they belong to the patient in any real sense would come as a surprise to the health care professionals who keep them.  Meaningful use requirements are going to quickly force providers towards more patient access to information, such as clinical summaries of visits and summary of health information.  The easiest solution to this is likely to be a patient portal with a view into an EMR, but that in itself doesn’t mean the view is useful.  Please correct me if I’m wrong, but I don’t believe any of the “meaningful use” requirements relate to how meaningful the information is to consumers.  It is telling that the requirements for how many patients actually view or download the information is very weak – only 5%.

Those in the health care business talk in a language of ICD, CPT, HCPCS, DRG, NDC, DSM, to name a few; throw in insurance terminology to complete the task of confusing consumers.  Each of those grows ever-more complex and insular, driven by needs for more detailed analysis, billing, legal protection, and other purposes.  Now we’re increasingly moving towards widespread use of various quality indicators, which are similarly very well-intentioned but may not quite be answering the questions consumers have, or should have. 

As best I can tell, no one in the health business – physicians, hospitals, payors, labs, IT vendors, etc. – really like the complicated languages that have evolved around them, and all would argue that the complexity greatly adds to the expense of running their business, but I don’t see any groundswell to simplify the situation. 

One might have thought that the movement towards consumer transparency might ignite such pressure, but that hasn’t seemed to have happened.  Transparency is one of those things that everyone is in favor of conceptually, but the details of how to do it and whether consumers will use it remain open.  UnitedHealthcare recently found that only 14% of survey respondents use the Internet to comparison shop for health care treatments and services, compared to 75% who use it to comparison shop for other goods and services, a statistic United hopes to improve through its enhanced myHealthcare Cost Estimator.  Aetna, Cigna, Wellpoint and other Blue plans have their own online cost estimator tools.  

In addition to efforts from payors to help consumers with health cost transparency, there are a number of other efforts.  I had been aware of Castlight Health and The Healthcare Blue Book, but was a little surprised to uncover a plethora of other firms, including ClearCost Health, NewChoice Health, and Change Healthcare.  Some of these are aimed at employees of certain self-insured employers, or members of specific health plans, while a few focus on the general public.  It is admittedly an uphill battle to get consumers engaged in thinking about price and quality, and these various organizations all should be lauded for their efforts to give consumers more and better options for doing so.  That being said, it’s somewhat like the talking dog: it is not that it does it well, it’s just that it does so at all.

All the efforts to make costs more transparent have to wrestle with two key problems: what is the “service” being bought, and how can that service be explained in consumer-friendly terms?  E.g., an “office visit” has numerous CPT codes that could apply, each with its own price, and many visits and procedures are accompanied with other services that have their own costs, which the consumer might rightly view as being part of the original service.  How many of us have had, say, a lab test or an X-ray and then been surprised at how many bills we end up receiving for them?  

At the risk of repeating an overused analogy, compare “buying” health care with buying a computer /tablet from the Apple Store or Amazon.  Computers have their own technical language that can be every bit as arcane as health care, but consumers are not forced to use it or fully understand it to complete their shopping experience quite satisfactorily.  When they are shopping, they get lots of options on price and features, with plenty of reviews, customer feedback, and shopping “wizards” to assist them. 

Buying health care, on the other hand, is more akin to getting your own PC back in the 1970s, which required buying a kit and/or components and then trying to assemble the whole thing yourself.  Health care transparency as we know it begins to look more like giving consumers the prices of each component in your PC and quality indicators from the chip manufacturing process.  Those do mean something, but are not really what consumers want.  The problem is that health care professionals are speaking in Greek (or perhaps Latin!) while we want to hear about our health in our own language.

People talk about “disruptive innovation” in health care, by which they often mean use of various forms of technology.  Technology is going to certainly play an even more significant role, but I have to wonder if the disruption will come instead from organizations which can make the health care experience for consumers simpler –much simpler.  I.e., radically rethink what the “products” are, what the processes should be, and how these are communicated to patients. 

Our health care system has many historical practices and preferences that muddle the roles of the various parties involved in it, but it’s helpful to remember that it all boils down to the patient as customer.  It’s their health, after all.

Reader Comments (2)

Definitely hard to shop when you don't know a thing about something. Healthcare is something that should be easily understood by ordinary people. Otherwise, we're on the losing end.

Definitely hard to shop when you don't know a thing about something. Healthcare is something that should be easily understood by ordinary people. Otherwise, we're on the losing end.

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