A combination of cognitive dissonance, Stockholm’s syndrome, and poor incentive structure have been a burden to the consumer healthcare experience, that is until the democratization of healthcare data. The decision-making power that patients now possess with access to “their data” is creating an environment that is not your father’s healthcare system. Information is really the only demarcation. So, what does the landscape look like for patients interested in evaluating healthcare products and services through the use of technology alongside their data?
Evaluating the quality outcomes of hospitals and healthcare providers alike is akin to checking references for any other product or service. The Leapfrog Group is a non-profit watch dog that provides a hospital-based Consumer Reports-like comparison tool across domains from maternity care to medication safety to inpatient care management. Particularly if you are an expecting mother, (the lion’s share of hospitalizations are for child birth), this tool is a great resource. They are the gold standard in evaluating hospital-based patient outcomes. The Centers for Medicare and Medicaid (CMS) also provide a hospital compare tool that offers critical KPIs, one of them being hospital-acquired infections (HAIs). The fundamental challenge with CMS data is it’s retrospective and based on Medicare patient data only.
Like healthcare quality data, healthcare pricing data continues to be a black-box. However, check out the most transparent healthcare provider in this country’s website, The Surgery Center of Oklahoma. Click on their website, click on the procedure you are looking for, and voila! Hat Tip to Dr. Kevin Smith for going against the grain and providing a glimpse of the possibilities in our healthcare system. The state of Virginia also offers a tool that provides information on claims paid by health insurance carriers throughout their state. Basically, claims data affords consumers a retrospective look at what insurance carriers paid healthcare providers for particular tests, procedures, etc. CMS carries the biggest stick in the payer world and offers some of the best tools for transparency as well. Change, especially in healthcare, happens with the industry leader (healthcare’s largest payer) using its critical mass to demand pricing transparency. What does it say about the implications of pricing transparency when the providers of healthcare services begin to sue the federal government over transparency requirements? Pricing transparency is the preeminent last mile in healthcare and the technology needed to disseminate that information is taking shape.
Service cost transparency is the most important financial aspect of making informed healthcare decisions. Though not to be discarded on the financial front are the cost and quality of prescription drugs. There are a litany of tools that provide incentives to consumers to fill their Rx. Blink Health, WeRx, and GoodRx are great for discounts and cost estimation at local and regional pharmacies. Online pharmacies such as healthwarehouse.com (Costco and Sam’s Club work as well) work for the procurement side of the business. “Authorized Generics” are another way to reduce your expenses and increase your odds of a quality product. Then there are pharmacies that take quality a step further in ensuring what you are putting in your body is the real deal. Valisure is a little-known mail-order pharmacy start-up that actually tests samples of the products it’s receives directly from the manufacturer. This FDA website can also lend a hand if you want to see if a particular drug manufacturer is on the naughty or nice list. Given that 80% of the active ingredients in all U.S. drugs, brand or generic, are coming from manufacturers overseas and 90% of our drug supply is generic, verifying the drug manufacturer’s standards is sound policy.
From quality and cost, we arrive at decision-making during the course of care that combines both of those concepts. Choosing Wisely is an organization that compiles recommendations from a spectrum of medical societies and offers consumers a SWOT analysis across many of the procedures, tests, and diagnoses that can be proposed treatment options. Whether a particular test, procedure, or treatment protocol is appropriate based on the presenting conditions is challenging even for healthcare professionals. And considering some estimates put healthcare spending waste at 25%, it’s worth a look.
Alas, using technology to actually navigate data exchange and communication. There are more tools on the market today than you can shake a stick at for managing your personal healthcare data. Electronically managing personal health records effectively is a key part of transitioning care from one provider to the next, understanding the underlying conditions that drive treatment plans, and allowing your care team to support you. Apple Health Records(Android is beginning to toe the line as well) has developed a great tool that aggregates your clinical data across different care settings using the FHIR API with several of the leading Electronic Medical Records (EMRs). The quality of the patient facing technology that providers offer is a key piece for patients to manage their information. Direct Messaging capabilities within a patient portal, for instance, give consumers portability and standardization when transferring their C-CDA to a referring physician and vice-versa. Being able to use a smart device to interact with the care team and manage personal health information are key indicators of a quality patient experience.
These technologies and many others are leading indicators that the healthcare consumer experience is catching up with other industry. Those that cater to smart devices will prevail. We’ve touched on the federal government trying to do its part through technology, the growth in payment parity of telehealth visits is another great example of bringing healthcare to the consumer and incentivizing providers to adopt that service setting. The days of yore are fleeting. The challenges with healthcare consumer engagement become presenting information to consumers in a way that makes them give a darn and improving consumer literacy around how the healthcare system is constructed. Stringing together a lattice work of tools is a great starting block. Shunning Stockholm’s Syndrome will take a generational time-horizon but rest-assured the generations that grew up at the precipice of the transition from analog to digital are up to the task.