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Consumerism in Healthcare-- Who Needs to Change and How Do We Make it Happen ?. Jon R. Comola Marcia L. Comstock, MD MPH Wye River Group on Healthcare June 7, 2005. To Recap…….
Jon R. Comola
Marcia L. Comstock, MD MPH
Wye River Group on Healthcare
June 7, 2005
Experience would strongly suggest that having either public sector (i.e., govt) or private sector (employers/health plans) arbitrate the tension between limited resources & unlimited expectations is incompatible with American culture.
SO…., whether you believe putting patients in control of these decisions is the right thing to do or not, there are no other viable choices!
If this is to be the ‘Brave New World’ of healthcare, how do we ensure it is operationalized appropriately???
CHANGE IS HARD!!!
Medical care revolves around the doctor-patient relationship & ultimately that relationship determines the cost and quality of care! The role of all other parties is to support that relationship..….
OK, is this realistic today???
(sort of ‘Trading Spaces’)
When it comes to the day to day on-going decisions about exercise, diet, smoking cessation, and other health behaviors , it’s the doctors that advise and it’s the systems that reimburse, but it is the patient that decides!!!
(We need “The Biggest Loser”!!!)
National Geographic August 2004
Source: Prochaska & DiClemente
Without really good behavioral health communication programs patients really don’t adhere very well ….
there are other barriers……….
Effective healthcare is all about decisions:
To make good decisions, consumers must have access to personalized care management tools or decision-aides for guided self-care management
RAND Survey 3/05
It’s really simple!!! (Ha!)
What is it?
We see unwarranted variation related to:
Dartmouth Atlas of Healthcare
The practice of medicine is anything but pure science today!
Harris Interactive, 3/05
“…there is sufficient evidence to suggest that most clinicians’ practices do not reflect the principles of evidence-based medicine but rather are based upon tradition, their most recent experience, what they learned years ago in medical school, or what they have heard from their friends….”. John Eisenberg, AHRQ
When the rules of clinical practice are not clear, variation results from subjective opinion, practice preferences, and hospital capacity.
IF there is evidence you are not a consistently good cook,
WHAT IS WRONG WITH A COOKBOOK??
Denounced as a scam designed by multimillionaire CEOs of health insurance companies to cut reimbursement by taking advantage of gullible physicians
Wm Plested, MD, AMA Board Chair, 2004
The US public is only moderately supportive of having health plans pay more to doctors for higher quality [38% yes, 17% no, 32% indifferent] UNLESS it lowers their health insurance costs [67% yes].
(perhaps this is more driven by self-interest??)
“Extreme Makeover “
The news is similarly grim when it comes to research on just how frequently and just how deeply the average physician gets into shared decision making with the average patient.
(study of >3000 medical decisions involved in 1,000 visits; looked at 6 key elements of informed consent or shared decision-making)
(but the real “Weakest Link”……)
Physicians don’t think it will make a difference in the patient’s behavior!!
3 strategies rated as the most effective:
Commonwealth Fund Health Care Opinion Leaders Survey
(academia/research; business, insurance, health care industry, labor/consumer advocacy orgs, govt)
“I’m too busy to worry about fixing the healthcare system”
“It’s an exit strategy”
“ I can predict my costs, as I shift more to employees”
“It’s a plan issue”
“Why can’t physicians get their act together”
“I need to focus on cost management”
Empowerment & Support
“I can be an agent for community collaboration”
“I’ll reward efficiency: P4P”
“I’ll focus on care management”
“I recognize the need for total system redesign”
“I need to focus on integrated care & outcomes”‘RED PILL/BLUE PILL’(the Matrix Redux….)
“I make widgets!”
“I spend enough on healthcare
as it is!”
“My plan is the expert”
“One size fits all is fine”
“I don’t want to have to worry
about adverse selection”
“I need to help my employees with information”
“Good decisions will help productivity”
“I need to pay attention to details!”
“People need to be able to shape benefits to meet their needs”
“I need to ensure incentives for wellness & prevention”‘RED PILL/BLUE PILL’
house calls, pharmacy delivery of meds, the milk man, full service gas station, dry cleaning delivery
stores staying open after 5 and on Sunday; the telephone company accepting payments through the grocery store, multiple locations for paying bills or customer service booths, travel agents who negotiate for you
credit card over the telephone, 24 hour access to account information over the telephone, then fax and eventually internet
on-line checking; catalogue ordering; Ebay
Has redefined expectations and created demand for things that look and feel more like self service-- you pump your own gas, you book your travel on-line; you print your own airline tickets and check your bags at the kiosk; you scan your own grocery purchases
WHAT WILL THIS LOOK LIKE IN HEALTHARE???