As we move toward a health care system that gives people more power and control over health care decisions, many experts worry that consumers will be bewildered by so many complex financial and medical choices. Some argue against consumer-directed health care because they don't believe that people can or should be left to make these difficult decisions.
But these concerns should not lead us to turn our back on consumerism and lock in old paternalistic, top-down driven systems. People do need expert help in navigating the growing complexities of treatment options, and the health sector is beginning to respond by offering options such as health coaches and chronic care management programs to help. And that?s just the start of the many consumer-friendly options that soon will be available in our information economy.
Today, when people are seriously ill or have a child with multiple medical needs, they find they must become actively involved in informing themselves about the nature of the illness and about treatment options. They rely on their doctors, of course, but also on information from disease groups, from real and virtual discussion groups, and on research from medical libraries and trusted websites, often becoming experts themselves.
And many people with routine health needs seek the security of having expert advice available through "concierge medicine." Here, people agree to pay a physician a fixed fee for ready access to appointments, attention to wellness care, help in locating specialists, and expert advice in the event of a medical problem.
Millions — tens of millions — of people would like to have that kind of access, but so far only a small number do.
Yet this kind of trusted health advisor will be an emerging force in the new world of consumer directed health care ? trusted agents that people will rely on both for routine health care advice and for help in making complex medical decisions.
We are seeing early beginnings. Today, many health plans offer their members a hotline number to get an instant consultation with a nurse, and a physician, if needed. Members use these hotlines to get quick advice on whether a sick child needs a prescription, a doctor?s appointment, an emergency room visit, or just some rest.
And some plans are moving this expertise online to provide access via e-mail to one-on-one consultations with physicians. For example, Blue Shield of California pays physicians the same for an e-mail consultation ($25) as for an office visit. The American Medical Association has created a reimbursement code for online consultations, and while they are far from the norm, the demand for efficient, cost-effective e-visits will inevitably grow.
Information technologies already make medical expertise available to anyone with an Internet connection. Millions of people get information that is clear and understandable through popular websites such as WebMD, the Mayo Clinic, Medline Plus, and Your Diagnosis. And disease specific groups, such as the American Cancer Society, the American Diabetes Association, and the American Heart Association, provide not only reliable, current information, but access to virtual chat rooms where patients can exchange medical information.
Information leads to empowerment, especially when someone is facing a crucial medical decision.
Several new companies are providing a different type of direct medical decision support to individuals and companies. For example, Health Dialog helps patients understand treatment options and choose what's best for them.
"In an increasingly consumer directed healthcare environment, it is critical that individuals have the information and support they need to become more involved in their healthcare," the company's website explains. "Health Dialog is built upon the idea that when individuals are more actively engaged in managing their care with their physicians, they are more satisfied with their care, quality goes up, and costs go down."
Health Dialog uses information from the Foundation for Informed Medical Decision Making which says: "When patients get sick, they sometimes face treatment decisions that can be confusing and frightening…Very often doctors make these decisions for patients, and many patients prefer that model…
"However, a growing body of research shows that when patients are well informed and play a significant role in deciding how they are going to treat or manage their health conditions…patients feel better about the decision process. Their decisions are more likely to match up with their preferences, values and concerns. These patients are more likely to stick with the regimens the treatment requires, and they often end up rating their health after treatment as better."
bWell International is another example of a company providing decision support tools and specialty coaching to help people choose a health plan, select medical treatment options, and even improve their health lifestyle skills.
"Effective health coaching includes risk factor identification and well-being planning that is highly personalized and customized to the individual consumer," says Phil Micali, founder and CEO of bWell.
Similar consumer support services are available through other new companies such as Consumer's Medical Resource.
One-on-one medical care management has been proven effective, especially for patients with chronic illness. One of the most successful is a diabetes care management program known as the Asheville Project, a collaboration between the City of Asheville, North Carolina, and the American Pharmacists Association (APhA) Foundation.
Employees of the City of Asheville with diabetes were enrolled in a program that provides their medicines and diabetes testing supplies free if they agree to participate in care management classes and see their community pharmacist for a routine check-up once a month.
Many of these workers would not take time off work for a routine visit with their physician, and problems often festered until they became serious. For those enrolled in the Asheville Project, a visit to their pharmacist on their own time detected potential problems earlier, and patients experienced fewer complications leading to emergency room visits and hospitalizations.
The program proves the power of engaging consumers as partners in managing their health care. Patients are healthier, they have gained new skills in caring for themselves and their illnesses, and their employer is saving money through lower health costs. Organizers attribute much of the success to the one-on-one attention of the program.
The Asheville Project is now being expanded to a number of other disease categories, such as asthma, hypertension, and hyperlipidemia (very high cholesterol), and to at least 12 other communities around the country.
Health advisors also have an important role in public programs. For example, many senior citizens have found it essential to have help in navigating the choices available through the new Medicare Part D prescription drug benefit.
The Centers for Medicare and Medicaid Services has offered its own consultants through 1-800-Medicare and through decision-making tools at www.medicare.gov.
But a number of other advisory groups have emerged as well. Groups like LIFE Senior Services, a private non-profit group, which offers advice at seminars and enrollment clinics in Tulsa, Oklahoma, for Part D. LIFE counselors will spend as long as it takes with seniors to help them make their decisions about the best plan. There are similar organizations in most cities in the country.
State governments also have partnered with pharmaceutical companies to provide enhanced care management for patients on Medicaid, proving again that involving health coaches and case managers can improve the quality of care, improve patient outcomes, and still save money.
Throughout the new information economy, health advisors will help people make better health-care and health-spending decisions.
Donald Kemper, chairman and CEO of Healthwise in Boise, Idaho, has worked for years to help people understand the crucial importance of "information therapy" as a vital and integral part of medical care. He says that writing prescriptions and ordering surgery or chemotherapy must be accompanied by high-quality information for the patient in a clear and understandable format.
Kemper argues: "Empirical research suggests that appropriately prescribed, decision-focused, evidence-based health information empowers consumers, enabling them to participate as active partners in their own care and improve their health outcomes."
Quality and price data are also coming from thousands of sources. The Colorado-based Health Grades Inc. launched a service this year that allows consumers to research the average costs of 55 hospital procedures. The company says it is the "Kelly Blue Book" of health care, referring to the popular automobile buyers price guide.
For $7.95, Health Grades will provide consumers a breakdown of average prices for certain procedures on a regional basis. Gastric bypass surgery, for example, would cost a patient without insurance an average of $34,379 in California and about half that if they belong to a health plan with a negotiated discount.
WebMD offers price and quality reports through large employers and insurance companies. And Aetna, which insures nearly 15 million people, last summer began providing members information on prices for about 600 medical procedures in the Midwest.
At the turn of the last century, the challenge for medical science was to combat infectious disease. At the turn of this century, the challenge is to find new and creative ways to combat the health problems associated with modern lifestyles ? sedentariness, poor diet, tobacco use, and the abuse of drugs and alcohol.
Clearly, this challenge requires a different approach. Researchers are unlikely to find a cure in a test tube or culture dish. But we are much more likely to find solutions through new incentives that encourage people to take an active role in improving their health and making better lifestyle choices.
The evidence suggests that they are not going to meet that challenge on their own. Several health plans already have instituted successful programs to help. Destiny Health's Vitality Program and Lumenos? consumer driven programs are models in providing patients with information and support to make better decisions about their health.
The Wall Street Journal recently reported on the success of a consumer-directed health plan that has been underway for years in South Africa. The company, Discovery Health, combines a health spending account, high-deductible insurance, and an incentives program for healthy living.
Members can collect points for things like quitting smoking, getting a flu shot, or exercising, and they can redeem the points to get discounts on travel, movie tickets, and electronics. The company found that members age 50 to 54 who were actively working to earn wellness points saw their health spending decrease even as they aged. People under age 60 with chronic conditions achieved elite status in the points program at a slightly higher rate than those who are healthy. Discovery's U.S. subsidiary, Destiny Health, mirrors the South African experience in the success of its Vitality rewards program in the states.
Another consumer-directed health care company, Lumenos, recently purchased by WellPoint, gives consumers control over routine health spending through a funded account. In addition, the plans offer health improvement strategies that feature personalized services like health coaches and access to a wide array of online health tools.
Consumers are rewarded for three critical decisions known to be associated with better health outcomes: Understanding their health through completion of an online health profile, enrollment in a personalized health coaching program, and graduation from a tailored health management program.
The marketplace will soon be filled with countless options for people to become smarter consumers of health care. And new companies and entities will aggregate and translate this data to become branded sources of reliable, quality information. A new discipline of medical professionals is likely to emerge — the health advisor — to help people seeking one-on-one advice.
The need for Information can be solved by an information economy. Technology will allow that information to be accessed instantly at little or no cost. Patients will get smarter, and they will force the health care economy to become more efficient and more patient centered.
This new era is not only coming, it's here.
Grace-Marie Turner is president of the Galen Institute, a public policy research organization in Alexandria, VA, that focuses on market-based health policy ideas.