The new “empowerment” concept is embedded in proposed and existing benefit plans across the board, from alternatives to the Affordable Care Act to employer-paid health care. In addition to health spending accounts and vouchers that result in greater share of premiums, higher deductible benefit plans shift health care shift costs to consumers. The point of these plans, say sponsors, is to make consumers make wiser health care spending decisions.
Patients Can’t Purchase Health Care Independently, Even If They Must Pay for It
The problem is this: a patient isn’t a free agent in purchasing health care.
Patients are almost always told what to do by a physician, but they have no idea what factors went into the physician’s recommendation. The physician “orders” the treatment, and the patient’s job is to comply. Especially older adult patients have learned to do as they are told.
Patients are often discouraged by the medical profession to challenge recommendations, or ask details how a treatment will benefit them in a quantifiable way. Physicians may disparage internet-savvy consumers and discount the sources of information.
Nor do patients know the full cost of the physician’s plan (sometimes the physician doesn’t either). The cost is rarely discussed between physicians and patients. Patients operate largely in the dark, without the information consumers usually have for purchases. Patients also can’t shop around. They don’t have enough of their own medical data or knowledge of where to go for additional consultation.
The Physician’s Role Will Change in Future
The economics of health care are already beginning to reshape how patients approach health care decisions, turning them into both consumers and decision makers. The national debate has politicized patients during a period in which their benefits are shrinking, cost sharing is expanding, and medical debt is rising. Consumers are becoming acutely aware of the affordability issues in health care.
Demographic changes are also dramatically changing health care attitudes and practices. Recent surveys of Millennials and Gen-Xers show individuals who are not aligned with physicians, want to make cost-conscious decisions, and want the facts.
Health care systems and providers will need to embrace consumer-friendly practices to succeed in the future. With customers that no longer have unlimited ability to afford expensive imagery or to undergo elective procedures, provider organizations will need to embrace consumer-focused strategies. The physician’s role, likewise, will become as much advisor as manager. Understanding that it is a patient’s choice to determine treatment, clinicians must define the benefits, harms, and costs of treatment options – both for full comprehension and decision by the patient.
But how do providers go about this?
How Providers Can Help Patients Make Good Health Care Choices
True patient empowerment requires that physicians put patients in the driver’s seat to make the best possible choices. Here are the five most important ways providers can make that happen:
- Share literature and studies with patients. Physicians should share research studies and literature with patients to inform them of the benefits and harms of various choices, along with other indicators supporting the recommendations. For example, patients should be aware of the rate of success for each option, including medications, and any limitations of research data.
- Supply patients with their medical record content. Physicians should provide patients all data in a secure format, or transfer it via a secure method to the patient’s preferred record storage. The data included should include images, history of visits, diagnoses, test results, and progress notes. The purpose of this data is to allow the patient to seek alternative opinions or even change providers. Providers have tended to treat this data as proprietary, but its purpose should be to help the patient.
- Inform patients about their quality measures. This helps involve patients in the process, realize what matters to their physicians, and focus on whether they are achieving their best health outcomes.
- Provide transparent pricing for diagnostic and treatment options. Demystifying charges will be essential to help patients act responsibly. While providers have distinct contracts with health plans and other payers that govern prices, it is not impossible to create pricing episodes that include facility and physician charges. Providers verify patient coverage and know the cost of care as well as patient copays. They should take the next step — aggregate costs of treatment or procedure episodes, including alternatives under consideration — for patient decision.
- Organizations should educate and assist their providers in shared decision-making initiatives to coach patients. It is a culture shift for physicians to step out of decision-making, because they are trained for action. Organizations and practices must help their physicians and other clinicians adjust to their new roles.
Theresa Hush is the CEO and Co-Founder of Roji Health Intelligence. As an expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs.