• Reflecting on the healthcare system while waiting at the hospital for a loved one

    Posted over 5 years ago
    by pnblog}

    Often when we talk about healthcare reform, it can be a rather abstract discussion -- you watch some tv show with ‘experts’ reflecting on some 20 page bill or hashing through the merits of a public insurance option.  Last week, however, all the intellectual and abstract ideas were brought into something very personal for me and my family.  

     

    My wife had a Hysterectomy, and I spent three days at Swedish hospital in Seattle caring for her.  With all the waiting time, it was hard not to reflect on the experience and think about it in the context of health reform.  I’m happy to say that my wife is now recovering on schedule, and she’s given me permission to share the story and my insights. 

     

    Once she had decided surgery was her best option, we became even more avid information seekers; we shopped for the procedure with the best outcomes and then the surgeon with the most experience and best quality results for this procedure.  The best available counsel we found was for a Robot-Assisted Hysterectomy because there was less risk, less pain and faster recovery times vs. the alternatives.   We didn’t have to shop for ‘price’ (thanks to Microsoft’s benefit plan, but that is a different future post)…but even if that were the case, we probably would have chosen a more ‘expensive’ option if it meant less risk and more productive days -- getting back to normal life as quickly as possible. 

     

    We all know that surgery can be pretty scary.   Throughout the experience, everyone from the doctor’s office to the staff at Swedish helped to make the experience a positive one, allaying any fears and making us feel comfortable and confident.  We often forget that healthcare is truly a people business.  In just three days – the number of different people we dealt with was amazing -- five docs, seven nurses plus the ancillary folks (lab techs, transport and other helpers).  They all took time to connect with our emotions while doing their jobs.  

     

    Swedish is leveraging technology to improve their systems.  You see it throughout the organization, starting in the lobby, with signs advertising the hospital’s new EMR system.  During the course of our stay, when there was time I asked various staff members about their experience with the new EMR, and they were positive about the system because they had all the information in one place.  While a common complaint was that the data entry took them more time, they felt overall it made them more productive and effective.

     

    This highlights that we need to remember that technology is a means to an end.  It is NOT the introduction of technology that will make a difference, but rather how leadership leverages the right technology to make a difference…in both quality results and economic outcomes. 

     

    I also saw a real focus on patient safety, starting with the pre-op processes.  Each member of the care team carefully checked her arm band, her chart and asked several specific questions to be sure she was getting the right action.  For us, the repetition became frustrating, but if this process were to improve patient safety, then it would be  worth it.  Despite the technology investments, the core safety process was in the human factors.

     

    After the surgery was completed, she spent two days recovering in the hospital.  This was a day longer than originally planned due to very low blood pressure and a declining hematocrit.  While I used the guest Wi-Fi for work and email, it was even more critical for answering key questions about her condition, the trade-offs, the next steps – which helped me to get some context and understanding to a) engage more thoughtfully with the care team about questions/choices and b) assure my wife about what was going on during the long time periods when neither doctor or nurse was around.  I think hospitals should consider leveraging their video and wireless infrastructure more effectively for patient specific education and connecting with their care teams.  This is potentially a big opportunity for improved patient compliance and care team coordination.

     

    Because the low blood pressure persisted, I called her primary care physician to get her baseline BP.  If we had stored this information in HealthVault, I wouldn’t have had to make the call – I would have just been able to look it up.  Furthermore, I would have preferred to have gotten her discharge information automatically transferred to HealthVault.  We were given paper copies.  This should be easier.     

     

    So, what’s the moral of this story? 

     

    ·         We can’t lose sight of innovation and there’s a risk that could happen if the government were to become the primary funder of health. 

    ·         Technology is a means to an end, but we have a long way to go to figure out how to use it smartly.

    ·         We can’t lose sight of how important the personal aspect of healthcare is.  The emotional support and human caring delivered by the care team was the critical component of our overall satisfaction. 

     

    This experience reinforced for me that a ‘healthy’ health ecosystem requires consumer choice -- it is a critical component to the effective functioning of markets and innovation.  We made the decision to ‘save time/hassle’ vs. saving dollars as we do in other aspects of our lives.  This really drove home for me that the debate about ‘rising health care costs’ doesn’t really account for improved patient outcomes in terms of fewer lost days of work/productive living.  I am all for comparative effectiveness of various options and knowing what things cost, but it needs to include patient values -- like less pain and getting back to normal faster -- or it may lead to bad unintended consequences.  I am more concerned than ever that increased government financing of health will ultimately lead to fewer consumer choices and will stifle future innovation with tangible economic benefits.

     

    I haven’t received the multiple confusing bills and outrageous line items of detail from the hospital stay yet.  Nonetheless, when it comes to getting a quality outcome from an advanced surgical procedure, I prefer the current U.S. health system with all its flaws to the alternative future of less consumer choice and innovation.

  • Empowering Consumers

    Posted over 5 years ago
    by pnblog}

    So this week’s question from the Washington Post RX Blog was:

     

    In the Baucus bill, insurers would pay a tax on the value above $8,000 for an individual policy and $21,000 for a family plan. What do you think of Sen. Baucus' proposal to impose a 35 percent tax on "Cadillac" health insurance plans?

    My response is below.

     

    We should have faith in consumers to make the right choices for their health -- only then will we reduce costs, expand coverage and drive value.

     

    The motivation driving this tax is that health insurance plans (Cadillac or not) are another form of compensation -- something your employer provides for you with pre-tax dollars versus your paying yourself with after-tax dollars. The employer's ability to use pre-tax dollars creates a misalignment. Rather than tax a small percent of plans, it would seem better to correct the core problem. Until consumers are educated and empowered about how their health-care dollars -- both pre-tax and post-tax -- are spent, real reform won't happen.

     

    One of the big snags in reform conversations is the idea that employment and health insurance are inextricably linked. Health insurance should be portable so that it can be taken from one job to the next and will cover you when you're temporarily unemployed. Labor mobility is one of the underlying strengths of the U.S. economic system, and health benefits connected to employment unnecessarily weakens labor mobility.

     

    Moreover, the concept of health insurance should be more focused on 'major medical' needs like other insurance where you pay into a system to prepare for a catastrophe. But the norm of the current system is first dollar coverage which pays for every routine procedure. The fact that employers can use pre-tax dollars and ostensibly provide greater benefits for each dollar spent has led to this situation. This has driven up total health costs through misaligned incentives, extra administrative costs and limited provider innovation (e.g. packaging of services to meet routine needs). If there were a consumer-driven market, consumers would understand how their dollars are spent and there would be a more innovative insurance market.

     

    The Wyden-Bennett Act provides this foundation. Consumers would receive cash from their employers equivalent to what the employer spends on health insurance. They'd have the option to buy the insurance they considered most appropriate, based upon need and determined by behaviors, through a health insurance exchange, which would be regulated by the government and encourage insurers to compete for their business.

     

    Consumers make health choices every day, so why shouldn't they decide the coverage they need and the amount they will pay for it? People don't need the government to help them pick their car insurance.

    Let's give people the right information to make the right decisions.

     

  • In the Health Reform Recipe, the Missing Ingredient Is the Consumer

    Posted over 5 years ago
    by pnblog}

    So this week’s question from the Washington Post RX Blog was:

    What's Your Take On Obama's Speech?  What did you think of President Barack Obama's Sept. 9 speech to a joint session of Congress? Was it effective? Did it "move the needle?"

    My response is below.

     

    I applaud the administration for shining a bright light on health reform. The government -- as buyer, regulator and leader -- must be a part of any solution. The political calculus has created a real sense of urgency to do something about this complex system which touches everyone and accounts for one sixth of our economy. The consequence however, through a lack of transparency and understanding, has reduced the public dialogue to be between "public insurance options" vs. "death panels." Framing the debate this way and consuming available public attention on "wedge" issues won't lead to a sustainable future system.

    My attendance at an Institute of Medicine workshop this week in the midst of the buzz about the speech served as a stark reminder about the depth and breadth of the hard problems:

    • Access (too many uninsured)
    • Costs (growing faster than inflation)
    • Demographics (aging populations driving up systemic costs)
    • Quality (not enough -- as measured by comparative outcomes, disparity in care geographically)
    • Worsening health (people dying because of a lack of focus on improving the care delivery process).

    I was struck by the number of smart, passionate people representing the major stakeholders working together to drive change. Veterans of the process recognize that change is imperative but hard -- because the details matter. We are in this predicament because incentives, tax policies, government reimbursement schemes and increasing specialization and capability of medicine have led us here.

    The president delivered an inspirational speech, laying out basic principles: everyone should have access, nobody with insurance will have to change it and cost growth must be slowed. Voters know there is no free lunch, and health is no different.

    We can't achieve reform without educating the public. A sustainable system is not as simple as providing more access. Consumers are ultimately responsible for their health and their daily choices cost the system. We need to help them engage in their health differently, be wiser purchasers, and understand trade-offs. As long as they believe the price of care is their co-pay and continue to engage as they have, there won't be sustainable reform.

    There are best practices at organizations like Geisinger that have re-invented care delivery and consumer engagement models. These leaders will tell you that success is about aligning incentives, understanding the details and making trade-offs.

    The difficult work of figuring out the details and making hard choices is still ahead.