This post may end up being a hot mess of disparate items never strung together like 10mm Mikimoto pearls. Consider that my black box warning.
Carolyn McClanahan a contributor to Forbes, physician, and financial planner published a column yesterday “The Problem With Patients In Controlling Health Care Costs”. Her column is drawn from a larger article in Health Affairs by Rosanna Sommers, et. al. Focus Groups Highlight That Many Patients Object To Clinicians’ Focusing On Costs. I am going to get Sommers article (it’s behind a damn paywall) and take a long look at that. But for now I want to speak to the larger issue that troubles me and perhaps others regarding what McClanahan presented. There are four primary challenges we face in trying to fix healthcare cost in the US that came out of these focus groups in the Health Affairs article.
They are:
- Patients only want the best: Patients see the more expensive the treatment the better. And if the patient is not paying for it (i.e. insurance, Medicare, etc.) they want what they want no matter what the cost. I wonder how often the family is driving that message?
- Reluctance to make trade offs between health and money: As McClanahan states ‘poor health creates poor finances’. People need to connect their health with their finanical health and plan for that illness or injury which is just down the road. Wellness and prevention is key. But in the focus groups they are not seeing that.
- Lack of interest in cost others pay: People feel they didn’t cause the crisis in healthcare so it’s not their problem. These focus groups just wanted to get what they could since it was costing a large corporation and not them.
- Noncooperative Behavior: Those in the focus groups felt personal interests won over the good of all. Why should they care if no one else is caring about cost.
These are only focus groups yet their opinions are on the depressing side of reality. I need to buy the article to see the make up of the groups, age, gender, economic status, etc. But even without that data this is troubling on many levels. It speaks to the larger issue, there are a group of people, not a subset, who seemlying ignores or doesn’t care about issues well within their capicity that can drive down the cost curve on healthcare and improve outcomes.
McClanahan presents three solutions that are helping to drive costs down while maintaining and improving outcomes.
- Palliative Care Movement which I have written quite a bit about here and other places.
- The Choosing Wisely is a movement and report that is trying to educate physicians and patients about unnecessary tests and treatments. There are 35 speciality societies that have identified many procedures and treatments are not effective. Their hope is to reduce how frequently patients ask for unnecessary care and aid physicians in turning these requests down.
- The National Institute for Health and Clinical Excellence (NICE) this is a program from the United Kingdom which brings cost into coverage decisions showing what the best care for the cost is.
Okay that is the article. I plan on getting the full article from Health Affairs and do a deep dive. But I am scratching my head. I just looked at “Twitter in Healthcare” from the Institute for Health. 66% of internet users looked for information about a specific disease. WebMD top five conditition are shingles, gallbladder, gout, hemorhiods and lupus. 56% of WebMD users sought information about pain relievers, anti-depressants, HTN medication, and hysterectomy. The percent of total internet users looking for medical information online were 24% drug safety and recalls, 14% memory loss, dementia or Alzheimer’s and 17% for chronic pain.
On one hand we have a group of people who are cost deaf and appear to be selfish. On another hand we have learners activly seeking knowledge about healthcare problems they want to solve. And on our third hand we have a small but highly active group of people seeking to expand and grow social media in healthcare. These groups overlap but I am not sure there is data that tells us what segment of the cost haters are seeking information about shingles and what is their motivation in learning. Do we know what the social media healthcare cognisenti do that is driving cost haters with shingles to use the internet to learn? These are gaps that we have that are impeeding our ability to apply social media tactics to healthcare strategies.
One final observation to add:
This guy tells me he is all for gay marriage but really just wants to get on @BuzzFeed http://t.co/HqpvtZvIpy
The above is from the NYT blog of SCOTUS coverage on the DOMA case. I think this speaks to a larger trend where we (the editorial we) are motivated by our online life to ‘get on Buzz Feed’ or to just do something to advance our ‘brand’. We are abdicating control of knowledge and information to companies who have financial goals and not outcomes and patient care goals. This will only grow as time moves forward. If we are off one degree today, in five years it will be 20 degrees. Are we leveraging social media for self-exposure at the expense of improved patient care? Perhaps all these little pieces are being put into place like mosaics and soon it will be a Gaudi Cathedral. Or is this what one person does here benefits someone over there. A butterfly flaps its wings in China and someone sneezes in Cleveland. My small post becomes an idea for Mayo Clinic. Only time will tell.