Saturday, December 23, 2006

clinical innovation, bottomup websites for transparency, Twenty Clinical Innovations to Build Patient-Doctor Trust: Tenth in a Series

“Tis The Season

The end-of-year holidays is the season for fierce fearless forecasting for next year.

Speaking of fierce forecasting, it is fitting that Fierce Health Care, a notable and quotable health care newsletter, has come out with its top five trend predictions for 2007.

1. Transparency takes center stage

“During 2006, employers, managed care plans, trade groups, state governments and federal agencies took a new and aggressive role in bringing pricing and outcomes data to the public, in many cases by posting aggregate hospital and physician data to publicly-accessible websites.”

This is a “top-down” forecast. It foretells those who pay will demand transparency from those who deliver care. Givers of care will have to cough up data to justify what they charge. Anybody with a transparent crystal ball knows much of this data will be transmitted via “publicly-accessible websites.”

One set of “bottom-up” websites not mentioned are physician practice websites. These are in the rise. No one knows how many doctor websites are out there, but probably 20% of doctors have websites, just as 20% have electronic health records. Medem, Inc, a San Francisco-based company supported by the AMA and seven leading specialty organizations, and other werb developers are making it easy for doctors to build these sites.

The websites are designed for transparency – how to get to the office, services offered, backgrounds of physicians, plans covered, and yes, in some case, prices charged. The idea is to market the practice by building trust through transparency expectations. Prices charged may soon become a common feature since managed care plans, led by Aetna, are already, in many sections of the country, posting physician charges on Aetna websites.

2. Universal health gains traction

“The drumbeat is getting louder: Massachusetts, Pennsylvania, Maryland, Illinois, San Francisco (and possibly California) took action on the issue of covering the uninsured this year, gaining traction for reforms that might have been shot down with comment a few years ago.”

Universal health is, of course, the quintessential top-down promise. With rising prices and turnover of control to Democrats, voices for universal health will grow shrill. Republican governors in Massachusetts and California supporting the movement will add to the clamor. But we are not there yet. There will be action at the state level but not the federal level. As I pointed out in my 2005 book Voices of Health Reform, the U.S. remains a conservative nation with deep distrust of centralized government and deeply embedded special interests. In the short and maybe even the long run, our desires for choice, competition, and enlightened consumerism may trump universalism. On the other hand, choosing between the two is not an either/or proposition.

3. Retail clinics shift care delivery assumptions

“The Minute Clinic that opened up across town may be too small and specialized to pose a direct threat to your facility…Most observers believe that the no-frills, high-convenience retail care delivery model began to have an impact on traditional providers in 2006, pushing consumers to expect cheaper, easier-to-access primary care than they were used to in the past.”

This is a superb example of “bottom-up” American entrepreneurialism and innovation at work. I commented on this at length in my December 21 blog and said, among other things, that there are signs physicians will soon get in this game. I foresee that hospitals and doctors, together and separately, will soon be opening retail clinics in local and national retail outlets, as marketing funnels to their main facilities.

4. Officials say "Prove It!" on charity care

“Over the past year, regulators kept up the pressure on voluntary hospitals to prove that they were providing a reasonable level of charity care. Not only did the IRS continue to scrutinize tax-exempt hospitals, state tax authorities and federal legislators got their licks in, too. Overall, over the past 12 months the hospital industry has taken a pounding on this issue.”

This issue is beyond my competence to comment upon, except to say the issue has been inflamed by outlandish bills by hospitals to the uninsured as a means of compensating for bad debt. These bills have aggravated the issue. This is issue is closely tied to the transparency issue, and you could look for Democrats to highlight the problem to show that they are four-square behind “reform” as a lead-in to the 2008 presidential election. Hospitals, and physicians, are likely to concentrate more on “consumer-friendly,” i.e. understandable medical bills.

5. Patients, employers choose overseas care

“If it costs $12,000 less and offers similar results, why not get your orthopedic surgery done in India? During the past year, some employers, and healthcare intermediaries like Raleigh, NC-based Indus health, have begun to encourage this line of thinking. Employers have played an important role in this trend, with some offering their employees hefty bonuses if they voluntarily agree to head overseas for expensive procedures.”

This is yet another example of a “bottom-up” revolt by consumers and the U.S. marketplace. The global marketplace and Internet accessible information are at work here. According to the National Coalition on Health Care, 500,000 Americans have gone abroad for dental care, cosmetic surgery, heart bypass, joint replacement, and other costly care. Favorite destinations are India, Thailand, Singapore, Costa Rica, and Malaysia. Bangkok’s Bumrungrad International Hospital counted 55,000 American patients. The New York Times published an article on the subject in its travel section (Jennifer Alsever, “Basking on the Beach, and Maybe on the Operating Table,” October 15. 2006), and cited these price comparisons by GlobalChoice Healthcare, in Albuquerque, coronary artery bypass, $75,536 in the United States but $11,438 in India; a $36,664 knee replacement versus $17,824 in Singapore.

A rich mix will always exist between top-down (government and big management) and bottom-up (consumers and markets) forces. There will always be thrust and counter-thrust between the two. This swing and counter-swing is a good thing. We need balancing forces.

1 comment:

Rob said...

Healthcare is not a traditional market because the consumer feedbacks can take decades to emerge.

A poor bypass operation looks like a good deal until it doesn't. How can a "consumer" know that choice's value when the result isn't immediate?

This is why treating healthcare as a free-market business isn't working. It's not a business. It's making people well and keeping them there. You can make money at it, but it is NOT a classic free market precisely because of the long lag in market information.