My mother trusts her doctor. My father is an internist and he recommended most of them. When he chose a plastic surgeon for her knee replacement, I also called and asked a lot of questions before signing. She is fortunate not to have to study the provider data, because she asked us to convert the data into trust in advance.
Information will set you free. This is the mantra of the National Healthcare Transparency Movement, which provides people with data to make informed choices about the quality and cost of care. The intention is correct-access to information is an important first step in enabling consumers to control their healthcare journey. However, there is a second step—understanding—which is essential to enable them to make judgments about choosing appropriate care. Data access is good, but if the patient does not know the meaning of the information, it is of no value. Every patient may be triggered to respond when they receive data: “I don’t understand.” Who can blame them?
The challenges of American healthcare are not clinical, but structural. The appropriate solution to meet people’s healthcare needs exists somewhere. However, although we have successfully developed complex medical interventions (advanced surgery, diagnostics and equipment, life-saving drugs), we have failed in the basic aspects: integrating patients, providers, employers and other payers, who are often Isolated in information islands so that they can work together. When patients are faced with who they can trust to perform shoulder surgery, or if this situation can be better treated with physical therapy, they need resources for informed shopping and analysis. Creating connectivity is the key to restoring the healthcare model by turning it from word of mouth to guiding information, putting patients at the center of the decision-making process.
Recent efforts to correct the model — from commercial navigation platforms and public entities such as CMS — have begun to break down silos and provide quality and cost data. The assumption is that if you put healthcare data in front of individuals, they will know what to do with it. However, so far, these measures have failed to produce the expected impact of changing behavior. The challenge lies in the data itself-it can be so dense that it becomes impenetrable, and its objectivity is questionable. Cost breakdowns are difficult to understand because they are usually presented in abstract forms that have little to do with the patient experience. Supplier quality is equally difficult to explain. Although many indicators have been introduced (this is why the STAR rating exists, and many suppliers have joined in trying to quantify the meaning of quality), the source’s self-interest may affect its value. For example, the premise of a healthcare plan that provides provider network services is that everyone in the network is a viable choice, and all providers are equal. Patients know that this is not the case, but even if they have the information, consumers are still lost in the medical desert, unable to make better choices than before. What else can be done to provide data to patients in a way that helps them on the right path?
We know where the problem is. The solution is human. When the solution for choosing appropriate care in complex systems is buried deeper, navigation providers mostly just skip the surface—helping patients resolve claims or make appointments for doctors. Tactical help is welcome, but a more transformative approach must be taken. Third-party platforms can — and must — play a key role by providing patients with a hybrid approach of software, data science, and human healthcare guidelines. The behind-the-scenes solution requires well-trained professionals who have clinical knowledge and analytical expertise to interpret data and provide information to help members get out of the desert—providing the kind of wise guidance that my mother received and expanding across the country. The quality and cost of the analysis provider is important, but it is also about supporting the discussion of different treatment options and ensuring that patients feel seen and heard by their clinical team.
This is a heavy burden.
Currently, despite the surge in technology companies entering the healthcare field, no one can provide the necessary information and explanation, a combination of learning and guidance. Early in my career, I led a focus group at a Fortune 50 Silicon Valley company, talking to employees who had received cancer treatment or cared for cancer treatment. They are very smart and data-savvy people. They managed to integrate all kinds of information, from survival curves and clinical trial studies to medical records, doctor notes and insurance policies. With all this data, the biggest gain is that they are more confused and unsure of how to interpret it to make a decision. What they want is someone to help them find a signal in the noise and hold their hand when they do.
Historically, healthcare data and analysis were controlled to create a seller’s market (suppliers, hospitals, pharmacies, payers) rather than a buyer’s (employer, member) market. We can create a new model that allows buyers to obtain information and a reliable and safe space to ask questions and set goals. Data can liberate patients, but as a healthcare system, we need to recognize the extra steps necessary to convince them of its value. This happens only when the patient can say “I understand”.
Photo: LumineImages, Getty Images
