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Freedom of Choice

June 1, 2006
by root
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For real consumer-directed healthcare, patients must have solid information at their fingertips.

Current thinking on the best way to reduce spiraling healthcare costs focuses on consumer-directed healthcare and the touted savings it will bring to American healthcare delivery. What many mean by consumer-directed healthcare consists of offering a range of healthcare benefit options to health plan members. Ironically, providing consumers with increased choices in plan benefit options falls short of making available to consumers what we all really want — better outcomes at an affordable price.Henry dephillips

The best way to reduce healthcare costs and empower consumer healthcare decisions is to give health plan members relevant information upon which to make informed judgments about their healthcare options.

Such information includes listing which hospitals provide particular services, the performance of hospitals, clinics and healthcare providers, and a comparison of the costs of those competing healthcare institutions and providers. In addition, individual health plan members should receive up-to-date information about their specific medical conditions and what evidence-based medicine suggests is the standard of care for the treatment of those specific conditions.

This type of helpful data should be available as part of an individual patient health record, electronically accessible to plan members, providers and payers. As a result, plan members will begin to have an accurate understanding of the quality and cost of which healthcare treatment is best for them. Having access to such information will allow plan members to make informed decisions about which treatment options provide the most value.

Information sharing among payers, providers and patients will result in the best outcomes at the lowest cost. When provided with more information and more responsibility regarding selection and payment of services, patients will choose treatment options at facilities that afford the highest quality at the best price. That's the definition of real consumer-directed healthcare.

Unfortunately, knowledgeable observers contend that increasing health plan coverage and premium options will not reduce the cost of healthcare delivery, nor make plan members feel as if their healthcare organization is doing all it can to help them make difficult healthcare decisions.

Today's collection of consumer healthcare records is a hodge-podge mixture of electronic and paper records (mostly paper). However, growing consensus recognizes three separate-but-related record parts whose integrated sum has come to define the Electronic Health Record: the Payer-based Health Record (PBHR), the Electronic Medical Record (EMR) and the Personal Health Record (PHR).

When looking at these three basic categories, you find a wealth of information in electronic format with the first, limited electronic data with the second (mostly electronic in hospitals), and almost zero electronic data with the third. Therefore, the fastest road to sharing meaningful data is to share payer-based patient health data with providers and patients at the point of care. This information is crucial to improving the quality of care delivery and providing consumers the opportunity to participate in and direct their healthcare decisions regardless of whatever benefit plan they choose.

However, there is more to it. Health plan members need help navigating the information that can be made available by documenting competitive care provider performance, competitive treatment cost and evidence-based best treatment standards for specific conditions. In short, health plan members need their health plan organizations to not just manage claims, but provide useful information to support member health decisions. Progressive, forward-thinking payers know this to be true and are already taking incremental steps to become the kind of healthcare managers their members truly want and need to benefit from real consumer-directed healthcare as we have defined it.

Who wins and who loses if real consumer-directed healthcare becomes a reality? Initial resistance on the part of healthcare providers to outcome report cards has faded as the need for and desirability of transparency has become more intense given the ubiquity of Internet and online access to information.

Resistance to the availability of competitive pricing information is also lessening due to the same technology-driven pressures for transparency. Payers willing to reassert their role as healthcare managers stand to reap the appreciation and loyalty of plan members and of corporations that are footing most of their employees' healthcare bills and are the ultimate drivers of genuine consumer-directed healthcare reform. Real consumer-directed healthcare makes us all winners who will benefit not only from reduced healthcare delivery costs but also improved outcomes and the increased affordability of healthcare delivery for everyone.

Author Information:

Henry DePhillips III, M.D., is executive vice president and chief medical officer of MEDecision, Inc., Wayne, Pa., a provider of collaborative care management.