For years, industry experts have been touting the emergence of the “new healthcare consumer” — an individual who is knowledgeable, street-smart about the ins and outs of healthcare delivery, and demanding of high quality in care and services. And many in the provider community have more or less ignored such predictions. Then a funny thing happened on the way to the future: employer-purchasers, frustrated by resurgent healthcare inflation, rearranged the landscape, and began moving more and more of their employees into so-called “consumer-directed” health plans, many using health savings accounts and similar tools as funding mechanisms.
All of a sudden, consumer-patients had “skin in the game,” and began to look more closely at what healthcare services cost and what the clinical outcomes of local providers really were. At the same time, employer-purchasers and health insurers began pushing hard on providers for greater transparency.
Thus, the landscape of healthcare in 2008 already looks different from just two years ago. And pioneering hospitals, medical groups and health systems are already differentiating themselves by creating transparency in clinical outcomes dissemination and pricing information, while improving consumer-friendliness.
As we reported in our December cover story (http://www.healthcare-informatics.com/december_cover), organizations like Geisinger Health System in Danville, Pa., and Alegent Health System in Omaha, Neb., are moving forward on various fronts in this area, negating the arguments of those who say that transparency and consumer responsiveness aren't possible in the world of healthcare. Geisinger (with its ProvenCare program combining publicly guaranteed sticker prices and protocols-driven care standardization) and Alegent (with its interactive, Web-based consumer pricing tool) are proving that it can be done.
Movement is also being generated at the hospital-association level. In Wisconsin, the Madison-based Wisconsin Hospital Association (WHA) has pioneered a unique statewide hospital transparency program that involves both hospital prices for a wide range of procedures, and clinical outcomes across a broad array of clinical quality indicators. The WHA's PricePoint and CheckPoint programs are being looked at by state hospital associations across the country, as other provider groups learn how to give better information to consumers.
What's being learned from all this activity? “The key implication for the whole transparency movement is that this gives consumers information that had not been available to them prior to this,” says Dana Richardson, R.N., MHA, vice president of quality initiatives for the WHA. Over time, as more objective information about outcomes and prices is made available and becomes used by consumers, Richardson says, a shift will take place in which consumers will use more objective information and will reduce their dependence on traditional, subjective kinds of information, such as overall local reputations and personal referrals.
“The balance between objective and subjective information” — the traditional reputation- and personal referral-based kinds of information consumers have relied on to make provider choices — “will shift.”
John Haughom, M.D., agrees, though he adds that the challenges of presenting useful clinical information to consumers are turning out to be manifold. PeaceHealth, a six-hospital integrated health system based in Bellevue, Wash., with care sites in Washington, Oregon, and Alaska, has spent the last few years posting many clinical outcomes on the organization's Web site.
“The number-one challenge,” says Haughom, the health system's senior vice president, clinical quality and patient safety, “is how you take complex information for complex conditions like chronic disease, and put it into a format that can easily be used by patients. It seems like it shouldn't be all that hard, but it is.”
For example, he says, “We started with diabetes, putting key parameter information on the Web site. But patients don't understand what hemoglobin A1c is about.” Haughom and his colleagues continue to work through the process of making such data useful to consumers, even as they add new data to the mix.
Ronald Paulus, M.D., MBA, chief technology and innovation officer at Geisinger, emphasizes that the industry is still in the earliest stages of what will be a long journey. “A couple of lessons emerge from all this,” he says. “One is that consumerism means lots of different things to lots of different people. All things being equal, my view of consumerism is that you ask the consumers what they want. But a lot of people aren't doing that yet.”
Consumers, and even employer-purchasers, are just beginning to look at programs like Geisinger's ProvenCare. But healthcare policy leaders and state legislators have shown considerable interest already, he notes.
Meanwhile, trailblazing organizations will continue to be creative. At the Detroit-based Henry Ford Health System, the six-hospital, 30-clinic system's consumerism initiative is going strong, reports Pamela Landis, the system's director of Web services.
The health system's initiation of primary care e-visits has resulted in “incredibly high patient satisfaction,” she notes. And, with 700 e-visits under their collective belt after one year (spread across 200 salaried staff primary care physicians), patients have neither abused the system, nor taxed the patience of their doctors. Instead, participating physicians are expressing satisfaction with the program (for which they are paid 0.6 RVUs — relative value units — per e-visit) for its streamlining of the care process and elimination of phone tag and unnecessary repeat doctor visits.
“We're finding this has been really useful for patients with chronic illnesses.” The key learning, Landis says, is that patients have used the program wisely. “We need to give patients a lot more credit for being intelligent.”
What is inevitable, many say, is that CIOs will increasingly be asked to spend a larger percentage of their time supporting systems that, in turn, support transparency and consumer-centeredness. Completing EMR implementations, building robust yet flexible data warehouses to drive analysis and reporting, and developing tools such as patient portals and secure provider-messaging mechanisms, will all play a role in the mix. Haughom says it's clear that the decision to put clinical outcomes on the Web has been a good one for PeaceHealth's future. “Baby Boomers are going to demand that we tell them what our performance is,” he says. “We're already seeing that happening.”