When a doctor diagnosed me with a knee condition 10 years ago and recommended surgery, I went home and searched online to find information about the problem, its symptoms, and steps I could take to stop the constant pain I was feeling. As I'm sure anyone would guess, the amount of information available to me with just one quick Google search was immense. So why did I still feel confused and overwhelmed?
Because none of this information specifically related to me. I couldn't figure out exactly which treatment step I should take first, how much it would cost, or even whether there were any alternative options available. I knew I could have gone back to my doctor with these questions, but he was strongly in favor of surgery, whereas I wanted to postpone going under the knife as long as I absolutely could. I felt lost in the healthcare system and didn't know where to turn.
Unfortunately, my experience isn't unique, particularly because healthcare consumers as a whole aren't an informed bunch. A recent Deloitte survey revealed that 76 percent of surveyed consumers felt they did not have a strong understanding for how the healthcare system works. This lack of awareness--especially to discern appropriate care and the associated costs of a particular condition--leads to increased and unnecessary utilization and exorbitant costs.
Fortunately, this mountain of a problem can be reduced to a molehill if insurers act the teacher and educate their members with tools explaining a person's specific treatment options, evidence associated with available choices, and costs for those choices.
"There's lots of healthcare information out there, but very little is useful," Paul Keckley, executive director of the Deloitte Center for Health Solutions, told me. Until health plans start offering customizable healthcare information that empowers consumers and drives their medical decisions, "we will continue to have an uninformed, uninvolved patient-driven system," he said.
"The good news is that consumers have an increased sensitivity to healthcare costs, so it forces them to consider how they use the healthcare system," Keckley noted, referring to the survey's findings that economic uncertainty has altered consumers' healthcare spending habits. This will help payers chip away at the "provider advantage," which he described as the consumers' view of doctors as the sole provider of healthcare information.
"Consumers can put a face to a doctor and a mental image to a hospital, but health plans are just something on the other end of the telephone," Keckley said. And that phone conversation almost always happens only when there's a problem with a consumer's health bill. Educating consumers, and improving their image to boot, means that insurers must take a "segmented approach to the market instead of their current one-size-fits-all model," Keckley said. "This will help avoid inappropriate, non-evidence-based care" that drives increased costs.
For example, the most appropriate care for a 50-year old man with early-stage prostate cancer is very different than for a man in his 70s with the same condition. In each case, an insurer could provide information based on the individual man's health status, products and services available under his specific plan, and costs for those products and services. This will allow each patient to make informed clinical decisions based on appropriateness of care.
In the 10 years since my experience, I've become quite adept at navigating my own path toward healthfulness, including consulting with multiple doctors about an issue, questioning my insurance company about coverage options, and seeking out alternative options. But it takes a lot of work and knowledge about the many intricacies of our healthcare system. If such a personalized tool was available to me back then, I probably could have avoided years of doctor visits, multiple rounds of physical therapy, and one unnecessary surgery. That would have been a positive outcome for all. - Dina