Consumerism in Healthcare: The Roles of Hope & Cynicism

Three days ago on Twitter, @dweilage, aka Drew Weilage (Our Own System) and I were tweeting about the roles of hope and cynicism in healthcare.

As 'younger' healthcare bloggers, both of us are concerned about burning out. We're choosing a career in an industry one of my graduate school contacts compared to a "donor wagon." We've all heard the sinking ship analogies.

One of the best places at a conference to listen for the 'real scoop' behind the scenes is in bathrooms. If you've never tried it, I highly recommend keeping an ear out during the coffee break rush.

Earlier this week at the Center for Information Therapy's Wired event, two healthcare execs were discussing whether or not they'd "bail out" before retirement (in the bathroom). Many of us enrolled in MHA/MHSA programs (Master of Health Administration, Master of Health Systems Administration) are asking ourselves if we should head for greener pastures and pursue MBAs.

Health management and administration students/early careerists blogging are, in some ways, almost worse off than the formerly warm-and-fuzzy-help-all-humanity type med students whose tailspin into despair we read live online.

You think people hate insurance agents? Lawyers? Try mentioning to anyone in the medical community you want to get your hands on a hospital and run the hell out of it. First, they doubt your mental acuity. Second, they doubt your management skills.

I can't tell you how many times I've had people tell me to "forget healthcare" and go into a more innovative sector with a rosier outlook. One COO of a children's hospital in California who had a Fortune 500 background said he'd probably leave the healthcare field at the end of his 3 year contract. There were "too many moving parts" with "no common goal" at his hospital.

My advice if you're in healthcare administration: Learn to duck and run or learn to turn the conversation quickly to more neutral territory, like, say the Olympics in China. Better yet, light some fires. Get things moving. Connect the people interested in "what's next."

People are charged up about the state of our healthcare system, and seems like everyone's got a good/bad hospital story. Once you mention you're studying/working in healthcare management, you'll hear tales of angels and demons. The good news is, both kinds of narrative teach us what we're really getting into here...and what we might be able to do about it.

I can't tell you how many times I've had people tell me to "forget healthcare" and go into a more innovative sector with a rosier outlook.

The thing is, I want a rosy outlook for our hospitals.

I want to see them working on entrepreneurial R&D ventures. I want to see them looking harder at business models that may improve efficacy and empathy in care delivery. I want to help them source the most innovative communication methods out there - the ones that would influence me to take a second look.

Although the medical blogosphere is rife with cathartic venting about the state of our healthcare delivery system, what these postings often lack is a sense of almost painful, naive optimism, a glass half full look at where we *could* steer the system if we pour hearts, minds, and dollars into the damn thing.

As my sister prepares for the birth of her baby, I'm finding the impetus to look at both reasons for hope (hello rose-colored glasses) and reasons to be cynical.

Today, let's take a look at consumer-centric care from both the optimistic and pessimistic perspectives. What reasons do we have for hope? What reasons do we have to be cynical?

Reasons for Hope:

  • Consumers want the next president to prioritize HIT. I say again, CONSUMERS WANT CONSUMER-CENTRIC HEALTHCARE, and improved access. More than half of us. Probably more like the "Middle 80"% of us...at least in Maryland.
  • Double-edged Sword: Privacy concerns shouldn't hold us back. Your healthcare data is no safer in the hospital, stored on a laptop (computer-based or OS based as opposed to web-based like in a PHR), or, even on backup tapes in a contractor's car. We need better privacy protection in healthcare in general, whether we choose to store personal health data online or on the back of a Better Homes and Gardens magazine.
  • "As the industry shifts from a wholesale to a retail model, a new market of consumers is demanding clearer information and personalized support. A company that pays careful attention to their needs, desires, and habits stands to gain a significant advantage over its competitors in this quickly burgeoning market." - McKinsey Quarterly "What Consumers Want in Healthcare"
  • Talking to patients about delays in the ER is a primary method to achieve higher patient satisfaction scores. Good news because 1. it requires staff to talk to patients! about wait times! and they may ask other questions! and 2. it means an evolution towards care that takes subjective experience measures into account ("empathy" rather than just clinical excellence, or "efficiency" of care).
  • Hospitals want to begin weaning themselves off Medicare, who is "a lousy payor." This opens the door to strategic innovations that depend less on guaranteed payments from CMS and more on payments from consumers. New 'Starbucks of primary care models' accept cash or charge, like the "cash up front" subscription model employed by Jay Parkinson's Hello Health.
  • Some hospitals are using mystery shoppers, or "undercover patients." This means groups like the AMA are beginning to consider the 'empathic' component of medicine, the subjective side of care delivery that consists of a patient's experience.
  • The double-edged sword: Sometimes consumers want to be involved participatory partners in care and sometimes we just don't want to know. Case in point: Cancer care and 'end of life' conversations with oncologists. The good news is that the mainstream press is covering this at all...which is vital because "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone."
  • CCHIT convenes a PHR task force and workgroup. Unfortunately, as e-Patient Dave points out, both groups lack an e-Patient (chalk another one up to dual placement on the "Reasons for Cynicism" list).
Reasons for Cynicism:
  • Our payment system sucks. Until we incentivize physicians for care rather than volume, we won't succeed in providing consumer-centric care that 1. the consumer wants and 2. the doc is paid to deliver.
  • Misinformation abounds. Motivations are hidden. Questionable coverage is out there. But in a transparent marketplace, consumers figure out pretty quickly who the charlatans are...we show trust by opening (or closing) our wallets. Unfortunately, very few people can tell us how much healthcare will cost us, even on a per episode basis.
  • Patients rarely use online ratings to pick physicians. However, this could also be due to a lack of physician participation and an amalgam of smaller sites without a clear leader (functionality, design, community strength), such as the "TripAdvisor" of doc rating sites.
The end result of this research: Make up your own mind. Do you choose to examine "what's next" in healthcare from the perspective of an optimist, a cynic, or both?

We need both. To reenvervate American healthcare we need people looking at what's possible, as well as what's probable. The only question is, how are you feeling today? Glass half full, or glass half empty?

No comments: