Consumer Focused Health

Another terrific day at the National Consumer Driven Healthcare summit in DC.

Today really seemed to bring home why CDHP appears to have stalled: it is neither for nor by consumers.

Dan Spirek from Trizetto got it right when he said “Consumers didn’t ask for consumer-driven healthcare. No one wants more financial risk”. Again we heard that consumerism isn’t about CDHP nor is it about those who are really sick and driving high cost. For consumerism to be truly effective, it needs to engage all of us in the process of choice and accountability in healthcare– and this is likely to start with ambulatory care and with significant support of the physician community. We had a more extended conversation with Dan that will be posted later.

Sara Collins from Commonwealth Fund went through quite a bit of survey data highlighting how badly CDHP performs–I found a number of their conclusions misleading, as perception doesn’t equal reality, and I didn’t find a number of the selected metrics particularly useful (I’m picky about my metrics)

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Terrific first day at the National Consumer Driven Healthcare Summit here in DC.

I attended 2 different sessions today, a mini-conference on Convenient Care (retail clinics) and the opening day of the full Consumer Driven Healthcare Summit

The moods were very different.

The Convenient Care Association had a small, but very enthusiastic group. Growth projections are enormous—from an estimated 500 or so retail clinics today to somewhere around 5-6000 clinics in the next 5 years. The conversation was around emerging business models in what appeared to be less of a Wild West than such growth expectations would lead you to expect—the atmosphere here was collaborative and determined, as the industry prepares to proactively address concerns on the part of physicians and insurers, heading off an escalation of regulatory and other challenges. We’ll have an update post on this session in subsequent posts.

The broader conference had a mood that was a bit more somber—it was clear that the first wave of CDHP had passed and wide-eyed enthusiasm about the plans and their impact has clearly been replaced by operational and policy concerns about how to bring consumerism into the broader healthcare system. Keynote speakers Jamie Robinson and Paul Ginsberg (interview will be posted soon) made it very clear that the initial wave of CDHP had passed and that the financial-only plans were not going to accomplish what early enthusiasts had claimed. To date, there has been about 5% penetration of the plans, and this has been accompanied by significant policy and consumer concerns around their ultimate impact.

What is more clear is that consumerism as a movement is here to stay, and that it is slowly permeating the broader health insurance/ payment industry. It is also clear that the movement to date has not yet reached sufficient mass to have moved the provider industry—and the provider industry is proving able to change practice approaches in response to incentives—but we have not yet changed the incentives to align provider incentives with desired provider practices. If consumerism is to succeed–and the winds of change are pushing for it– engagement of the consumer and the provider community with real incentives for appropriate change will need to be tied in seamlessly to the payment mechanisms.

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I’m flying out to the Consumer Driven Summit tonight and look forward to meeting those who reached out over the last few weeks.

I’ll be blogging about topics covered and people I come across and will have a series of interviews to be podcasted after the summit.

If others of you will be there, please reach out and introduce yourselves.

I was reading some of the letters to the NY times today and am still shaking my head about the faulty metric being used to measure the effectiveness of Medicare: low administrative cost.

Now, setting aside that the way administrative cost is measured still misses significant cost shifted to other parties (namely providers and DOJ), in theory, it still doesn’t make any sense to me.

When a chicken gets its head cut off, it also “benefits” from reduced administrative costs . Lots of activity, with no wasted sugar going up to the brain…is this the “efficiency” we want for our health system?

Similarly, the postal service “wastes” less on profit than Fedex. Yet, when you need your package to actually get there the next day (and know exactly where it is along the way), which one do you use? I thought so…

I had my first experience with my HSA plan as a patient this morning– I got a well-patient physical at Kaiser Permanente’s Long Beach office.

I do have to say that it was fast– I was in a little before 9 and out by 9:40, including check-in, doctor visit, and labs.

As I have mentioned before, my Kaiser premiums for a $3000 deductible account are significantly lower than the McKinsey COBRA– embarassingly, I can fund more than my entire family deductible from the premium difference for my own account, let alone including the premiums for my wife. This will allow me to reduce the premium even more next year, as I take a higher deductible amount.

As what did I get for a low-premium visit?

First off, everyone was friendly and they made pretty clear that I had no pressing health issues and they were aware I was a M.D.

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A recent Wall Street Journal/ Harris poll shows that consumers are supportive of separating employment status from healthcare.

Sixty-nine percent of Democrats and 55% of Republicans believe the U.S. health-care system could be improved by creating an insurance program that isn’t linked to individuals’ employers. Only 6% of those polled disagree strongly with that proposal, while 21% said they aren’t sure.

And this would seem to make sense in an era where changing jobs occurs relatively frequently, and most people are not employed by large organizations and therefore are not certain to find group coverage. As I’ve explored in a previous article, the employers providing health benefits are not doing it because they gain great benefits in optimizing the health of their employees.

However, despite the poll’s headline “Americans want leaders to address coverage for uninsured” the data within the poll shows that Americans do not care strongly about changing the system, which means that little is likely to happen when hard choices need to be made. As marketers will tell you, people who do not feel strongly about an issue are unlikely to actually push for change.

In the data presented below, it is clear that only up to ~1/3 of those responding actually felt strong agreement with any of the statements, and this is in the absence of any hard choices or trade-offs. As we’ve seen with health proposals in the last few decades, the details of those proposals are likely to drain support from different factions as compromises are made.

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As the summer comes to a close, I wanted to let my readers know that the change in seasons brings me some life changes as well– I’ll be getting married next weekend and then will be traveling to the lush island of Kauai for my honeymoon.

I’ll look forward to returning to our discussion of healthcare and consumerism when I return. Hope everybody is having a wonderful Labor Day weekend!

Any tips from those who’ve been to Kauai?