Consumer Focused Health

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.

However, it was also pretty clear that the physician had about 7 minutes to spend with me, and he wasn’t about to stop to provide significant lifestyle or preventive counseling or make a real connection with me as a person. I would have had to interrupt his flow to get him to do more than a preliminary scan (listen to heart/lungs, assess basic risk factors from history while giving obviously canned spiel). This was very different than the full morning executive health exam (costing ~$1500) I had experienced the year before thanks to my employer.

Overall, I got what I wanted, a set of basic blood tests to check for cholesterol.

Here’s where the shift to HSA really kicked in– and where its clear that existing organizations don’t have a clue vis a vis transparency.

My doc initially recommended a full workup panel– thyroids, STDs, diabetes markers, kidney tests, CBC,etc. On hearing that I thought I had to pay for the labs with my plan, he had 2 reactions:

1. I don’t know much about this business stuff, but I have no idea how much the labs cost (and hopefully that lab downstairs does),
2. Why don’t we just cut the labs down to a CBC, BUN/creatinine, and cholesterol panel?

So we can see immediately that you still don’t have a strong push for transparency even where an organization clearly has access to all the data (as they are partnered exclusively with salaried providers). Even then, it is clear that physicians don’t believe that many of these tests are valued by patients–very small amounts of pushback significantly reduce the diagnostics ordered–this makes you wonder why they were ordered in the first place. (Dr Wes has an interesting commentary on the lost art of using a differential diagnosis before bringing in the diagnostic artillery–thanks to Kevin MD for the link).

As we can see, even a physician who spends a lot of time thinking about consumerism ended up making off-the-cuff decisions about a medical visit due to a complete lack of information about pricing trade-offs against expected benefits. It was also clear that my physician (and most that I have encountered) have little interest in patients perceived to be “not sick” and that our healthcare system focuses on addressing sickness rather than optimizing health (I clearly could stand to lose a few pounds–but Kaiser won’t save any money by enrolling me in any programs).

Thoughts?