The Patient Dilemma

March 6, 2019

 

Taking care of one’s health is neither easy nor fun, is confusing and frustrating and may be driving up healthcare costs more than anything else. Health plans raise their prices to keep up with a sicklier America and health systems continue to invest in greater efficiencies and ways to improve health outcomes in order to increase margins to make ends meet. While each work continuously using various approaches and structures to improve and ensure their critical viability there is little end in sight of things becoming better.

So, while I’m the first to agree that improvements can be made in both the private and public sector, we should take a closer look at “The Patient Dilemma.” Those of us in the industry find the complexities and the ever-changing regulations costly and expensive to keep up with and employ tens of thousands to understand the latest government regulation or the value of the newest technology to hit the market this week. If the healthcare industry is having a hard time keeping up, how can we expect patients to navigate the system? The unfortunate consequence is that a large number of Americans decide not to enter into the medical “maze of the unknown” –that is until their condition becomes so intolerable and hence far costlier than if they attended to it in the first place that they resort to whatever care they can find, usually an ER, the most expensive place to seek care.

This is not a means issue. People of all income brackets have issues with their health and desire for immediate answers and direction. The decreasing number of providers combined with an increasing number of patients creates a perfect storm for a lack of access to appropriate care and timely information. But even the best providers are not at fault for lacking speed of service; most simply have too large a patient load and only so much time to devote to patient communication. This exacerbated by the lack of integrated information systems further slowing the process of care.

Making matters worse, many patients have become hesitant to take early action when a medical issue arises out of fear of unknown costs, lack of knowledge regarding the nature and extent of their illness, and a scarcity of comprehensible resources to answer these basic questions. The course for many is to do nothing which often results in their condition worsening and increasing the cost of care for their condition and for all. I’m not blaming patients, but fortunately there are resources to address some of these issues, which I will explain later.

From a social perspective, the incessant pharmaceutical TV commercials promoting newly released drugs to treat various conditions aren’t helping the situation either and creating a movement of cyberchondria. Viewers reactively go online, find a symptom related to the commercial and run to their provider, only to find out they don’t suffer from the condition in the first place.  Then they get the bill.

While health plans, health systems and the government are well intended, and the private sector has every right to be profitable, the inherent conflicts of interest coupled by self- preservation are simply not helping to drive down the cost of care. New models continue to come to the market but these don’t solve the need for patient awareness of existing and preventable conditions or what to do about them until conditions worsen, co-morbidities occur, and costs rise for all.

So, what’s the answer? Like most things in life: knowledge. Today software and technology can literally place most health-related answers in the hands of the patient. Intelligent screening questionnaires followed by personalized responses that guide the patient to take action are becoming more readily available. Comprehensive health management tools not only provide answers, direction and transparency for patients, they relieve the stress and anxiety of not knowing what to do.  Further, some of the newest platforms also provide predictive analytical models for employers, health plans and health systems to better understand future costs of their employee, member and patient populations. And now, for the first time there exists technology that creates prescriptive paths forward for stakeholders to take action before issues arise or worsen. And when it’s backed by behavioral economics and behavior change principles, it addresses the unique needs of individuals to motivate and nudge them just the right way to drive sustainable health change. The intended result is to maximize health for all, lower costs and improve patient satisfaction.

Patients will do the right thing if they know what to do, learn how to do it and be reminded when to do it. Not knowing what one doesn’t know is not a cure but rather a curse that can now be avoided through consumer friendly, and thus patient friendly technology.