- My.Trusted.MD
- Columns
- Healthy Living
- Heart Advisor
- Surgery Insider
- Medical Imaging
- Nutrition & Life
- Skin Care & Beauty
- Wellness Report
- A Patient's Journey
- Insurance Dispatch
- Medical Bill Advisor
- Medical Marketing
- Physician EMR Review
- Practice Appraisal
- Entrepreneurship
- Medical Billing
- Healthcare PR
- New Health Leader
- Quality Advocate
- RHIO Monitor
- Hippocrates
- Personal Musings
- Bloggers
- About
- Contact
Consumerism and RHIOs: Rhetoric or Reality? Notes from CalRHIO Summit.
Featured in: Hippocrates
This post is inspired by the author's latest look at the progress of "RHIO movement", based on attending CalRHIO Summit III this week.
The title is provokative and is intended to stir up a healthy debate. After all, almost every RHIO proclaims to serve the interests of consumers. Why ask the question then?
Without a doubt consumer-friendly rhetoric is de rigueur for anyone asking for taxpayer dollars or positive press to aid RHIO fundraising. But how do we check the substance of these claims?
Let us apply our "consumerism test" ("Healthcare Consumerism: Setting the Record Straight") to CalRHIO as example:
Specifically, how is the organization meeting the requirement of "publically releasing the information relevant to facilitating the consumer choice". Let us start with reciting a few basic facts about CalRHIO:
- Members are large organizations, representing every aspect of healthcare delivery, purchase and policy-making.
- CalRHIO primary sponsors are the state's largest providers and payors (Sutter, Kaiser and Blue Cross).
- The first project (ED Linking) is focused on connecting ERs to reduce duplicate labs, a major money-loser.
- Future roadmap incorporates nearly every benefit, expected out of Health IT, but no details on how to get there.
- No agreement exists (as of now) of how to quantify Health IT benefits, let alone who will pay and who will benefit.
No doubt, CalRHIO has potential to deliver value. ED Linking project is a no-brainer. Everybody is losing money in Emergency Departments and anything that can reduce the amount of unreimbursed care should be easy for everyone to agree upon. So far so good.
But reducing liabilities is the opposite of consumerism. Would CalRHIO help profitable customers change providers and plans?
If you believe this will really happen, then I will sell you some oceanfront property in Kansas and a few bridges in Brooklyn.
OK, maybe this is a metaphor taken a bit too far, but let's look at the motivation of the CalRHIO members and more importantly sponsors. These organizations have gotten as large as they are by being fierce competitors. Do not let "non-profit" designations of some mislead you. The folks there know how to drive tough bargains.
Don Corleone taught us to "keep your friends close and your enemies closer". In that regard CalRHIO is an ideal meeting ground for competing interest groups and competitors within those groups. But let's not forget how the meetings of the "five families", "the commission" and their ilk usually ended: a bloodbath with a winner taking all.
This is already starting to happen. In trying to please every stakeholder, CalRHIO may end up pleasing none (ED Linking project aside). Stakeholder groups are realizing that the key to their future is building their own networks with no ambiguity over who is in charge. Some of these networks may call themselves RHIOs. Others may not even bother.
Silicon Valley Pay-for-Performance consortium is a great case in point. After being recruited to join a RHIO, the top Silicon Valley employers realized they might as well develop their own program and then recruit providers to compete for bonuses. Another model is led by IPAs that focus on physician bread-and-butter issues. Dr. Levin's report from Inland RHIO innaugural meeting is consistent with this theory: "The Winding Path to Health Information Exchange".
CalRHIO Summit was closed with the singing of Kumbaya (I am not making it up!). Nice song, but I think it is only taken seriously at hippie gatherings. The idea of CalRHIO as a Woodstock might not help the organization earn credibility with hard-nosed businesspeople and be entrusted with their data: the real source of competitive advantage.
So how do we net it out? Does it mean there is no future for CalRHIO and similar organizations?
Not really if instead of trying to boil the ocean they focus on tasks no one else can credibly lead: helping private networks interoperate instead of trying to build and control one themselves.
This is the idea David Brailer voiced at HIMSS. But when I asked him at the Summit how far should CalRHIO go into becoming a network operator instead of standards-setting body he gave an evasive non-answer.
These changes of heart show where "design by committee" would lead us. The future is in private networks.
email
delicious
digg
technoratiAuthor Info
Trackbacks (0)
The URI to TrackBack this entry is: http://trusted.md/trackback/7214
Comments (8)
Consumerism and Consumer-Centered Care seem to be two sides of the same coin to me, but with these two terms havings slightly different perspectives:
Consumerism: Ability to have informed choice in health & wellness universe and demanding a response to: "I want my healthcare this way" question. Consider this progression: patient => consumer => shopper
Consumer-Centered Care: Delivery (and financing) system rearranging itself around consumer in the center, implementing all the points you mentioned. Quite a few may not be visible to consumer, e.g. many patient safety measures
While the two terms may be different they are definitely interdependent. Consumerism as pressure from consumers will force the system towards Consumer Centered Care.
To put it another way, Consumer Centered Care is the ideal, and Consumerism is the mechanism that will give stakeholders the financial motivation to get there.
OK.
And then there's Consumer-Directed Healthcare, within which Health Savings Account (HSA) and high-deductible insurance plans (HDHPs) are contained.
With all this focus on the consumer, it sounds as though it's a win-win for masses and we can rest assured that our country's healthcare ills are about to cured!
Yet there is great debate about what is possible, what is hype, and what is simply market manipulation.
Steve Beller, Ph.D.
www.nhds.com
Exactly, there is too much confusion and people often compare apples and oranges. Here is my attempt to sort things out:
Consumerism: A natural desire of every consumer to have greater choice and take greater control over their healthcare decisions. This is the pent up pressure in any healthcare system, whatever the financing / delivery might be.
Consumer Centered Care: An "idealized" healthcare delivery and financing system, putting consumer in the center of focus and thus responding to Consumerism. This is mostly a theoretical construct with some clinical research to support it.
Consumer Directed Healthcare: A movement to shift healthcare financing responsiblity to consumer and thus tap into the force of Consumerism. May or may not result in Consumer Centered Care. This is ideology, hype & market games.
Hope this covers all bases.
I think all of this is a response to several problems with the healthcare marketplace:
- The way that the system separated the buyer and seller (Patient and Doctor) using a third-party payment system. When you don't care how much something costs as a patient or doctor, the cost will necessarily go up.
- The lack of accountability of physicians. It is strange that the idea of Consumers should even be called into question. Nobody would try to invent "consumer centered restaurants," or push consumerism in the food industry. These industries have always been accountable for their quality and cost to their consumers. Medicine has never been accountable for either.
- The perverse incentive the current system gives toward poorer quality. If I see more patients, I make more money. If I take more time with my patients, I make less. The obvious flaws in this system make a new system necessary.
I think the concept of value is very helpful. When I buy something, I am always looking for value. I am willing to pay more for something if the quality is high enough. I am willing to accept lower quality if the cost is low enough. The problem in the past (as stated above) is that neither quality nor cost was known at the site of the transaction. It is most important for healthcare consumers to know the quality of the product if they are to make decisions on what they intend to spend on their healthcare. I really think that the consumer directed healthcare trend is simply a market reaction to the trouble of the third-party buffer. It is inevitable that this will continue and will continue to drive the desire for those consumers to know that they are getting a decent value for what they are spending. Those of us with the ability to show them that our quality is superior should be able to get more business and be paid more for the product. It is intuitive that people want to know they are getting value in their healthcare. Who wouldn't? Well, those who are opposed to P4P are basically recommending we keep the whole transaction in the black box. I sincerely doubt that this will be tolerated by healthcare consumers.
Rob
Augusta, GA
For other writings, check out
So, it sounds like we all agree that focusing on benefits to the consumer makes good sense, but just because the term “consumer” is used to describe some healthcare model/strategy, it doesn’t necessarily mean the consumer will benefit. Separating the hype from the actual or potential value of a proposal to the consumer isn’t always clear … and the devil is truly in the details!
I agree that our sick payment system is part of the problems: It pits provider against payer; obfuscates actual cost of care and value delivered, rather than enabling informed choice through transparent pricing and knowledge of quality; and rewards certain groups of stakeholders, which devastating others. Not good at all!
I also agree that accountability in healthcare, reflecting many other areas of our political and economic systems, has been something people and business worked hard to avoid. CYA, pass-the-buck, loop-holes, plausible denial, playing ignorant, taking the fifth, changing the test results, creative accounting, and silencing and ignoring minority/contradictory opinions are some common examples of avoiding accountability (and fair play) through deception and manipulation. We see everywhere in our society. Our current version of Capitalism depends on it! What a sick system; healthcare is only a reflection. Our people are bad … our systems are.
In a healthy and wise system, people would be encouraged and rewarded to seek objective, critical feedback and to use this knowledge for continuous quality improvement. Being accountable would be admired and people would be eager to share and discuss their lessons learned, because such constructive collaboration would emerge and disseminate new knowledge, spark innovation, and focus on continuous gains in value.
On the positive side, I see for the first time ever a window of opportunity in healthcare. For the last 10-15 years, our failed strategies were 100% fiscal-focused, i.e., using managed care to moderate increases in healthcare expenditures by reducing benefits, increasing co-pays, limiting access to care, reducing provider reimbursement, and paying on a per-capita budget (“capitation”) basis. Improving clinical outcomes was not a factor, and quality of care has suffered greatly. Recently, however, care quality has come into the picture.
But here’s where those devilish details get you. What is “quality,” how should it be measured, how should it be rewarded, and how should it be continuously improved for everyone? These are the most important questions we ought to be focused on answering!
Steve Beller, Ph.D.
www.nhds.com
#7: Fertile Soil
Much is made of how P4P will drive IT adoption - a "build it and they will come" mentality. I truthfully think it will be far better to drive IT adoption to cause a fairer payment system to show up. I think the most fertile soil for a "cleaner" marketplace is one in which there is the ability to be accountable for the quality of the work. Regardless of how you define quality, the measure of quality is nearly impossible without IT. Many say that IT adoption won't happen until a fairer payment system comes, but I have seen a huge increase lately in the interest of small practices for EMR. I think the main reason for this is the relatively lower price for the technology, the more general acceptance of IT in general, and the great improvement in the EMR products. We are more profitable now with IT even in this perverse payment structure. Most docs realize that managing all the information on paper is untenable and is better done with computers, it just has taken time for the technology to be able to deliver on those promises.
I think that widespread IT adoption will be itself a driving force for radical change in the medical marketplace. No longer will procedures be king, the information will be where the interest will be. Physicians have long let others hold information on our practices in the exam room - now we have the ability to have better information than anyone. This will allow competition based on the quality of our information and the ability to improve the overall quality (however you decide to measure it). If there is a good program out there, it is probably the DOQ-IT program, which reduces the activation energy needed for practices to go up on EMR. This does not focus on the using a money carrot to lure doctors to IT, it just helps them do things many of them already want to do, knowing that once doctors are on EMR, the monitoring and correcting of their quality will be far easier than it is when they use paper charts.
Rob
Augusta, GA
For other writings, check out
Said superbly, Rob! You make a strong business for health IT (HIT); and your PowerPoint presentation at DOQ is powerful.
As healthcare practitioner and inventor of a HIT system, I can appreciate your points about the critical need for IT in healthcare quality improvement. This is a something I began recognizing in the early ‘80s, i.e., the great potential of computers in the clinical arena as a means for aiding in diagnosis, treatment prescription, process guidance and assessment, and outcome evaluation and feedback. Unfortunately, this potential has barely been tapped since few providers use clinical information systems to (a) support providers in making diagnostic and treatment decisions by coupling patient problems with evidence-based knowledge; (b) manage and assess the execution of plans of care; and (c) collect and share outcomes data and lessons learned. The dominant trend in every realm of science is the increasing value and usage of computers[i], yet healthcare lags far behind as clinical decisions are made largely without the aid of computer software.[ii]
In the next few weeks, my partners and I will be presenting a blueprint for the first a fully integrated, interoperable, cross-disciplinary, patient-lifecycle wellness HIT system with decision support, alerts/warnings, outcomes assessment, workflow/process management, biosurveillance, and business intelligence functions. This would be an affordable system designed for all providers, from the smallest practice to largest facility, as well as for other stakeholders.
In addition to having the typical EHR/CPOE functions, this next-generation HIT system would assist with diagnostic and evidence-based treatment selection decisions, establishing and updating plans of care (PoCs) based on flexible evidence-based practice guidelines, aligning hospital resources with the execution of PoC orders, and coordinating a patient’s PoC (inpatient and outpatient) across providers and facilities.
It would also automatically deliver treatment process data (e.g., examining variance from clinical pathways) and clinical & financial outcomes data to teams of researchers/academicians who analyze and interpret the data, collaborate with subject matter experts in consensus groups to establish and evolve evidence-based practice guidelines, and disseminate the guidelines as needed.
And it would help detect and manage outbreaks and bioterrorist attacks, assist first responders in handling victims in an emergency, link providers within and between RHIOs, speed adjudication and reconciliation of claims, support collaboration via virtual forums, and provide knowledge management and business intelligence tools.
It would use existing HIT tools, legacy systems, and IT infrastructures; use new tools on the drawing board; and use an innovative, secure, clean, simple, inexpensive P2P (peer-to-peer)/decentralized architecture of “Computerized Health Agents” (http://nhds.com/health/cha.html) that communicate via SMTP (e-mail) or other cost-effective means. This proposed system is also very flexible and can accommodate any existing and future data standards and formats, as well as work with any third-party applications.
I hoping that this blueprint will at least peek people's interest in what is possible.
Steve Beller
[i] Working Group on Biomedical Computing, Advisory Committee to the Director, National Institutes of Health. The Biomedical Information Science and Technology Initiative (1999) Available at www.nih.gov/welcome/director/060399.htm
[ii] Weed. L. (2004) Shedding Our Illusions:
A Better Way of Medicine. 2(1):45-52. Available at http://www.srmjournal.org/article/PIIS154625010400009X/fulltext
Post new comment
Syndicate
This post makes me wonder how "Consumerism" compares to "Consumer-Centered Care." Here's my take on the latter.
Consumer-Centered Care (also called Patient-Centered Care) focuses on the following:
See the Ten Rules for Health Care Reform from the National Academies web site at http://www4.nationalacademies.org/onpi/webextra.nsf/44bf87db309563a0852566f2006d63bb/717a437322ba309b85256a80006f9377?OpenDocument
Schoenbaum, S.C. , et al. (2005). A 2020 Vision of Patient-Centered Primary Care. Journal of General Internal Medicine; 20 (10): 953–57. Available at http://www.cmwf.org/publications/publications_show.htm?doc_id=307907