This week I had an interesting exchange with a prominent advocate of Consumer Driven Healthcare (CDH), regarding my last post: "People Powered vs. Consumer Directed Healthcare: What is the Difference?"
His initial reaction was that I was taking cheap shots at the CDH movement. But as we kept trading emails it became clear that PPH and CDH worldviews are really complementary in moving healthcare in the right direction.
People Powered Health(care) fulfills the original promise of CDH:
What do I mean by this? At the core of both movements is the right ideal: people (call them consumers, patients, citizens or whatever) have to be in charge of their healthcare decisions. They should not suffer from mis-management or mal-feasance of 3rd parties. So far so good, who would object to that?
Now, what is the best way to implement this empowerment?
Of course there are plenty of tools at our disposal. I summarize them into a large bucket of "technological, medical and political innovations" in my definition of People Powered Health(care). There is a long and growing list of such tools and techniques available, including:
- Peer-to-peer support networks
- Wellness, fitness & prevention programs
- Health information search & reference
- Online health & medical consultations
- Medical devices for self-monitoring at home
- Price transparency & consumer-oriented financing plans
- Retail clinics & medical tourism
- Online health cause activism & citizen action
- ... etc, etc, etc
What is not to like here? Well, empowerment is a great idea but can really work only when people are ready and willing to take charge. Pitching empowerment to people who are not ready is risking backlash, which I hinted at in referring to "surveys on CDH plans not being accepted by consumers" (here are the proper links: from WSJ health blog and from my friend Fard). I know I am stepping into the larger issues of personal responsibility, which has more to do with politics and morals than healthcare. But the real question is:
Can top-down change REALLY promote bottom-up empowerment?
Of course top-down programs could create an environment which benefits those who are ready to be empowered. But it is as likely to stir resentment from those who do not and simply want "to be taken care of". Which is why Consumer Directed Healthcare has been turned into such a political football. Which is a shame.
People Powered Health(care) merely takes CDH back to its roots
Find people who are the most active and ready to take charge of their health. Give them the tools. Watch adoption and improve the tools. Invite them to become co-creators of programs, technologies and peer support. Enlist them to promote healthy behaviors to their peers. Make empowerment spread.
There is a Russian proverb that says "you cannot make someone happy by force" . The idea is PPH is to engage creative energies of the people who are ready and active today to help those who are not there yet. This is about spreading responsible health behaviors through people's existing social networks. This is the real future of CDH, PPH or whatever you call it.
Which is why CDH movement faces a real choice: Embrace the real empowerment or be buried by the backlash.
UPDATE: Stephen Bolles responds with "An Open Letter to Trusted.MD". I agree with his key conclusions and his second paragraph is especially telling:
I know from experience (having developed consumer web products for UnitedHealth Group) that health insurers don’t understand some core consumer needs and expectations, don’t accept the implications of the research that shows their own customers don’t trust them, and the kind of ‘legacy thinking’ that limits imagination and innovation in health care services delivery will highlight the inability of insurers to really re-align themselves with a legitimately retail health care marketplace.