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People Powered vs. Consumer Directed Healthcare: Take Two

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Is People Powered Health(care) really a repudiation of consumerism? Absolutely not! Think of it as fulfillment of the original CDH promise.

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.

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Comments (3)

Submitted by Anonymous (not verified) on Mon, 08/13/2007 - 9:09am.

I am a big fan of free-market solutions to reform our dysfunctional and unsustainable health care system.  More competition and consumer-choices will drive down prices, encourage innovation, increase patient care and improve the quality.  In fact, the retail health clinics are a perfect example of competition at work.  Unfortunately, consumers do NOT have access to relevant tools that are necessary to help them make informed, cost-effective choices for finding the best value for common health care services.  There are plenty of health care content sites out there, but no meaningful price transparency tools for ROUTINE health care services, so I have decided to start a grass-roots initiative that relies on social networking to help consumers find the best value for routine health care services.  My initiative is called,, and includes a directory of true prices for common health care services based on actual visits by individual consumers.  The contents of the directory are contributed by consumers to share with other consumers – and everyone is invited to participate, including the insured and insured, by anonymously posting prices they paid for routine health care services (such as MRIs, mammograms, x-rays, CT scans, vaccinations, office visits, dental and vision), along with their personal recommendations on the provider. This tool benefits all consumers directly and this is a solution that consumers can benefit from immediately, without having to wait for legislation to pass, complicated programs to be initiated, or waiting for the country to decide how to reform our health care system.  The site was launched last month and everyone is encouraged to participate.  If enough consumers participate to share prices – consumers will have created a powerful tool to help make informed healthcare purchasing decisions and everyone benefits by exposing health care prices.  Consumers save money by shopping for the best value and eliminating wasteful spending on overpriced services.  This is one small step in helping to reform our current health care system.  Check out the website, and let me know what you think.

Submitted by Greg Scandlen on Tue, 08/14/2007 - 4:02am.

Dmitriy, my friend, you chose the term "versus" which means "against." If that is not what you meant, you should have chosen a different term. But then you aren't being very careful or thoughtful in any of your comments here. Your source of information about CDHealth is a single article in a newspaper, which in turn is based mostly on a distorted survey by the Kaiser Family Foundation. How distorted? It didn't even get the fundamentals right. It reports 2.7 million people enrolled in CDHealth programs in 2006 when we know for a fact there were at least 10.5 million enrolled. This number comes not from a bogus survey but an actual nose count from the insurers.

We also know from studies far more rigorous than a newspaper article that most people (not all) are pretty happy with HSAs and HRAs -- we are taking more control, feeling invested in our own care. We are using generic drugs more, emergency rooms less, preventive services more, and complying with our treatment programs better than people with conventional insurance. This has all resulted in a substantial lowering of cost trends.

Your list of tools is excellent, but most of these have come about BECAUSE of CDHealth and the fact that more people are controlling more money in health care. Now that we have control over (some of) the money, we are demanding the tools that help us do it better. It is all part of the growth process -- a little bit of money causes demand for these tools, these tools help us become more confident in health care, the growing confidence lets us demand more control. We are untying the apron strings of the insurance nannies.

CDHealth is only a beginning, not the end of a transformation. Your PPH may be a fine addition and help move the trend further. Bravo if it does. But let's give a little credit to the pioneers who started the transformation, shall we?


Submitted by hippocrates on Tue, 08/14/2007 - 9:43am.


I do not position "versus" as "against" here. You are right, PPH could be viewed as the next logical step in CDH, which is exactly the point I am making here.

BUT, what is very critical is to point out the difference between asking consumers to make sense of the tools handed to them vs. inviting them in as equal partners and co-producers of health services. The point here is that healthcare's "supply side" must learn and embrace the consequences of power on the individuals - especially exercised directly. In my experience there is a long way to go, but now individuals do have direct mechanisms to apply pressure - especially through the Internet media.

Finally, statistics numbers aside (KFF survey or nose count) the point of PPH vs. CDH comparison is who truly is in the driver seat. The WSJ health blog post is most remarkable for reactions of real consumers in the comments. By that (anecdotal) evidence there is a long way to go.

Of course anything that gets us there is helpful, but authentic consumer empowerment will really shake up the supply side of healthcare. Part of my reason for coining a new term is to move beyond the political debates around CDH as we know it - towards something most could agree on.

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