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Responsibility of Patients
Featured in: Quality Advocate
Steve Beller, PhD looks at the role of personal responsibility in achieving healthcare quality. Necessary but not easy!Should patients be proactive and responsible for managing their own illness?
Certainly! But there are at least two issues to consider.
One issue has to do with what I'm calling "Well-Care." The goals of Well-Care services are better health outcomes and reduced cost. The two primary objectives are:
- Preventing serious illness and complications of chronic illness (reducing morbidity rates)
- Improving well-being and quality of life (e.g., having a more positive emotional state, having greater physical comfort, being more productive, being able to act more independently, etc.).
Well-Care is applicable, in somewhat differing ways, to all four main healthcare categories of care:
- Catastrophic care involves emergency treatment of accident victims and inpatient treatment of people with serious medical (including psychiatric) conditions.
- At-Risk care involves people who are not yet ill, but who are at risk of becoming ill due to their physical condition (e.g., obesity), behaviors/lifestyle (e.g., smoking, alcohol consumption), genetic predispositions, and/or living and working environments.
- Chronic care is for people with chronic conditions, such as diabetes, for which there is ample potential for complications and worsening health.
- End-of-Life care is for people who have no hope of recovering (they will only get worse and die).
For catastrophic and chronic care, complying with the plan-of-care (PoC) is one way patients should take responsibility for their health.
I suggest that patient compliance would be optimized if there is adequate patient and care-giver education, professional and social support (including the family), ongoing health status feedback and recommendations, and a system that coordinates care enabling all the clinicians treating a patient to work together coherently across the healthcare continuum. A well-trained “health coach” armed with the right tools – similar to a case manager – could offer the Well-Care.
The second issue centers around the implication that the PoC is a good one, i.e., it is a valid, evidenced-based, cost-effective way to treat the patient’s illness in a way that speeds recovery (if recovery is possible), avoids complications and/or relapses, and helps optimize quality of life and well-being. But due to the knowledge void, as well as numerous problems with evidence-based guidelines, our diagnostic systems, lack of care continuity, etc., there is great uncertainty that even the best doctors consistently select the best PoC for each patient and deliver the treatments in the best way. Diagnostic aids, PoC execution management, care coordination tools, ongoing systemic knowledge-building collaboration and outcome studies, a high-fidelity healthcare system, etc. are all part of the solution. Unfortunately, our country has been painfully slow in addressing this issue.
This second issue goes to the heart of a thorny issue surrounding consumer-directed health plans and the “transparency” debate, i.e., how can a patient/consumer select the best treatments and providers when there is so much ignorance, uncertainty, and complexity? Making such decisions, after all, is essential to taking a proactive approach to disease management.
In addition to changing key elements of our current healthcare system, one suggestion is to use “infomediaries,” which are businesses that advise consumers about their treatment and provider options. This is similar to the independent agents who give consumers information about the technical performance, reliability, customer satisfaction, and prices of products and services for automobiles and other products. Using such independent advisers in healthcare might help payers overcome consumers’ current lack of trust in them and enable consumers to make more informed decisions.
Steve
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technoratiAuthor Info
Dr. Steve Beller is a clinical psychologist, author, consultant, researcher, software inventor, and CEO/President of National Health Data Systems. His life goal is to work with others to help re-direct the course of humankind, so we don't have to be ashamed of the world we’re leaving our children.
Toward that end, Dr. Beller spent the past 25 years in creative pursuits, including inventing unique software systems, writing about the healthcare crisis and cures, and developing close personal and professional bonds with fine individuals across the globe.
Dr. Beller's current activities are devoted to (a) consumer empowerment through comprehensive mind-body-environment health assessments yielding deep understanding, “information therapy” supporting self-maintenance and knowledgeable decision-making, and guidance from collaboration with health professionals & peers; (b) continuous improvement of sick-care and well-care safety, effectiveness and efficiency through use of evolving evidence-based guidelines; (c) international efforts to improve the health and well-being of the elderly and impoverished; (d) establishment of cost-effective information exchange architectures using next-generation technologies; and (e) supporting first responders and trauma department staff in pandemics, disasters and terrorist attacks.
For more, please see his extended bio here.
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Comments (6)
#2: Alignment
Profiting off of medicine is OK (in my opinion) if you allign the motivation to do well financially with the patients' wellbeing. Patients profit personally when they are given well care, so they are willing to exchange the benefit they get with a financial profit. The problem in the current system is that if the doctors do a good job for their patients, the only ones who profit financially are the middle-men. Even worse is the fact that the patient's well-being is more aligned with the doctor's financial harm than benefit (the longer I spend with you, the less money I make). Finally, the highest value doctors (primary care) benefit the least financially, while the doctors valuable to the least number of patients for the smallest things (surgical subspecialists) are the ones making the most money. So overall the system is screwed up and there needs to be a realignment of motivations. Don't just take away financial motives, realign them. The current system is not a capitalistic one, it is a profiteering one, where neither the good doctors nor the patients profit.
Rob
Augusta, GA
For other writings, check out
<<The theory [of Well-Care] is sound, but the one thing I have discovered in my 30+ years in the aerospace industry working as a metallurgist, nothing works in the real world like it does in the lab.>>
Actually, there's good evidence that aspects of Well-Care work. See the FixingHealthcare blog for good information on community-based wellness programs. And I'll be publishing more online about an expanded concept of Well-Care we're developing. We're also developing the concept of Infomediaries and I'll be sharing those ideas, as well.
As far as profit goes, my thoughts are largely aligned with Rob's. A related perspective is that competition is healthcare is misdirected. And a way to give primary care physicians a more prominent role and sensible compensation is the "Advanced Medical Home” model.
Steve Beller, Ph.D.
I should have qualified my statement.
Health care providers, i.e. doctor, hospitals, even pharmaceutical companies are entitled to a profit. Without them, advances in medicine and improvements in patient care could never be attained.
But one of the problems that has developed over the past so many years, with the advent of the new "ownership society" is that businesses no longer focus on the real reason they are in business, that is to provide a product or service more economically, than individuals in society can do for themselves. Instead they have become blindly focused on the bottom line to the detriment of the consumer.
No where is this more evident than in the health care industry, where doctors and hospitals, squeezed by decreasing payments from the government and health insurance companies, are forced to reduce the quality of care provided to patients, for the sake of health insurance company profits, and lowered tax burdens.
It is unconsciounable that we permit an industry to thrive, i.e. the health insurance industry, which acts against the people it is expected to help, the consumer, by devoting hugh resources to screening out sick patients, and finding ways to retroactively cancel policies when patients get sick.
You're right Rob, profits are being misdirected, but neither should the focus be on profits. The focus of all businesses needs to be redirected to serving the consumer. When that occurs, profits will follow for the best companies.
Maybe that process can be speeded along, if patients were more knowledgeable and took a greater part in their prescribed care, which I I believe can be aided with the adoption of the a "Well-Care" philosophy.
OK, enough ranting for one day, time for golf!
Many of us have been through the process of taking a dream and turning it into reality. A good example is to build a home. In the beginning we develop an image of what our dream home will look like. We may even start with an artists rendition followed by the architect's plans. With current technology we can even see what it will look like using 3D computer animated drawings. From the architects plans the contractors and sub-contractors begin the process of constructing that dream into the structure we will eventually call home. Along the way the reality of costs and design specifications influence the process and alter the original image. When the move in date occurs we realize that the home we originally dreamed of is not exactly the one we are moving into in the end. It never does but that is not the purpose of dreaming. The purpose is to motivate us to make the changes that will improve our lives. A well planned home is better than no home at all. I think there is a similar process occurring in healthcare today. What Steve and others are doing at http://wellness.wikispaces.com/ is to begin the process of creating the "architect's plans". In some instances the construction has already begun. Way to go Steve! Your efforts are to be applauded.
He would not focus on banishing profit from healthcare!
Why?
Look at Great Depression. Unemployment at 29%. People starving to death. Doubts in the viability of Capitalism. Blaming Big Business for all woes. Infatuation with communistic ideas.
Enter FDR.
He resisted the calls to nationalize the industry and instead focused on reforming it. He realized the the problem is not in profit itself but with the rules of the game to get it. Pre-Depression incentives encouraged "robber baron" behavior at the expense of general public.
How Did He Fix the Economy?
Familiar word: Transparency. Yes, there were many other stopgap measures to staunch the bleeding, but SEC is FDR's most lasting legacy. Before mandated financial reporting, corporate management had not been restrained from manipulating assets to profit at stockholder's expense. Transparency went a long way to fix the mis-alignment.
Takeway?
If even China has abandoned the centrally planned economy and Canada is moving away from single payor, perhaps we should be able to build a fair functioning market here in America.
So We May Need Healthcare SEC!
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Author: Details
First Name
Steve
Last Name
Beller
Degrees
PhD
Short Bio
Dr. Steve Beller is a clinical psychologist, author, consultant, researcher, software inventor, and CEO/President of National Health Data Systems. His life goal is to work with others to help re-direct the course of humankind, so we don't have to be ashamed of the world we’re leaving our children.
Toward that end, Dr. Beller spent the past 25 years in creative pursuits, including inventing unique software systems, writing about the healthcare crisis and cures, and developing close personal and professional bonds with fine individuals across the globe.
Dr. Beller's current activities are devoted to (a) consumer empowerment through comprehensive mind-body-environment health assessments yielding deep understanding, “information therapy” supporting self-maintenance and knowledgeable decision-making, and guidance from collaboration with health professionals & peers; (b) continuous improvement of sick-care and well-care safety, effectiveness and efficiency through use of evolving evidence-based guidelines; (c) international efforts to improve the health and well-being of the elderly and impoverished; (d) establishment of cost-effective information exchange architectures using next-generation technologies; and (e) supporting first responders and trauma department staff in pandemics, disasters and terrorist attacks.
For more, please see his extended bio here.
"Well-care" is a laudable concept, one to be embraced, but as the old saying goes, "it's easier said than done." The theory is sound, but the one thing I have discovered in my 30+ years in the aerospace industry working as a metallurgist, nothing works in the real world like it does in the lab.
Even in my case, I know what I should be doing to enhance my chances of survival, but it's still difficult. There are too many things I've learned to enjoy in life, that I just don't want to forego. What's the point of living, if you can't enjoy yourself?
As far as imfomediaries, that is something that is no doubt a good idea, considering the current state of health care in the US, because not everyone is capable of doing the research to be pro-active, or just simply doesn't want to do it. But do we really want to add an additional layer of cost to an already high cost health care system?
I know I've probably missed your point, and likely even gotten a little
off track here, but hey, that's my perogative. After all, I am the patient.
I just think we need to get the profit motive out of health care, which I believe would eliminate many problems which exist with US healthcare, but I also know "that's easier said than done."