Health 2.0: Priming the pump- Jump starting health care consumerism By Scott Shreeve MD

Scott Shreeve co-founded MedSphere, the Southern Californian open source distributor of the VistA EHR. His latest effort is Crossover Healthcare. Scott has been tracking recent developments in the consumer driven health plan sector. Today he shares his take on a series of reports that suggest the CDHP movement may be faltering. The following piece was originally published on his blog, which can be found here.   

Jumpstart (jŭmp stärt) v.

1. Starting an automobile engine that has a weak battery by means of jumper cables 2. Start or re-start in a vigorous manner3. Start something by tapping into another source of power

A recent report by the Wall Street Journal casts some concern over the vitality and validity of the entire consumer driven health movement. The critique provides some hard numbers regarding the actual uptake in numbers which is significantly less than some other reports indicate. Worse still, a recent report by Towers Perrin indicated that many people with HDHP plans are dissatisfied with their consumer experience to date.

A few representative (and instructive) comments from the WSJ article include the following:

“…the approach appears to be stumbling — largely because of consumers’ unease in using them"

“…consumer-directed health plans often report lower satisfaction and confusion about how the plans are supposed to work"

“If I were a product manager in any other industry and saw scores
this low in customer satisfaction and understanding, I’d be thinking of
pulling that product from the shelves”

“One reason for the frustration is the uphill battle many consumers describe in trying to shop for their health care."

“Few employers are focusing on the costly measures — such as
offering better coverage or more consumer education — that may be
needed to accelerate these plans.”

“…the vast majority of companies still do not have the time, effort or resources to prime the pump."

So, is consumer driven healthcare just another passing fad?

The WSJ article and the Towers Perrin report fairly acknowledges
many of the obstacles to consumer driven health uptake in the market.
However, I was always taught by my father that obstacles are what you
see when you take your eyes off the opportunity. Therefore, my read of
these articles was that smart, nimble entrepreneurial companies should
be jumping up and down at the opportunity to jumpstart consumer
directed adoption by health plans, large employers, and consumers
themselves. In fact, as I have highlighted before,
in the new healthcare paradigm of increased informational complexity
just wait until we get into genomics and true personalized medicine!)
advisory services will become essential.

As I have also stated before, "Consumer Directed Healthcare" is a
misnomer. Consumers can’t "direct" or "drive" healthcare because they
are just one player in a complex game. In addition, consumerism as the
is an oversimplification which miscalculates the role of
consumers within the value driven reform movement currently underfoot.
However, consumerism will undoubtedly be important because consumers
are being asked to pay for more of their healthcare bill – whether or
not they are in a HDHP. Rising premiums, rising deductible, and overall
rising costs mean that the inevitable cost-shifting will be directed to
the least (initially influential person in the power struggle ->

However, with enough of the cost pressure being redirected to
consumers, and with increasing concerns over healthcare quality,
safety, and value, consumers will inevitably self-organize to become a
powerful and influential voice. Consumers are currently and will
increasingly be emboldened by a new cadre of health information
providing the next wave of information technology that can
aggregate, analyze, and advise them regarding their personal health
information. These companies will leverage core principles of value
driven healthcare
, transparency, and web 2.0 that support and empower
consumerism to make rational health care decisions. The interactions
that occur will be personal, relevant, timely and engage the consumer
at the medical condition across the full cycle of care. These
interactions will also add value to the consumer, support them in their
new role as health care shoppers, and help them achieve the very best

This is the level and type of support required to help nurture the
fledgling consumer movement. I don’t believe that anyone can honestly
tell me that a more engaged consumers is bad for the health care
system. However, no one should be under the impression that after 50
years of healthcare paternalism, consumerism is currently at the "just
add water" stage. So between the current state and the fully activated
state, there needs to be a consumerism catalyst – a trusted third party
like HealthEquity*, who is solely focused on helping consumers
understand HDHP and HSA’s so that they can "better save and spend their
health dollars". HealthEquity is an example of a company "priming the
pump" by aggregating information, analyzing data, and provide value
added advisory services back to consumers.

This is exactly what is needed to jumpstart the Consumer Empowered
Health market – next generation Health 2.0 companies that serve as
"catalysts of consumerism" by offering a suite of consumer advisory
services. These services will empower consumers to not only understand
their CEHP plans, but also make rational health care choices across all
aspects of the care cycle and demonstrate superior outcomes in a
transparent and value driven health system.

Now, that is something to drink (water) to!

* DISCLAIMER: I am currently consulting with HealthEquity to build out their consumer platform.

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3 replies »

  1. The problem with insurance is that most people don’t undertand it or how much it REALLY costs, because it’s provided to them from their employer. There are vastly more employees than employers.
    The quickest and most brutal education a person can get is when they lose a job and get a COBRA statement… how much for that plan a month?!?!
    Since most employers are faced with stripping benefits as most agent’s “solution” to the problem, HSA plans are catching on. And with that, the employees are for the first time, seeing what first dollar coverage looks like and it’s true costs.
    The real solution is out there… and has been for over 50 years. It won’t fix healthCARE, but it certainly does wonders for employers who provide health INSURANCE. The problem is the distribution model and the confusion about “benefits” and “insurance”.
    Provide the “benefits” yourself… don’t buy them from any insurance company. Just buy true insurance. That’s it. And most HSA plans allow for that… take on all the small stuff, and keep the insurance for the big stuff. Let the employees keep the copays, but don’t buy them from the carrier.

  2. Rodin, I think no matter who foots the bill for healthcare people want to know they are getting proper and quality care because it’s their bodies and their life that are at risk – free or not.
    Allocating their own limited funds on healthcare sounds great until you get an invoice for $1000’s in treatment costs – yea like most non-saving Americans have that few extra thousands in the bank to “allocate”.
    And just where do people get get all that FREE info on cell phones, mp3’s and laptops; from the people selling them. Knowing features and benefits (sizzle not steak) does not inform you on reliability, functionality, quality and more importantly safety. Had your laptop battery catch fire yet?
    And what about physician value verse outcome – who’s going to compile the info? Do doctors willing to try difficult procedures which produce a higher failure rate get a worse value/outcome rating? Do we then get docs only doing the safe procedures to avoid a negative rating?

  3. I agree that consumer driven health care is in its infancy, and information on how to purchase health care services is critical to becoming an effective consumer. There are few other industries where information on product quality and cost are so difficult to obtain. Of course, this is compounded by the third party payment system. When someone else foots the bill, we have no motivation to efficiently spend limited dollars. The second key ingredient in consumer driven health care is to have consumers be responsible for allocating limited funds to spend on their health care. Perhaps consumers will then routinely question the effectiveness/necessity of medical treatments and look for alternatives. Perhaps they will start to live a lifestyle which promotes health, rather than assume that there will be a pill to cure almost anything that goes wrong.
    It is a shame that we know more about which cell phone, MP3 player, or laptop provides the most value and functionality, and we know so little about which physicians provide the best value and outcomes.