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Better Records On Our Cars Than Ourselves?

Doug klingerDid you ever stop to think that many people probably have better service records for their cars than for 
their bodies and minds ?

Having spent many years involved with the collection and management of health data to facilitate predictive modeling, early intervention and disease management, it became clear that doctors, hospitals and insurers typically have far more information about our health than we do.

Maybe the time has come for the US healthcare establishment to follow President Obama’s lead and turn its collective attention to rapidly enabling the collection, storage and private and secure exchange of personal health information in a standardized, cost-effective and efficient manner.

Our population is aging, a growing number of middle-aged people are caring for aging parents, there is an ever-increasing range of healthcare interventions and consumers are being asked to shoulder more of the burden and make tough choices about their health priorities, treatments, medications and how they will finance their well being.

It’s increasingly clear that improving healthcare quality and cost effectiveness are critical to our nation’s health and economic future. Engaging consumers in healthcare decision-making now appears central to driving the needed change. But, without a concerted healthcare establishment-wide effort to unlock consumer health information and enable it to flow freely and appropriately between consumers, the healthcare delivery system and payers, can we really make the kind of progress that has been envisioned?

It seems a bit unlikely that internet search companies, data storage companies, systems integrators, healthcare software vendors, hospitals, insurers or physicians will all put aside their differing philosophies, conflicting incentives and varied infrastructure to band together and lead the way. That leaves consumers and the Government. Will consumers mobilize and force the healthcare establishment to change ? It could happen. But, it seems more likely that this is yet another problem that will be heaped on the newly-forming leadership team in Washington.

While we are waiting on Washington to enable health information exchange, take a moment to think about the pension plan. 

Now something of a dinosaur, the pension plan used to be central to the financial life of so many Americans. Not that long ago, people who worked for companies often spent most, if not all, of their careers at one company. One big driver of this behavior was the promise of the pension plan. Work long enough and you will be rewarded with a paycheck after retirement. A simple idea that worked for a long time all over the World. One day, that all began to change. Companies were laboring under the weight of pension obligations. Workers were becoming more mobile, changing jobs and locations. And, the 401(k) plan came to light. Responsibility for retirement planning started shifting from companies to employees and the Government provided the tax incentives along the way to make this idea work. In a short period of time, Americans from all walks of life became investors. They were asked to take on a new kind of responsibility for their finances. They started asking questions, making tough choices and ultimately found themselves in control, like it or not, of their financial future. That worked well in good times and not so well in bad times, like today. Still, the change came and it seems unlikely that we will turn back.

This same kind of transition to personal responsibility and accountability will probably take place in healthcare sooner or later. It won’t happen in the same way or over the same period of time. But, it will probably happen. And, the members of the healthcare establishment, working together with Federal and State Government, have the power to drive this change. To empower consumers, to engage them and ultimately to help transform the U.S. healthcare system into a beacon for the rest of the World.

Doug Klinger serves on the board of MedCommons. Before joining MedCommons, spent ten years with CIGNA, where he served as CEO of CIGNA Dental, among other roles. His resume includes a stint with Monster.com, where he led the company's North American unit.

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20 replies »

  1. It is very important to stay on top of your health and have a check up at least once a year to ensure that you remain healthy. Many health problems are curable but you need to catch them in time. Do not wait to go see a doctor because it may be too late.

  2. The issue of privacy came up only briefly in this discussion. I think this is a large obstacle in terms of getting consumers involved in demanding change.
    The interesting thing, though, is that current discussions about health data privacy completely miss the mark. Until consumers can actually “see” their health care data, they will not be comfortable sharing it across health care systems and/or through HIEs.
    I can “view” my health care data through a portal, but I don’t feel comfortable sharing the remaining 90 percent (?) of my health care data until I am allowed to look at it. I imagine many consumers feel that way, although this concern has yet to be publicly articulated.

  3. The success of the US healthcare system (as reflected in extended longevity) was one of the main drivers in the demise of traditional company pensions. Pension plans assumed retirees would be paid for 10-15 years after leaving the workforce, not 25-35 years.
    “It’s increasingly clear that improving healthcare quality and cost effectiveness are critical to our nation’s health and economic future.”
    Probably true. But fixing our healthcare system without tending to our badly broken national retirement system could also strain our economy with millions living longer lives without the resources to support themselves.

  4. You totally lost my interest when you brought up pension plans, or the lack of pension plans that most of us have.
    We were sold the 401(k) at the behest of corporate American that couldn’t keep our jobs long enough for us to retire, and big finance that saw fees in all those accounts.
    Our politicians then proceeded to suck the finance industry for contributions while looking the other way while they dealt themselves fees and high living in New York City.
    Corporate American is now lining up to get a piece of the health care IT dollar. It’s the new Pentagon. The issue of whether it will benefit me in my old age is questionable because I’m never going to have the resources to retire and have an old age.
    As the title of your article makes clear – Sears and Toyota are far more interested in the health of my car than anybody in Washington or New York is in my health.
    Frankly I hope that WalMart, operating on the cheap, will get into health care because I have more faith in their ability to be efficient and whittle costs down than I do in anybody in DC.
    Corporate American gave us the 401(k) and then they flushed it. Why should I trust them with my health?

  5. Doug Klinger should be on one of President Obama’s Medical Task Forces. His summary of the situation and urgently needed remedies is right on target. This country needs more thinkers like him.
    Yours Truly,
    (An insider in the medical community)

  6. “…a very Pollyannish view of consumer responsibility for their IRA’s, 401K’s, etc.”
    I agree. And I also thank inchoate b.e. for putting a fine point on the terms.
    These modern employee-paid plans furnish everyone an easy to grasp picture of the retirement landscape, unlike pension plans which (like today’s health care, btw) are seen as “free,” a benefit to go along with paid holidays and uniforms.
    There are valid reasons for companies to spoil employees to protect against their being lured away by the marketplace. But paid health care insurance becomes handcuffs. Job-lock may be good for the company, but in the long run the market can benefit from stirring the pot. Imagine the impact on every workplace when health care becomes portable. For one thing bosses and subordinate supervisors will find more creative ways to keep good people.
    “…many eligible employees do not save anything, or save very inadequate amounts of money towards their retirement. Studies have shown that participants have too much money in either funds that pay money market rates or too much in their own company stock.”
    Bingo!
    As time passes we ALL will get smarter. I wouldn’t be shocked to see CD’s or T-bills as IRA options. (Events last September and since are a jarring reality check along that line.) But one tweak to the system will result in more savings: opt-out rather than opt-in. Clean and simple. More savings overnight.
    Regarding risk my view is different. I fully agree that risk management is appropriate for all kinds of life’s misfortunes. Car crashes, fire, product liability, weather events, even death itself. Insurance is appropriate for every kind of risk except health care. Just as the reward for not wetting your diaper is a dry diaper, the reward for taking personal care of your health is good health. But for professional health care everyone’s risk is 100%. I know very few cases of people getting to the finish line, other than by accident, without the need for health care. In fact, that “end of life” expense (which we all hope to incur) seems to be one of the biggest costs of all.
    Risk management and rationing are words used to discuss scarcity. It’s time to stop rationing health care and start looking for ways to make it more abundant. If other countries can do that there is no reason that it should not be done in the US.

  7. The post has a very Pollyannish view of consumer responsibility for their IRA’s, 401K’s, etc.
    Study after study has shown that many eligible employees do not save anything, or save very inadequate amounts of money towards their retirement. Studies have shown that participants have too much money in either funds that pay money market rates or too much in their own company stock. In either case, the investments are too unbalanced on the risk scale.
    There was also the problem of employers offering a veritable supermarket of plan options. As with many other things in life, too many choices breed indecision and lack of action.
    Why do we believe that consumerism in health care will have any better result, when health care is a magnitudes more complicated in the decisions to be made.
    Consumerism in health care may be a good thing, if people can be taught how to evaluate risk and return in health care and in other aspects of their lives. It may also work for some subset of procedures, diseases, wellness activities but not for others.
    Ultimately, if we are going to say that we are going to go to a consumer-centric approach, are we willing to let consumers make their decisions and not have them labeled as good or bad in the eyes of some expert sitting in a think tank or academic institution? If we are not, then let’s say so and find a system that we can live with.
    Ultimately, a consumer-centric model says that you will be responsible for risks you take and create: you want to let your kids play football or gymnastics – then you pay for their sports injuries. You want to climb mountains – then you pay for specialized medical care that is a result of your risky activity. You want to forgo vaccinations – then you pay for medical care (yours and those that get sick as a result of your decision) that results from not having one. Just don’t expect your employer, health plan, government or neighbors to pick up the tab.
    Gee, just think about the effect putting that kind of responsibility back on the shoulders of consumers will have! Can consumerism advocates live with it?

  8. It can be amazingly difficult to even get access to your medical records. In December, I was treated in the emergency room of my county hospital — the place you go when you don’t have health insurance. I’m on a waiting list to see a specialist, but they’ve only got to the referrals from September so far; a doctor who is a friend of a friend offered to try to help, but he needed to see those records. Even for another doctor, with the patient’s permission, one has to apply in person or by regular mail, and then it takes a minimum of two weeks!

  9. The healthcare system is falling apart, but as a health advocate I am assured a job as medical industries are in high demand always. Many poeple these days are utilizing
    medical call center and telephone triage services to skirt high medical costs. A nurse line combined with certified nurse triage practicioners is a great alternative to going to the ER and being charged those astronimcal fees.

  10. “cost effective and efficient manner”‘
    I thought we were talking about the US federal government. The concepts of “cost effective” and “efficient” are not possible in any government program. Why do you think the government contracts out the admin of Medicare and TriCare?

  11. Agree w. Dr. Lippin. It is an intuitive myth that consumerism will result in cost savings – likely, the opposite is true (by my anecdotal experience).
    BTW: Even though I agree that a centralised database would be useful … the huma body/car analogy is simply misleading. Please let’s stop using it.

  12. Agree w. Dr. Lippin. It is an intuitive myth that consumerism will result in cost savings – likely, the opposite is true (by my anecdotal experience).
    BTW: Even though I agree that a centralised database would be useful … the huma body/car analogy is simply misleading. Please let’s stop using it.

  13. couple of observations on John Ballard’s post:
    1)”… I have to admit that modern individual retirement plans (Roths, IRA’s, 401-k’s, Keoughs, and their cousins) promise greater rewards, partly because they are portable. One need not be employed for five, ten or more years to become “vested” because they are employee-owned.”
    participants in 401ks are always 100% vested in their own contributions & any earnings on them. Most 401k plans DO have vesting schedules for any employer match; while some plans have graded vesting schedules, 5yr cliff vesting (no ownership of employer match until completion of 5yrs service) is not unusual.
    2) “Which brings up the second important subject: who pays? Company-paid employee benefits must be recovered in the price of products or services sold. The auto industry is a bleeding illustration of the crippling impact of this economic reality”
    I don’t disagree with what you’ve said, but if employee benefits are wages – essentially how they’re treated in law – it may well be that employees’ DIRECT wages – take-home pay, the spendable dough they earn, whatever you wish to call it – is REDUCED by some fraction of the value of those indirect benefits. In fact I believe more than a few labor economists take just that view of benefits.
    In other words, provision of health & other benefits is factored into total compensation, & mismanagement of that input in its entirety is certainly something on which any company’s management should be judged.

  14. Common – info has always been power in Medicine
    Do you really expect that the powerful in Medicine will give up all this info to “mere health consumers?”- we used to call “patients?” Do you really think the average IQ patient can understand much of the info? As a physician I can’t understand the esoteria/obfuscation of many medical specialties.
    I,for one, am for transparant sharing but many patients don’t want to accept responsibility for their records as much as providers don’t want to give up the power over the infantalized dependent patient?
    Dr. Rick Lippin
    Southampton,Pa

  15. We are going to benefit from a generational change in that more people will be DEMANDING that they have their medical records and history available for them to review and for their providers and doctors to access. All you have to promise is that a future system can eliminate you filling out several pages of duplicate and near duplicate forms in health offices and you will win most of the vote.
    Quite a few of the older patients and those with chronic conditions usually have their records of past tests at home in binders or scanned into their computers. As parents age, many of their offspring will want to be able to check up on their parents results and follow ups via email instead of telephone calls if they are out of their parents locale.
    There are privacy concerns of course, but we seem to have nailed the ATM concept pretty easy and buying billions of dollars on line via the web. There will always be a criminal element which wants to find info, however, we also find more criminals in the health care field who are providers who are cought via computer analysis of their biling and prodedures.
    I see all of this like the transition to digital TV. I and others have pristine High Def Tvs and enjoy the many benefits of DVRS and Blue Ray DVDS. In reading my local South Florida newspapers it seems that the hold up for finaly ditching analog TV is some old fart who uses rabbit ears on his 26 inch Philco and says that HD TV is a big patouey since he can’t see the difference anyways.
    Like High Def TV and the consumer electronics business, you make it too complicated and the adoption rate will be stymied by too many competing formats and not being able to find the “play” button among the many choices.
    In a decade, we should all be laughing at how silly it was to not do the EMR transformation sooner when you swipe your health card and your health history with your meds, allergies, ID of stents and other hardware is instantly charted.
    For the blog here, there is an article in the new March 16th issue of Fortune magazine on page 36 about the digital records change being done by Caritas Christi Health Care run by the Boston Catholic Diocese. There are a lot of good bits of info about why and what the CEO is looking at with the change to EMR.

  16. Your wistful look at pension plans brings up a couple of valid points regarding the health care debate: portability and funding.
    Thank God I am the beneficiary of one of the old-fashioned “defined benefits pension plans”. (Two, actually, because I worked for a second company for five years which “vested” me for a second token pension as well.) But I have to admit that modern individual retirement plans (Roths, IRA’s, 401-k’s, Keoughs, and their cousins) promise greater rewards, partly because they are portable. One need not be employed for five, ten or more years to become “vested” because they are employee-owned.
    Which brings up the second important subject: who pays? Company-paid employee benefits must be recovered in the price of products or services sold. The auto industry is a bleeding illustration of the crippling impact of this economic reality. I read somewhere that Starbucks pays more for health care than for coffee! Something very wrong with that picture.
    A little-known part if the Bush administration’s policy (which never saw the light of day) was a proposal to make the employer’s portion of employee health care insurance premiums no longer deductible as a business expense. This would be a logical first step in uncoupling insurance from employment altogether. That, of course, is politically unrealistic. But the idea makes good sense practically, because it makes the cost of insurance easier for the beneficiary to grasp, while giving the employer a competitive advantage.

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