OP-ED

Health Insurance Exchanges Will Transform Health Care. Magically Increase Transparency. Improve Access. And Maybe Even Lower Costs. But Only if We Get it Right …

NPR ran a story recently about how some retailers are retooling efforts to appeal to consumers in light of increased competition, particularly from online vendors.

Many are striving to be more “customer friendly”; Kohl’s department store was mentioned for adopting a “no questions asked” return policy with the idea that customer loyalty could be enhanced as the retailer made itself easier to do business with.

Comparisons between health care and retail abound, and while we say it is ideal for the consumer experience to be the same in both industries, in fact they are much different. The gap between the two industries was well-illustrated in this video of a shopper in a grocery store. We see them at the counter having their items rung up. But they aren’t told the prices and when they are given the receipt at the end, they’re told the final amount due may actually differ from what they see on the receipt.

Let’s take the analogy a step further: what if the customer expected the same “no questions asked” return policy from Kohl’s? Or a money back guarantee? In health care, only recently has the federal government taken steps to impose financial penalties in instances of poor care (which is the health care system’s equivalent of a “return policy” from providers).

When our team was at Subimo we initially focused on cost and quality (outcomes) information on hospitals. It was clear that – for the same procedures – there were both low cost and high quality providers as well as high cost and poor quality providers. Our efforts with transparency were designed to help people sort through the information so they could make more informed decisions and understand what quality outcomes might mean to them. We knew there was much variation in outcomes with certain procedures (e.g. aortic aneurysm repair) and less variation with others (e.g. normal vaginal delivery). Helping people understand when a poor outcome was more likely to occur helped them with their decisions (and presumably made them better shoppers).

And now our team is providing the latest expression of consumerism in health – private exchanges and online shopping platforms that are designed to help consumers wisely spend their benefit dollars while addressing cost considerations of employers. Private exchanges that provide personalized benefits for consumers and transparency around the price of insurance as well as the employer’s contribution continue to sustain my optimism when it comes to the goal of making health care more oriented towards consumers. I truly believe that transparency and personalization will not just expand but will become touchstones as consumers learn to navigate the health care system, from choosing insurance to finding providers, products and services.

Even with my optimism and with all the market buzz about exchanges, I can’t help but be reminded of disconnects between health care and retail shopping, especially when the differences surface regularly and are so easily remedied. Case in point: Hurricane Sandy caused a longer stay than anticipated on the East Coast, leading to a shortage of prescription medications. I first called our pharmacy benefit manager, asking for a one week supply of meds to be filled at a local Virginia pharmacy. They told me to call the insurance company. Our doctor called the Virginia pharmacy who then called our insurance company for an “override”. The override was approved for five of six prescriptions but declined for the sixth. Why? The patient lives in an area (Chicago) that was not affected by the hurricane. Even though the patient was in Virginia, and not in Chicago. Even though the other five prescriptions were approved. No amount of dialogue could change the insurance company’s decision and the void of logic and common sense (not to mention customer service) was astonishing. I can’t imagine a service person at Nordstrom’s not anticipating this and working proactively on their client’s behalf, especially if they worked at the doctor’s office.

So while I am heartened by how consumer-driven health care has become – retail clinics, quality rankings as examples – I’m reminded that we are only as consumer-centric as our weakest link(s). For every example I have, I know that there are many more. There are plenty of weak links throughout the healthcare system. Like Kohl’s, each of us can look at the top things that make our business difficult for people to deal with. With often only modest effort, we can make changes to significantly improve the consumer experience, lower frustration and minimize confusion.

While technology and financial realities accelerate consumer-oriented innovation like insurance exchanges, I am mindful that the entire industry has to ensure that every facet of the business reflects the same level of consumer orientation. We each need to fix our weakest links if we want to see innovation deliver on its promise.

Ann Mond Johnson is the chairman of board of managers of ConnectedHealth, LLC.

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Life Disability Policiescary boot campTomMD as HELLChuck Miller Recent comment authors
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Life Disability Policies
Guest

Yes very important to choose right health insurance policy and first read very carefully the terms of the policy very important.

Tom
Guest

After reading through most of the comments here I realized very quickly that many of you are feeling the pain of high prescription costs and poor prescription drug benefits. While recently helping a family friend navigate through the Prescription Assistance programs offered by the major pharmaceutical companies we developed an easy to use service for other to be able to take advantage of the free medication programs that are offered. In most cases, you can receive your meds for FREE from the pharmaceutical companies. Over 4200 medications are covered under the PAP programs.I strongly encourage you to visit http://www.redemedllc.com so… Read more »

DeterminedMD
Guest
DeterminedMD

My last comment for this thread. I’ve talked about solutions plenty since first commenting here. The majority of commenters aren’t interested in reality, because most have just pressed for PPACA to stay in place and either hope, or deceive, that things will proceed fine and people will have quality of care at realistic pricing. Mandating is always wrong, irregardless of the twisted perspectives others continue to echo. People have the right to say “no”, and then deal with the consequences. But, Democrats and socialists want all to suffer, and believe me when I say with conviction and past history as… Read more »

Sandra_Raup
Guest

Thanks! I love a frank discussion! Happy Holidays to you, too! And I agree with you about communities. I hope your assessment isn’t true. Maybe it is, but I hope it’s not.

BobbyG
Guest

People live too long as a whole, we keep people at younger ages alive too long that natural selection would appropriately end with respect,
__

That’s pretty fucking cruel and simplistic. Predictable, from you.

DeterminedMD
Guest
DeterminedMD

Takes one to know one, jerk!

You just can’t leave it alone, hope ya choke on it!

Sandra_Raup
Guest

Thanks legacyflyer. I was thinking that was it, but I’m wondering about the specifics. What advice is given to stop smoking? Lose weight? Exercise? Drink less? These aren’t easy, and I’m not sure the problem is all one sided. Most people are aware of their issues and probably do try to the best of their abilities, and I wonder sometimes if we don’t understand the problems well enough and are not even necessarily giving the best recommendations. I wonder if all our recommendations for low fat in the 1990’s (including for children) actually affected people’s ability to maintain a reasonable… Read more »

DeterminedMD
Guest
DeterminedMD

What is it with many of you? Have you met the average patient circa 2012? They think that health care interventions come in these little round or oval products called tablets or capsules, that MRIs and PET scans will draw circles around the culprit lesions and then robot devices will make 2.5cm incisions and neatly remove them, so the patient can recuperate in less than a week. And then go back to their Krispy creams and Frozen lattes while sitting in their cars, puffing away on Marlboro Lights and typing furiously away on little devices, usually in 140 character lame… Read more »

Sandra_Raup
Guest

See what you think of this. I was sitting in a resort restaurant looking over a lake in Wisconsin when I noticed a man in his 50’s darkly tanned, smoking and drinking a beer. He looked like he had had many cigarettes and beers in his lifetime. I imagined having a “lifestyle” discussion with him and thought he might not be receptive. I was wondering if we should have people decide when they are 25 (30 for men? They mature later? Or is that discriminatory?) if they want to (1) pay more because they want to life a risky life;… Read more »

DeterminedMD
Guest
DeterminedMD

What the Left/liberals/progressives are unfortunately somewhat effective in blurring are the boundaries of life and cultural standards that maintain societies. I hate overtolerance as much as intolerance, and that is what was one main element of this past election. These people, who I firmly believe really do not make real sincere efforts to practice what they preach, just pass laws and browbeat people into accepting their failed premises, are just as lame and disruptive as their republican counterparts. PPACA is going to fail for numerous reasons, by providers, patients, the health care insurer system, hospitals, and ancillary care parts. Politicians… Read more »

Sandra_Raup
Guest

I probably agree with you more than you realize, I just prefer to talk about solutions. I also believe it’s not as easy to lose weight, stop smoking, stop drinking, etc. Look at how difficult it is to get people with eating disorders to start eating again. It’s all too easy to look at life via a rational view, but I’m not sure that gets at all the unconscious and emotional motivations we’re subject to. Bottom line – I think we can serve patients better, and until I’ve explored all those options, I’m not ready to write whole populations off.… Read more »

legacyflyer
Guest
legacyflyer

Determined,

Wow – lots of anger in that comment.

Sandra,

I believe Determined is referring to all the standard bits of advice that doctors give their patients; stop smoking, lose weight, exercise more, drink less, etc.

DeterminedMD
Guest
DeterminedMD

Today’s outrageous comment: people as patients are more and more cheap, entitled, and narrow minded. And you all pontificate and bloviate about utopian health care environments and cost containment. Truly disingenuous, dishonest, and deceitful. The average American citizen voted for basically one of 2 things at least in the presidential part of the election: what’s in it for me, or, care for yourself or just get out of the way. The usual commenters here either are in pathological denial of this obvious polarization, or, their naïveté is pathologically clueless. People expect to live to what really amounts to biologically inappropriate… Read more »

Sandra_Raup
Guest

Do you have specific examples of “act[ing] on what the doctor tells him or her to do to live responsibly”? Just curious what advice you’re referring to.

Chuck Miller
Guest
Chuck Miller

No one can adequately purchase healthcare as an informed consumer as the system stands now. There’s a great story in today’s Kaiser Health Newsletter about a reporter who tried to shop for an MRI and couldn’t be quoted a price because every provider had a different negotiated rate for every healthcare plan.

You don’t know what costs are until after you’re billed.

Exchanges may help consumers make better choices about healthcare plans, but they won;t make them better consumers of healthcare.

Peter1
Guest
Peter1

Providers are prohibited from quoting how much insurance pays them. Want price then ask for cash pay, however that number will be significantly higher than what the provider will get from insurance.

Dan Ross
Guest
Dan Ross

And a partridge in a pear tree!

matt
Guest

Healthcare is broken and anything that can be done to improve it is better for everyone.

legacyflyer
Guest
legacyflyer

Don’t be so specific with your recommendations.

legacyflyer
Guest
legacyflyer

Kim, I am a Radiologist so some of what I am about to say is not typical for other docs. The reason that the PATIENT is not a customer is: 1) They don’t chose to come to us – they are typically referred by another doc or we provide service in the hospital they have come to. 2) They don’t pay us. Other than a small copay, we are typically paid by Insurance Companies or the Government 3) They typically have no idea of how to judge the quality of our service. 4) They can’t upgrade their services or order… Read more »

Kim Bellard
Guest
Kim Bellard

I find it interesting that some people can view the concept of treating patients as customers as a bad idea. Hmm, treating the patient experience as important, giving people choices, having consequences for entities who do not treat the patient well and/or do not provide value — these are things someone opposes? Honestly? As for Margalit’s long-standing support of a public option, I think that’s fine — IF Medicare has to play by the same rules. Same oversight and rules, honest accounting of costs, no subsidies on marketing & such from SSA and other public agencies, no artificial price controls,… Read more »

Margalit Gur-Arie
Guest

Why should Medicare have to play by “the rules”?
Medicare is there to serve the public good. It should be given every advantage possible…

Kim Bellard
Guest
Kim Bellard

You seem to be implying that only Medicare/public options serve the public good, which would imply an ideological bias that makes dialogue impossible.

If the rules for private options don’t serve the public good, why are they there? If they do serve the public good, why wouldn’t they apply to the public option?

Margalit Gur-Arie
Guest

No, there are many things that may serve the public good, but Medicare is a public good. Obviously Medicare should operate in a lawful manner, which I believe it already does. However, it should not be artificially forced to compete with private for-profit (or revenue) businesses. Just like public schools are not forced to compete with private ones and Police departments are not forced to compete with private security outfits. Medicare should be allowed to control prices and use its heft (and mission) to negotiate the best possible terms for its members. The private “options” are there to make money… Read more »

Natasha Deonarain, MD, MBA
Guest

Wow! It’s quite magical hanging out on THCB today! It’s amazing to see exactly how correct Elizabeth Kubler-Ross was on the 5 stages of grief. But she probably thought she was talking about the individual. No, this is the “collective” mind-set of a medical community watching American healthcare breathe its last. Some of us are still in denial. Some have moved on to anger, arguing back and forth. Some are looping to a vain attempt at bargaining their way out, while some are getting really depressed. It’s been quite easy to predict who will actually survive this mess, and who’s… Read more »

DeterminedMD
Guest
DeterminedMD

Nice post. The average reader here reads it as this, in general:

Kyteig sht tvrctctt nn d rfgkjjf sdrr hen hdhdhehee ok btctxt aosoivyb.

Tried to throw in some vowels for some coherency.

Natasha Deonarain, MD, MBA
Guest

Sigh. You’re right, it is so hard speaking a different language. I’m so sorry, Dr. Determined ;( Can you ever forgive me?? Here’s something interesting. Like all paradigms, shifting our thinking is painful and slow, and met with little comprehension from nay-sayers who still struggle to figure out why we ended up in the place we are today, through their actions from yesterday. I think America is going through this crisis, but it applies to all aspects of our life, not just healthcare. Which is probably why we’re still struggling to understand that health won’t be found through disease-oriented pursuits,… Read more »

DeterminedMD
Guest
DeterminedMD

My comment was not a shot at you, but to certain commenters. Sorry if I offended. They give the impression those who dissent are alien.

I liked your comment.

Natasha Deonarain, MD, MBA
Guest

Yikes! I think I’m going to bow out of this one…I seem to have got way in over my head. I’ll just crawl back to my little Health Conscious Movement at Facebook@TheHealthConsciousMovement and keep trying to squeak about changing the world by changing ourselves first, painfully, one at a time :). In the meantime, we can all have a happy holiday with my upcoming article that’s going to be published on http://www.kevinmd.com called “What advice could I give to the next generation of doctors”…I wonder what that could be??? Blessings, and have a Happy Fantastic Holiday!!

legacyflyer
Guest
legacyflyer

Determined,

You and I seem to be on the same page with this post.

I think this post would have been an excellent to use for a game of “Buzzword Bingo”!

http://en.wikipedia.org/wiki/Buzzword_bingo

Margalit Gur-Arie
Guest

If you want people to be treated like customers, then make them customers. Get rid of Medicare, Medicaid and most insurance regulations and EMTALA and HIPAA and everything else. Then if you have money, you will be treated like a customer because you are a customer. If you don’t have money, you will be treated like all retail establishments, including the best and the nicest ones, treat people who have no money. Kohl will not let you take home that nice pair of jeans if cannot pay for it in full. Maybe wait for a sale, or put it on… Read more »

BobbyG
Guest

How about being treated like “citizens”?

“One Dollar, One Vote” didn’t seem to work out so well in 2012, ‘eh?

MD as HELL
Guest
MD as HELL

Which citizens? The Makers or the Takers?

BobbyG
Guest

Lame, Ayn as Hell.

Peter1
Guest
Peter1

“Is that the health care system we want?”

That appears to be the system Republicans want.

Why is it Republicans want the free market to fix health care but they don’t want the free market to fix storm relief? I didn’t hear Governor Christie saying people should buy insurance if they want their homes and neighborhoods rebuilt after Sandy.

Margalit Gur-Arie
Guest

Precisely. The only thing I don’t understand is why liberals feel compelled to support this junk. What are these exchanges supposed to achieve? A more effective way to funnel tax dollars to private insurance? Better tools for “consumers” to pick their poison? There should have been a public option, i.e. anybody can buy into Medicare, and only people buying into Medicare could receive tax dollars to subsidize their premium. It would have helped Medicare and the people. And if everybody opted to get the subsidy, and “insurance” would have gradually migrated to Medicare for all, so be it. And if… Read more »

Peter1
Guest
Peter1

Trouble is Margalit Medicare doesn’t fund election campaigns or give jobs to politicians family.

This is the hurdle that’s always a bit too high for us to clear.

Sandra_Raup
Guest

A significant problem is that Medicare is not that great. Almost everyone with Medicare has a supplement insurance policy or they have another program, such as Medicaid, if they qualify. “Medicare Advantage” may provide better coverage, depending on what you selected and how much you’re paying yourself, but that’s just insurance.

Kim Bellard
Guest
Kim Bellard

Great post, Ann. Right now it seems like everyone else — e.g., doctors, insurance companies, the feds, — is in line ahead of patients in terms of being treated as customers . Until patients really start acting like it is really their own money, it’s going to be tough to change the existing mind-sets.

Peter1
Guest
Peter1

“Until patients really start acting like it is really their own money, it’s going to be tough to change the existing mind-sets.”

You like getting three written quotes?