Giving Consumers the Tools and Support They Need to Navigate Our Complex Healthcare System


As physicians and healthcare leaders, we are already well aware that the majority of patients do not have the information they need to make a medical decision or access to appropriate resources, so we didn’t need to hear more bad news. But that is precisely what new research once again told us this spring when a new study showed that almost half of the time, patients have no idea why they are referred to a GI specialist.

While the study probably speaks to many of the communications shortcomings we providers have, across the board our patients often don’t know what care they need, or how to find high-value care. Last year, my organization commissioned some original research that found that while a growing number of patients are turning to social websites such as YELP, Vitals, and Healthgrades to help them find a “high quality” specialist, the top-ranked physicians on these sites – including GI docs – are seldom the best when we look at real performance data. Only 2 percent of physicians who showed up as top 10 ranked on the favorite websites also showed up as top performers when examining actual quality metrics. (The results shouldn’t surprise you as bedside manner has little to no correlation with performance metrics such as readmission rates).


As providers and health care leaders, we lament that our patients are not better informed or more engaged and yet across the board, we have not given them the tools or resources they need to navigate our complex system. But now for some good news: all hope is not lost, and patients can become better consumers, albeit slowly, if we all do our part.

First, as health care leaders, we must continue efforts to educate all patients that quality of care matters and that quality varies. Part of this is helping patients understand that not all medical care is of equal value. Unfortunately, as reported in Modern Healthcare, the Choosing Wisely campaign hasn’t made much of a dent moving the needle, but the work that has been born out of this initiative continues, and some medical systems are looking to take it to the next level. Cultural change is hard and it is slow, so we must “keep on keeping on” in these efforts, despite glacial rates of progress.

Second, those of us who wear a provider hat must compel patients to participate in their care. Initiatives like OpenNotes are a great addition, offering patients and families a full transparent electronic medical record they can even contribute content to themselves. Research has shown such initiatives improve doctor-patient communication and trust and spur shared decision-making.

Of course, even the best of resources can often be overwhelming, especially in the face of a patient dealing with something like a breast cancer diagnosis. That is why employers, the largest providers of health care coverage in this country, have an obligation to help their employees. (And in helping their employees they can usually help themselves by lowering their healthcare spend when employees make higher value choices). Several years ago, we saw high deductible health plans soar in popularity; they were all the rage, and supposed to be the panacea to get patients more engaged. Today we know better, and according to Willis Towers Watson in their 2015 annual survey, the top performing employers also rely heavily on value-based insurance designs and network strategies, like Centers of Excellence, to steer their employees to higher value care, as part of their overall benefit design. With these in place, employees aren’t shopping for care in the dark; they have some guide rails which push them toward higher quality providers and higher value treatment options.

New data shows savvy employers are even taking these “guardrails” to a new level. The latest NBGH annual survey of employee benefits revealed that 36 percent of employers plan to offer their employees high touch concierge services this year. This is about more than steering employees toward higher-value choices; it is about actually talking them through the decision-making process.

Finally, a suggestion and one note of caution for all of us – we cannot rely on technology alone to solve this problem. The technology industry has made a fortune creating “apps” and other tools that promise to get patients more educated and engaged in their care and to help them make better healthcare decisions. But at the end of the day, we have to be careful we cannot rely on technology alone to save us. First, doing so ignores the “digital divide,” which in health care also means specific populations have less access to tech or are just less likely to use tech (e.g., the worker in a manufacturing plant not tied to his smartphone, or the older patient who can’t read the screen). But second, and more importantly, tech can never take the place of a real conversation between provider and patient or provider and healthcare navigator. These conversations often reveal additional concerns the patient might have or other real-world limitations. For example, Martha can’t refill her prescription because she doesn’t have a reliable source of transportation to the pharmacy. It takes a person-to-person conversation to reveal these issues and a thinking human-being to help problem solve.

If we continue work to support these conversations, educate patients, and give them benefit designs that help guide them, we can make a dent in this enormous problem. After all, if understanding your health care choices is giving you an ulcer, shouldn’t you know that is why your primary care doc referred you to a GI specialist?

Dr. Cindi Slater is the SVP for Medical Affairs for ConsumerMedical. She was a Clinical Instructor of Medicine at Harvard Medical School, and practiced internal medicine and urgent care at the Brigham & Women’s Hospital in Boston for over 20 years.

8 replies »

  1. Excellent insight on your article! Patient education is paramount to their success in navigating the complex healthcare landscape.

  2. Patients need to be aware of their health status or progress. Keeping patient informed
    and patient involvement in health care decision making is crucial. Today healthcare is moving from volume-based care to value-based care. We have to ensure they receive clear and understandable information.

  3. I think, visiting a doctor on a regular basis is as important as maintaining overall health. Especially for people in age. In case of unforeseen circumstances, you should always have a medical transportation team near you and the possibility to be examined in several hospitals. https://medic-trans.com/

  4. We need to do anything to cause the patient to be thought-of as the buyer…. then the hospital or doc or other provider will finally believe it is dealing with a tender human being, not a giant greedy insurer from Wall Street with endless resources and deserving to be shafted.

    I think vouchers or Medi-bucks might also work here as quasi- money as long as they are refundable and have value to the patient…and as long as the provider knows they are potential assets belonging to the patient, not a third party.

    Of course we are in a crazy price crisis now and HSAs and ABHPs won’t get us very far [Patients all have to be virtual millionaires to be secure in today’s health care marketplace]. But they are a critical next step.

    We really need something like vouchers now because governments do have to be kind and altruistic to the poor and needy and yet the patients have to be seen as the purchasers of their care. I can’t think of any other way to do this.

  5. Thanks or link to the Willis Towers Wilson piece.
    “Tax-dvantaged account-based health plans (ABHPs), an upstart idea at the millennium, are now omnipresent across every industry. Eighty-six percent of employers plan to offer them in 2016, up from 54% five years ago. The long-term effectiveness of ABHP design in helping to control health care costs — a subject of much debate and further research — will become increasingly clear over time as employers move to encourage employee enrollment in their ABHPs. Enrollment has more than doubled, from 20% to 43%, over the last five years.” I hadn’t heard “ABHP” before, but they define them as high deductible plans linked to an HSA.
    Re their effectiveness, Rand Corp research indicates an emphatic “yes”. And once someone figures out advisors and concierge and price transparency etc. the impact will be that much greater.

  6. “The docs used to be such agents”

    Maybe. I am not so sure about that. My best guess is that most of the time most doctors didn’t really know outcomes of other doctors. Most of the time you just knew if he was a “good guy”. Since the example was GI docs, I know that the people most of my fellow docs send referrals to are not necessarily the ones with the best outcomes. We might know who the really bad docs are and avoid them, but even there I see some pretty weak docs continuing to get referrals.


  7. It would be good to start acknowledging the slowly worsening level of community based Social Capital that forms how we all resolve the social dilemmas occurring within each persons civil life. As health systems, we would be better off to participate in this problem rather than assume that our healthcare for Complex Healthcare Needs can somehow overcome this problem, citizen by citizen (aka “patient”). Remember, our nation’s healthcare has now evolved to the point that virtually no one in the hospital that a person encounters, other than a few Family members, has a pre-admission “caring relationship” with the person:
    It is likely than obesity, maternal mortality, adolescent suicide/homicide, substance addiction, mid-life depression, mass shootings and paralyzed social mobility are all related to our nation’s progressive loss of social capital after the Korean War. There are three types of Social Capital that can be measured: bonding, bridging and linking. I offer a definition of a Caring Relationship.
    …A social interaction between two persons,
    …….occurring with an evolving Purpose, Synergy and Permanence,
    …that both persons understand as representing a Beneficent intent
    …to enhance each other’s Autonomy by communicating In Harmony with
    …Warmth, Non-critical Acceptance, Honesty and Warmth.
    The basics haven’t change since initially elucidated more than 60 years ago by Carl Rogers, Ph.D.

  8. The patients desperately need agents. The docs used to be such agents, but can hardly do so if they are paid by hospitals or are direct employees of the health plan….or if they have joined an ACO that rewards less care. Who serves this purpose now? Too often it is legal representation–or they are on their own.
    What we ethically need is patients and doctors (nurses too, but they might get fired) marching together to hospital administrations and politicians’ offices and Pharma firms and protesting the confusing billing systems, the costs of drugs, the needless bureacracies in hospital admission systems, the forced reduction in length of stays, the take-over by hospitalists replacing the patient’s own doc, the deliberate blockage of interoperable EMR data to other physicians, etc. ad infinitum. There are endless problems that docs and patients could both work on.

    This would be a natural tool that ‘patients could use to navigate our complex health system.’ as you say in your title of this article.