By CINDI SLATER, MD, FACR
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.