BCBS of Minnesota has set up an interesting approach to transparency and measuring provider performance. They’ve created a site called HealthCareFacts.org for consumers to look at and compare provider details, set up a subsidiary called Consumer Aware to run it, and are now marketing it to the world. The model is nutritional labeling. I met Amelia Schultz (the VP of Sales at Consumer Aware) and she set up this interview with founder and CEO MaryAnn Stump. (The interview was recorded on Feb 14, but posting was delayed because I had to fix some technical problems with it. All better now, I hope!)
TECH/CONSUMERS: Internet health use survey, with UPDATE
For you survey geeks, Cisco sponsored a study of Internet use in health care among patients. Here’s the press release & here’s the detailed results
.
If anything the “demand” numbers look lower than in some other surveys (things like wanting to use email with docs, access lab results, etc). But the “supply” numbers (those doing that) are much lower, of course.
UPDATE: I got a really good comment/question about this from Dirk at Aurora IT. "Those numbers really seem to conflict with most of the other
healthcare-related Internet use surveys I’ve seen. Do you buy it or
rather them?" So here’s my answer to Dirk, given that this type of survey is absolutely in my wheelhouse.
I’m looking into it. Hopefully the Cisco guys will share more data with me. They did this survey through one of their main mkt research vendors who isn’t too well known in the obscure part of the survey world that focuses on consumer health care IT use. I don’t know if they have good data to compare it to historically on the same questions, but I kind of doubt it. My first take is that the numbers saying that they can get services from their doctors are a touch higher than usually reported–but that may be an indication that these services are spreading (finally!!). The demand side numbers seem to be quite a bit lower than I’ve seen from other surveys, especially Harris over the years. (e.g. Harris has reported more than 70% wanting their lab results online both in 2001 and 2002 –I think they did it again more recently but I can’t find it). But that seems to be connected to the way that they’ve asked the questions, and frankly it’s unclear how they’ve done that from the results reported. (multiple choice vs most important on the question "Assuming these services were all available from your primary care provider, which would be most important to you?"). But we’re way down in the weeds of survey methodology here.However, the good news is that this is new data on the right topics, and I’ll ask the Cisco folks if they can share a little more of the results.But kudos to Cisco for researching into this–especially as they don’t sell anything that directly relates to it.! As you can tell, there’s a paucity of good data about the specifics of who does what and who wants what in this arena, and they’re helping to fill those holes. And given the amount of people who are offering solutions in this space, well it’s clear that more needs to be known about what consumers really want rather than less!
PODCAST/TECH/CONSUMERS: Bob Lorsch from My MedicalRecords.com
Next I had a good combative chat with Bob Lorsch who’s sunk a lot of money into MyMedicalRecords.com and believes that a standalone personal medical record company can survive and prosper. I’m somewhat skeptical, so it was fun to get into a little bit of contention. Here’s the interview.
CONSUMERS/QUALITY: LASIK–not as user friendly as it’s supposed to be
There’s been lots of BS about how the price reductions in those ads for LASIK "prove" that cash based consumer payment works in health care. I always thought they were like the teaser prices in travel adverts in the Sunday papers–only good if you were leaving Tuesday at midnight, staying 4 months, taking no luggage, and having to fly the plane yourself while the pilot takes a nap.
And now HSC shows that it’s not as advertised.
HSC president Paul Ginsburg, Ph.D., points out that current efforts to increase price transparency for health care services often downplay “the complexity of decisions about medical care, patients’ dependence on physicians for guidance about appropriate services, and the need for information on quality.”
Ginsburg cautions that simply giving consumers a price list of “a la carte” services does little to help them make informed choices about which providers will cost less for an episode of care, let alone which providers offer the best value — or the optimal combination of the lowest cost and highest quality.
The article also points out that insured people have different needs for price information than uninsured people. Insured people need to know what their costs will be under their insurance and benefit structure. And policymakers should be careful not to overlook the role of health plans in negotiating better prices and translating complex price and quality data into usable consumer information that can potentially help steer patients to lower-cost, higher-quality providers, the article notes. Researchers chose the LASIK market for in-depth analysis largely because the vision correction surgery is widely regarded as the self-pay market with the most favorable conditions for consumer shopping. LASIK is an elective, nonurgent, simple procedure, giving consumers time and ability to shop; screening exams are not required to obtain initial price quotes, keeping the dollar and time costs of shopping reasonable; and easy entry of providers (ophthalmologists) into the market has stimulated competition and kept prices down.
However, LASIK patients still face significant hurdles when shopping from inconsistent bundling of what’s included in the procedure price to misleading advertising to quality concerns.
— Inconsistent Bundling. The package of services included in LASIK procedure fees varies across providers. For example, one critical factor is whether the cost of enhancement surgery is included in the fee. A price quote that appears to be the best deal but does not include follow-up operations if needed might end up being the highest-price option.
— Misleading Advertising. Misleading offers for free consultations or for LASIK for $299 and promises that LASIK would eliminate the need for glasses and contacts for life have all come under scrutiny by state and federal regulators, resulting in enforcement actions and settlements to halt the misleading practices.
— Quality Issues. Many industry observers expressed concern that LASIK is regarded as a commodity by some consumers, leading them to shop only on price, when provider quality may vary considerably. Even when consumers are interested in obtaining quality information, the study finds that it is not easy; those wishing to compare provider quality must gather information on success and complication rates from each LASIK surgeon’s practice.
Which of course means that if we’re going to get to real consumer purchasing, we need to figure out a rational way to price for rational bundles of service–and we have to make sure that providers are showing apples to apples comparisons.
CONSUMERS/QUALITY: A DIY Approach to the Diabetes Epidemic by Amy Tenderich
#1 health care blogger, well actually #1 patient blogger, but probably the most important one in the whole medical blogosphere, Amy Tenderich has written a book called called Know Your Numbers, Outlive Your Diabetes about (obviously) how to manage diabetes. We don’t deal much with actual medical care over here at THCB, but for your holiday Monday I thought that an introduction to her book would be a great start. And of course who better to introduce it than Amy herself!
Forget any inkling you may have had that the media is sensationalizing the "diabetes epidemic" story. It’s real folks. In fact, the American Diabetes Association just launched a campaign called "Every 21 Seconds" as in that’s how often another American is diagnosed. Diabetes now affects the lives of 20.8 million children and adults in this country, and at the going rate, could rise to 50 million by the year 2025.
With the medications and tools available here in the US, the devastating effects of this disease are largely preventable.
TECH/CONSUMERS/BLOGS: Information Therapy and Other Ways to Change the World
Josh Seidman, the President of the Center for Information Therapy, and someone I must confess to knowing and liking, has descended into the mire and started his own blog. He told me that a friend had suggested it to him—I told him his friend can’t have liked him very much!
The blog is called Information Therapy…and Other Ways to Change the World. I must also confess that I’m partly responsible for the recent entry on PHRs as I’ll be a presenter with Josh at a webinar for the Center on PHRs and Information Therapy which is coming up on Tuesday January 23. The idea is that we’d generate a little interest and get a few potential new members for the Center to listen in. I was hoping to invite THCB readers to fill out the crowd. But within 12 hours of sending out the announcement, they’d had more than 100 sites sign up, which means that we’ll have to do it twice at least, and I’m not sure there’ll be room for any more.
I’d like to think that Josh and I are such a draw that we’re responsible for the crowd. But I tend to think that (in my view 6 years too late!) the PHR is finally starting to get the attention it deserves. If you are really keen to attend, send Dorothy Jeffress at the Ix Center an email, and she’ll see if she can squeeze you in.
TECH/CONSUMERS/HEALTH PLANS: Not much employer backing for HSAs
Those of us who feel that the CDHP movement is largely being used as cover by employers for reducing the benefits (i.e. compensation) that they’re paying employees will not be too surprised by this new analysis. The source, Vimo, though is somewhat surprising for two reasons. First, it’s a little technology start-up that’s providing comparison shopping for health, and second—as is clear when you listen to the interview I did with CEO Chini Krishnan—they are more than favorably disposed to the notion of individuals doing their own shopping for not just health insurance but all types of medical goods and services. So it’s hard to imagine them benefiting from bad news about HSAs. Yet what they’ve discovered, confirming research done by the more usual suspects such as HSC, is that as employers convert their benefit offerings over to the HDHPs, they are not funding their employees’ HSAs.
Here’s the key part from their analysis:
First, the difference (in numbers) between HDHP (3,168,000) and HSA (820,000) means that there are a lot of individuals within the group and individual markets who aren’t opening HSAs, even though they’re entitled to them. Second, HSA asset levels are also lackluster. The same AHIP study lists the average HDHP deductibles as HDHPs $2,378 for single coverage and $4,760 for family coverage. The average HSA balance in the Inside Consumer Directed Care survey ($1,180) is less than fifty percent of the average deductible for single coverage.The simple fact is that HSA creation and asset levels are lagging HDHP enrollment by a significant margin.
And realistically given that some people are funding their full HSAs, given that the average is well below half the maximum, the median HSA account probably contains close to $0. What’s going on then? Well Vimo knows the answer.
Certainly there are immediate and significant savings available when companies or individuals migrate to HDHPs. This cost differential can be pocketed as a one time gain, or it can be used to fund most or all of the HDHP deductible by depositing the difference into an associated Health Savings Account. It would seem that many employers are opting for the one time gain.
If you’re in a business which depends on these accounts and CDHPs being adopted by a bunch of happy consumers, you can see that there is plenty of potential for angst amongst employees who discover that the move to the CDHP is basically telling them that they have to dip into their own pocket for something the company used to provide. In what is a very considered and well put-together report—which I’d recommend you read all of—Vimo discusses the impact of this “transfer” on both consumers and employers. And true to their business model they are squarely on the side of looking out for consumers and employees.
I approve of them telling the truth, even if it’s a truth that opponents of the CDHP movement will highlight. After all, if this thing is done wrong, the longer term political consequences may be a future in which there is no such thing as a high-deductible plan or HSA—and that will leave Vimo with a whole different business problem.
BLOGS: that #1 health care blogger can’t be kept quiet
Amy Tenderich becomes ever more famous: TypePad Featured Blogs: Diabetes Mine.
But keep your eye on that site for Sunday (hint!)
TECH/CONSUMERS: Revolution Health & MedBillManager
OK for those of you desperate to take a look at Revolution Health’s "invite only" site, here is an officially blessed invitation to go sign-up (and of course to look at what $500m buys you!).
Meanwhile, at the other end of the opulence scale, start-up Medbillmanager is attempting to compete with Revolution/Intuit et al in the way consumers deal with their medical and insurance billing/payment.
Obviously it’s early days. But it’s well worth taking a look at both of these two sites to see how new web technologies are putting information, organizational capability, and just maybe power, into the hands of consumers.
TECH/CONSUMERS: Deciphering a revolution?
Fard gets a sneak peak at Revolution Health’s site over at HealthCare Vox.
