More Information Is Not Always Better: Pulling Consumers Into Active Choices About Testing

Wendy Lynch

Posted 5/01/12 on the Altarum Institute’s Health Policy Forum

“I’m thinking of getting a full-body CT scan,” Jane said. “What do you think?” Here was a healthy, active 72-year-old with no specific symptoms considering an expensive screening test. When asked for a reason, she shared that strokes run in her family and a doctor told her that she might be able to see if there was a possible bulge in a blood vessel in her brain. Plus, while they were looking, the scan could see if there was some other problem.

When asked how it would affect her to know – do you think you would consider brain surgery if there was a problem? (probably not); what might you do differently if you knew? (I don’t know); do you know whether a bulge in her vessel would definitely cause a stroke? (not necessarily); she hadn’t really gone that far. She just thought she should know.

Continue reading “More Information Is Not Always Better: Pulling Consumers Into Active Choices About Testing”

What Makes a Person Expensive in Healthcare? Not What Most People Think.

Posted 4/4/12 on the HCMS Blog

A question from the audience last month: “We spend the most in healthcare on a small portion of really sick people. You don’t expect them to shop for care during an emergency do you?”

I was giving a presentation about the important role that cost-conscious consumers can and should play in healthcare. The person asking the question, as everyone could tell, disagreed with the idea. While I doubt anything changed her mind, her loaded question illustrates some common misconceptions in healthcare: 1) high costs are driven by catastrophic medical events; and 2) treatments for these severe conditions leave little room for discretion and often require quick medical  decisions.

Continue reading “What Makes a Person Expensive in Healthcare? Not What Most People Think.”

Activating Consumers with Financial Control: Lessons from Health Savings Accounts

Wendy Lynch

Posted 3/6/12 on the Altarum Institute Health Policy Forum

Health Savings Accounts are growing up. No longer an oddity, millions of families have accounts funded by tens of thousands of employers (1). After almost a decade, the cumulative evidence about consumer-directed health plans is quite compelling. For those waiting and wondering if CDHPs “work,” three recent reports provide a convincing answer.

The Chief Medical Officer for Cigna health plans said this about one study: “Each year the evidence increasingly shows that properly designed consumer-driven health plans can lower health risks, reduce medical costs and drive engagement. The data once again shows that the combination of incentives, easy-to-engage health programs and consumer decision support tools can improve health while reducing costs.” (2)

Continue reading “Activating Consumers with Financial Control: Lessons from Health Savings Accounts”

Are Consumers Ready To Transform Health Care? If Not Now, When?

Wendy Lynch

Posted 1/26/12 on the Altarum Institute’s Health Policy Forum

There is a massive untapped resource in health care: consumers. Like a sleeping giant, unaware of its size and power, consumers have yet to realize what effect they could have on the system simply by asking questions or making choices. It’s not certain when, or if, consumers will awaken.

Consider this finding from our recent online survey of consumer opinions (1). The survey asked a national sample of about 3,000 employed individuals about where they get health information and how they use it. Only half of all respondents ever remember a doctor offering them multiple treatment options from which they could choose. Let’s remember the evidence: individuals who participate in medical decisions have better outcomes, better recovery, lower costs and higher satisfaction than those who don’t (2). Against this backdrop combined with national agencies promoting shared decision making with their “Questions are the Answer” campaign (3), and the new Physician Ethics Manual (4) insisting that the patient should be the primary decision maker about options, this answer is disturbing. But not surprising.

Continue reading “Are Consumers Ready To Transform Health Care? If Not Now, When?”

High-Cost Hospitals: Because Patients are Sicker? Think Again.

Wendy Lynch, Ian Beren, Justin Shaneman and Nathan Kleinman

Posted 12/30/11 on the HCMS Blog

It’s not surprising news that inpatient healthcare costs vary from hospital to hospital; large differences in price for the same procedure are common. But the reasons for variation are less clear. Some hospitals have consistently more expensive fees for identical treatments. However, these differences do not necessarily reflect better care: a recent study found that some high-cost hospitals rank low in quality scores and some high-quality hospitals are relatively low-cost (1). Plus, evidence shows that spending more does not produce better outcomes, higher satisfaction, or more appropriate care (2, 3).

Some plausible reasons for price differences include higher negotiated rates with health plans, delivery of additional or unnecessary services, poor efficiency or management of hospital stays, or several other possible causes. Yet, the most common assumption most of us make when we see price differences among hospitals is that some hospitals have patients that are simply sicker.

A recent HCMS analysis of hospital use by employees of a large, regional employer refutes that assumption.+   The graphic below shows cost per admission at ten different hospitals in the same geographic region according to the severity of illness burden of the patients the hospital treated. Most hospitals fall along this expected cost trend, with a median cost of $2,300 per increasing unit of illness. However, a few had costs above that expected rate of $15,000 to $20,000 per admission.

Continue reading “High-Cost Hospitals: Because Patients are Sicker? Think Again.”

Paying Patients To Take Drugs, Or Helping Them Make An Informed Choice

Wendy Lynch

Posted 11/29/11 on the HCMS Group Blog

It’s hard to imagine something scarier than a heart attack: crushing pain, combined with the realization that the organ you rely on to beat every second of every day is in trouble. Suddenly, you are mortal.

Many patients who experience a heart attack consider it a wake-up call, and a reason to take better care of themselves: “Maybe I should walk more and lose a few pounds.”  Certainly, for heart-attack victims who are prescribed a medicine to drastically reduce the chances of another heart attack, there is a strong motivation to take it.

But here’s the surprising part: often they don’t. In the year after a heart attack, only about 40% of patients take medications as prescribed (1).

Continue reading “Paying Patients To Take Drugs, Or Helping Them Make An Informed Choice”

The Biggest Health Disparity of All: Control (Part 2)

Wendy Lynch

Posted 11/10/11 on the Altarum Institute Health Policy Forum

Patient Activation is a popular topic in recent health policy discussions. Activation means that a patient is informed, participating in his or her care, and feels comfortable and involved in decisions (1). It sounds powerful. Lower activation is associated with a higher rate of medical errors (2, 3), lower adherence to recommended medication (4), and lower satisfaction with care (2). Conversely, active participation in decision making results in less expensive treatment choices (5), faster recovery (6), and better perceived outcomes (5).

Continue reading “The Biggest Health Disparity of All: Control (Part 2)”

The Biggest Health Disparity of All: Control (Part 1)

Wendy Lynch

Posted 11/8/11 on The Altarum Institute Health Policy Forum

In any other industry, minority and elderly discrimination would be front-page news. A recent study confirms elderly and minority customers get higher-cost hospital care than other more affluent white customers and are more often exposed to harmful, even deadly outcomes (1, 2). Fact: care for these patients will cost significantly more, yet their health outcomes and personal safety will be compromised. But in health care, it is not news.

This is the nature of health care disparity. But it reveals an even more troubling issue we rarely discuss: information, choice, and control. Not only do these patients receive substandard, over-priced care (1), they likely don’t even know it! The system limits information, limits choice, and offers patients little control over their options. In this and a subsequent blog, we will explore how lack of choice and control institutionalize the very disparities we aim to eliminate. 

Continue reading “The Biggest Health Disparity of All: Control (Part 1)”

Note to Consumers: the Rules in Health Care are a Little Different

Wendy Lynch

First posted 9/28/11 on the HHCF Blog

Let’s say you’ve invented a new product. Before you can sell it, you need to figure out its price such that you maximize revenue without pricing it higher than your customers will pay.  If it costs more than similar products, you’ll need to figure out how to convince people to pay more for your product than they might elsewhere.  This is how healthy, rational consumer markets work, promoting innovation that balances cost and quality. To contrast, now imagine you’ve invented a new product in healthcare. Guess what?  You get to set the price without worrying what cost consumers will tolerate because they won’t be paying for it directly, and it doesn’t need to reflect how well the product works!

Why Advocate For Consumer Choice in Health Care?

Wendy Lynch

First posted 9/27/11 on the Altarum Institute Health Policy Forum

There is no shortage of important topics in health care; the U.S. faces thousands of challenges, from the prevalence of childhood obesity and hospital infection rates, to the affordability of new specialty medicines and end-of-life care.  Our delivery system is far more expensive and far less safe and effective than it could be.  Providers deliver care of ever-increasing complexity within brief, often-rushed encounters, leaving limited time for dialog.  So, why invest resources and attention on an individual’s preferences about treatment?

The answer is simple: consumer involvement in care decisions results in safer, more effective, and less expensive health care. (1, 2, 3) Additionally, consumers who participate in care decisions report higher satisfaction, faster recovery from illness and better quality of life. (4, 5) Finally, care plans resulting from a shared-decision-making process result in better medication adherence and clinical outcomes. (6, 7, 8)

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Uncertainty: The Similarity Between the Financial Markets and Health Care

Wendy Lynch

First posted 8/18/11 on the HCMS Blog

A question: Does uncertainty in medicine mean consumers should be more or less involved in choices?

As the country watched wild swings in the stock market these past weeks, every investor faced unfortunate hindsight: if only I had cashed out at 12,500! Combined with the pain of continued uncertainty, many investors decided to remove their (remaining) funds simply to stop the discomfort of an unknown future.

While we all dread the anguish of downward market fluctuations and wonder daily what it is store for our dwindling nest eggs, no one can change the fundamental truths of investing: risk and uncertainty.  Yes, experts can advise us and help us assess varying degrees of risk among options, but no one can guarantee the success of our investment decisions, no matter how well informed.

If the world of financial markets is this uncertain, should investors be less involved in the decisions about where they place their money and how much risk they assume?   One could easily argue that the average investor is not capable of making good decisions.  So, should we all find a seasoned stock broker to make decisions for us, independent of our personal circumstances and preferences? After all, they are the experts—right?

Continue reading “Uncertainty: The Similarity Between the Financial Markets and Health Care”

Informed Choices: A Critical Responsibility for Health Care Consumers

Wendy Lynch

First posted 6/07/11 on the Altarum Institute’s Health Policy Forum

Did you know that doctors make different treatment choices for themselves than they recommend to their patients? A recent study found that doctors are more likely to take on the risk of death to avoid serious complications than they recommend to patients. (1)

Here’s an example question from the study: To treat or not to treat Avian flu? Two-thirds of doctors said they would rather take a 10 percent chance of dying of Avian Flu than a 6 percent chance of death and 4 percent chance of paralysis from the treatment. Yet, more than half would recommend the treatment for their patients. Knowing what they know, understanding what they might face, considering whether or not they might get sued, doctors make different choices for patients than for themselves.

Continue reading “Informed Choices: A Critical Responsibility for Health Care Consumers”

In Health Care, Why It Is Best That We Choose for Ourselves

Wendy Lynch

First posted 6/23/11 on the HHCF Blog

Faced with a difficult medical situation, it is not uncommon for patients to ask doctors for advice.  But asking, “Doctor, what should I do?” is a very different question than, “Doctor, can you help me understand and weigh my options?” It may sound like semantics, but your involvement and participation in making personal health decisions can make a difference in your recovery.

A recent study showed that patients who make their own choices report better recovery than those for whom choices were made by doctors (1).  Regardless of WHAT choice was made, the patients who did their own choosing reported better physical and psychological outcomes; active choice-making had its own healing power.  It may also protect us from unwanted consequences.

Continue reading “In Health Care, Why It Is Best That We Choose for Ourselves”

Being A Consumer Isn’t Just About Money, But About Choice

Wendy Lynch

First published 5/5/11 on the Altarum Institute Health Policy Forum

Imagine you heard about a friend who purchased and moved into a new home based on the advice of his realtor. He later regretted the decision, learning that he paid twice what he should have, there were unsafe levels of pollution nearby, and the roof leaked. Would you wonder why your friend hadn’t done his homework? Or would you assume that, because he is not a property expert, it was wise to rely solely on advice from his professional realtor?

Asked in a different way: when considering the purchase of an important product or service, how important is it to be personally informed about that product?

Continue reading “Being A Consumer Isn’t Just About Money, But About Choice”

A Football Team Without a Front Line. That’s Medicine When (If) Primary Care Declares Independence

Wendy Lynch

First published 4/25/11 on the HCMS Group Blog

Behind closed doors trouble is brewing, and maybe it’s about time.

The situation has all the elements of a daytime drama: an exclusive cartel dictating price; a powerful committee with secret members and closed-door meetings trying to avoid exposure; members threatening mutiny; and media “spin” making it hard for the public to tell good guys from bad guys.

No, I am not referring to the NFL dispute between owners and players.  This is medicine.

The soap opera around the RUC (Relative-Value Update Committee) is real and the stakes couldn’t be higher: this little-known group influences the allocation of 2.5 trillion dollars (1) in healthcare spending each year.  But a closer look leads me to believe things are about to change.

Continue reading “A Football Team Without a Front Line. That’s Medicine When (If) Primary Care Declares Independence”