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).

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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)”