Consumerism Driving Healthcare Change

On reflection, the 2019 Thinkathon impressed with a wide variety of influential speakers.  For those of you who may not know, the Center for Health Innovation and Implementation Science holds an annual event gathering over 300 people throughout the medical industry to troubleshoot the most significant issues preventing healthcare from advancing to a newer and more efficient model.  Between the two Innovation Forums, breakout sessions and networking opportunities, the Thinkathon presents a range of presenters, innovators, and leaders in their fields, to engage the audience in subjects endemic to improving our Healthcare system.

 I chose to write my reflection piece on the presentation of Deborah Gordon, a senior fellow at Harvard Kennedy School and an expert scholar on Healthcare Consumerism.  On first blush, my knowledge of consumerism practices in healthcare is mostly drawn from my own experience.  Although I have fortunately not had to grapple with any significant chronic conditions, I have been to the emergency room off and on through my childhood and adolescent years for various injuries sustained during my activities.  My parents handled the financial side of those visits, so it was only as an adult caring for my sick wife that I truly got a taste of the consumer’s journey through the medical environment.  For a little background, my wife came down with a mysterious affliction shortly after our marriage last October.  She could not keep food down, and everything outside of water irritated her stomach.  She lost a considerable amount of weight and had to stay with her parents for a week during the ordeal, as she was too weak to care for herself while I was at work.  Admittedly, I felt panicked during this period as she went through a colonoscopy, endoscopy, and saw two different specialists try to diagnose her condition. Twice she had to go to the emergency room to tackle dangerous dehydration and nutritional deficits. Miraculously, she recovered without the doctors ever figuring out what caused the episode.  Although grateful for her rejuvenation, it was not long before the bills came in and I got the first-hand experience in the cost of care.

Deborah began her presentation by calling attention to Kenneth Arrow, an American economist, mathematician, writer and political theorist who rose to prominence in the 1950s and ’70s as a significant Post-World War 2 figure in neo-classical economic theory. Explicitly in 1963, he declared that healthcare was ‘different’ than other consumerism markets and, in doing so, set the tone for the medical field into modern times.  Americans spend trillions of dollars, out of pocket, every year for our medical expenses.  The current system does not consider the consumer so much as it sets prices and practices by older standards and expects the customer to adjust their expectations.  Among the barriers to a clear sense of patient agency, Price Opacity stood out to me.  I remember that during the consulting with various specialists during my wife’s illness, I remarked to her how difficult it was to ascertain the price of procedures or visits.  Without the medical literacy to fully understand her condition, nor the measures that would most effectively address her illness, I found myself merely agreeing to the recommendation of any medical professional she saw on next steps.  I doubt I could tell you the point of all the tests she took or chronicle the progress of her medical investigation.  At the end of things, I had several bills from different offices for high prices I had somehow underestimated.  My limited understanding of both my insurance provider’s coverage options and the costs of these procedures led me into an awkward position financially and left me leery of ever returning.  As a consumer, I found this self-doubt and bemusement a frustrating emotion to trudge through, especially as I wanted to trust the system for my own eventual care going forward.

A consumerist based healthcare system would address my aggravation and the sea of similar experiences among patients throughout the United States.  Deborah pivoted from point to point, discussing how Clear Pricing and Clarity practices would allow us to not only understand what we were paying for and how much but to also evaluate the value of that service before arriving at a decision.  If the consumer could hold the medical field accountable, we could influence the standards of quality necessary to make the hefty financial decisions involved justifiable.  She also suggested that tailoring the customer experience from the medical side could allow us to feel more heard during our healthcare journey and accompanied by experts who would be able to advise us on our next steps, options, and financial approaches.  With a focus on portability, we might avoid the loss of health benefits when necessary and the difficult decisions of whether to stay in a career or job that is unfulfilling simply to cover the essential medical benefits.  The changes she suggested were significant, a complete restructuring of the service side of medical treatment and the involvement of insurance companies.  I felt vindicated, sitting in the audience, reflecting on my past.  She outlined a system that I could trust and feel confident in navigating as a non-medical professional.  With such complicated bodies, it can be challenging to understand all the factors that influence our health and continued longevity.  Currently, the average consumer struggles to feel in control during moments of significant vulnerability.  Healthcare is a necessary service for our nation, and yet so many feel helpless when forced to engage with it.  I personally thought it and based on what Deborah was presenting, I felt that this patient-centric angle has always been the White Whale of the industry.

 Working at the Center for Health Innovation and Implementation Science allows me to see several of Deborah’s concepts actively utilized.  The mission of CHIIS has always been to leverage our implementation methodology and innovative experience to drive patient-centric changes in the healthcare environment.  The new Healthcare system we envision, Healthcare 2.0, sets the patient experience as one of the cornerstones of the structure.  The more we can engage with healthcare professionals and their care environments, the more we can teach and lead teams towards that pinnacle of customer satisfaction the industry is trying to reach.  Deborah helped put into words several of the frustrations I had experienced previously and reinforced the mission I work towards with my colleagues here at the center.  If I can be part of the change which will help people throughout the country better engage and take ownership over their own healthcare journey, I will consider it to be a cause worth working towards.

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