Posts Tagged ‘Wendy Lynch’

Patient vs. Consumer – or Is It One in the Same?

Too often, the consumer versus patient debate is centered on money, which is too bad, because money is just a mechanism to create the real difference – involvement in and ownership of choice and responsibility of the outcomes. Who ultimately should decide what happens to your body?

The goal of consumerism is not to save money by limiting care, but to encourage and empower individuals to make informed choices. Like a home buyer who doesn’t inquire about safety, quality, or price, too often we agree to medical services without knowing all our options, or their benefits and risks. Money matters because we behave differently when we pay for things ourselves. When we hold the purse and write the check, we are more likely to ask about the price, value, and safety of any product.

In most cases, we accept that buyers have a shared responsibility when purchasing products and services. However, when this discussion revolves around healthcare, the outlook and opinions tend to polarize to extremes.

Several articles and blog discussions over the past six months have sparked emotional debate about the potential dangers of asking citizens to spend some portion of their own money and behave like consumers when using health care. Strong objections to even using the word consumer arose because, they argue, health care is not like other products. For many people, health care is not a desired product, but a fundamental need that should not be evaluated based on cost. And in general, people believe that because most decisions are complex, patients need medical professionals to make time-sensitive, highly sophisticated and technical decisions on their behalf.

Those concerned about the risks of consumerism focus almost exclusively on the risks of not receiving necessary care due to lack of knowledge on medical issues. But there is another side to this. One of the least quoted results from the famous RAND health insurance experiment, which examined utilization differences between people with high and low deductibles, is their conclusion that those who got free care were exposed to more harm than good because they had higher rates of inappropriate treatment than those who paid for their care. Those sheltered from expense were simultaneously exposed to greater risk from over-treatment.

The single most important way you can help to prevent errors is to be an active member of your health care team. Patients who are more involved with their care tend to get better results. Leave out the ‘consumer’ label if you wish, but don’t assume that distancing patients from direct involvement in choices, i.e., buying them, is safer or healthier for anyone.

Saving Your People and Your Business

I just read a new book from cover to cover in one sitting. The book, written by Wendy Lynch, PhD and Hank Gardner, MD is titled, Who Survives? How Benefit Costs Are Killing Your Company.”

However, I believe the subtitle of the book, “Saving Your People And Your Business,” better summarizes why business owners, HR managers, senior executives and, maybe most importantly, government legislators – ESPECIALLY those who are actively pontificating about healthcare and healthcare benefits – ought to take an hour and read this book.

Folks, this book is worth the read for the clear-headed narrative around benefits alignment and the discussion of the aptly used reference of OPM (Other People’s Money). Wendy and Hank have a real gift for taking on an often divisive discussion topic that I’ve heard debated and passionately defended everywhere from in boardrooms to breakrooms – the U.S. healthcare system.

Three years ago, I was faced with an elemental question by my dying mother related to her healthcare and the ensuing/mounting bills: “Honey, just tell me who I owe, what I owe and if it is fair.”  That ridiculously obvious and reasonable question was incredibly difficult to answer because of the perverse mis-alignment of the current system’s lack of transparency to the patient and caregiver around cost and value.

Yet it was/is not misaligned out of spite nor malice, but because the people paying the majority of the bills were not the patient but rather the insurance company and the government (Medicare in my Mom’s circumstance). Ironically, the people that were paying the bills could have answered Mom’s questions, but over the decades, they continued to lose touch with a patient’s need and inherent desire to get the best value for any given service. It is also true that patients have lost touch with caring about value, as every medical expense seemed like any and every service was simply a $20 co-pay regardless of intensity (unless you were uninsured, which then meant you were simply screwed and at the mercy of the system).

One of my favorite quotes from the beginning of the book helps to summarize why it’s worth reading:

“I was ready for a new explanation, but old beliefs die hard. Several months into our collaboration, Hank and I had a conversation about patterns of costs in a company facing significant challenges. He asked what I thought about their insurance plan and absence policies. Because my answer showed I was less interested in policies and more interested in employee health, he issued me a direct challenge: make the effort to understand the over-arching influence of economic incentives or it will be difficult for you to help employers.”

Times have changed for healthcare. The idea that patients have the right to spend OPM is fading away. Patients are now spending more and more of their own money. Not only that, but they are asking the same question that my mother asked, “It’s my money now. Was it a good value for the money spent?”  To me, that cataclysmic shift from OPM to MMN (My Money Now) follows the core premise that economists have long understood (and Wendy and Hank eloquently and concisely convey in their book) – that we have a right and responsibility to take care of our healthcare expenditures.

I don’t mean to sound arrogant (passionate maybe) but every CEO and legislator should read this book because without grasping its insight, without embracing its core precepts, healthcare costs will continue to spiral out of control. And those left with the massively accruing bills will never be given the information they need to determine the value for the services they access. Without alignment of incentives, U.S. healthcare will remain a $20 all-you-can-eat buffet. Sadly, if the buffet continues, there won’t be anything to bring out of the kitchen to restock because we’ll run out of resources and money to serve the hungry customers who continue to pile in the door and return to the line again and again.