Health 2.0: Priming the pump- Jump starting health care consumerism By Scott Shreeve MD

Scott Shreeve co-founded MedSphere, the Southern Californian open source distributor of the VistA EHR. His latest effort is Crossover Healthcare. Scott has been tracking recent developments in the consumer driven health plan sector. Today he shares his take on a series of reports that suggest the CDHP movement may be faltering. The following piece was originally published on his blog, which can be found here.   

Jumpstart (jŭmp stärt) v.

1. Starting an automobile engine that has a weak battery by means of jumper cables
2. Start or re-start in a vigorous manner
3. Start something by tapping into another source of power

A recent report by the Wall Street Journal casts some concern over the vitality and validity of the entire consumer driven health movement. The critique provides some hard numbers regarding the actual uptake in numbers which is significantly less than some other reports indicate. Worse still, a recent report by Towers Perrin indicated that many people with HDHP plans are dissatisfied with their consumer experience to date.

A few representative (and instructive) comments from the WSJ article include the following:

“…the approach appears to be stumbling -- largely because of consumers' unease in using them"

“…consumer-directed health plans often report lower satisfaction and confusion about how the plans are supposed to work"

“If I were a product manager in any other industry and saw scores this low in customer satisfaction and understanding, I'd be thinking of pulling that product from the shelves”

“One reason for the frustration is the uphill battle many consumers describe in trying to shop for their health care."

“Few employers are focusing on the costly measures -- such as offering better coverage or more consumer education -- that may be needed to accelerate these plans.”

“…the vast majority of companies still do not have the time, effort or resources to prime the pump."

So, is consumer driven healthcare just another passing fad?

The WSJ article and the Towers Perrin report fairly acknowledges many of the obstacles to consumer driven health uptake in the market. However, I was always taught by my father that obstacles are what you see when you take your eyes off the opportunity. Therefore, my read of these articles was that smart, nimble entrepreneurial companies should be jumping up and down at the opportunity to jumpstart consumer directed adoption by health plans, large employers, and consumers themselves. In fact, as I have highlighted before, in the new healthcare paradigm of increased informational complexity just wait until we get into genomics and true personalized medicine!) advisory services will become essential.

As I have also stated before, "Consumer Directed Healthcare" is a misnomer. Consumers can't "direct" or "drive" healthcare because they are just one player in a complex game. In addition, consumerism as the panacea is an oversimplification which miscalculates the role of consumers within the value driven reform movement currently underfoot. However, consumerism will undoubtedly be important because consumers are being asked to pay for more of their healthcare bill - whether or not they are in a HDHP. Rising premiums, rising deductible, and overall rising costs mean that the inevitable cost-shifting will be directed to the least (initially influential person in the power struggle -> consumers.

However, with enough of the cost pressure being redirected to consumers, and with increasing concerns over healthcare quality, safety, and value, consumers will inevitably self-organize to become a powerful and influential voice. Consumers are currently and will increasingly be emboldened by a new cadre of health information companies providing the next wave of information technology that can aggregate, analyze, and advise them regarding their personal health information. These companies will leverage core principles of value driven healthcare, transparency, and web 2.0 that support and empower consumerism to make rational health care decisions. The interactions that occur will be personal, relevant, timely and engage the consumer at the medical condition across the full cycle of care. These interactions will also add value to the consumer, support them in their new role as health care shoppers, and help them achieve the very best outcomes.

This is the level and type of support required to help nurture the fledgling consumer movement. I don't believe that anyone can honestly tell me that a more engaged consumers is bad for the health care system. However, no one should be under the impression that after 50 years of healthcare paternalism, consumerism is currently at the "just add water" stage. So between the current state and the fully activated state, there needs to be a consumerism catalyst - a trusted third party like HealthEquity*, who is solely focused on helping consumers understand HDHP and HSA's so that they can "better save and spend their health dollars". HealthEquity is an example of a company "priming the pump" by aggregating information, analyzing data, and provide value added advisory services back to consumers.

This is exactly what is needed to jumpstart the Consumer Empowered Health market - next generation Health 2.0 companies that serve as "catalysts of consumerism" by offering a suite of consumer advisory services. These services will empower consumers to not only understand their CEHP plans, but also make rational health care choices across all aspects of the care cycle and demonstrate superior outcomes in a transparent and value driven health system.

Now, that is something to drink (water) to!

* DISCLAIMER: I am currently consulting with HealthEquity to build out their consumer platform.