Fed up with our health care delivery system? Maybe even angry? What should a person do? What can a person do?
I recently wrote a post on drivers of change in health care delivery such as the aging population, adverse lifestyle behaviors, shortages of physicians and developing consumer expectations. I planned to follow up today with what those drivers will produce as change in the delivery system. But a commentator responded to the post that patients are being shafted by their doctor, insurance company, the pharmaceutical and medical device industries and others. Maybe you feel the same way. You can wait for the government to fix things – but that could be a long wait. Or, you can take some personal action and fix for yourself or your company what actually can be fixed now. So I decided instead to respond today with just a few suggestions that can make a big improvement in care while actually reducing costs. There are others in “The Future of Health Care Delivery – Why It Must Change and How It Will Affect You.”
If you are a CEO or other senior leader of a company consider these options. Offer your employees a high deductible policy, give the employees the premium savings and create medical savings accounts or health savings accounts so staff can purchase care with tax advantaged dollars. Second, offer wellness programs. Let your staff sign up for nutrition, fitness, stress management or smoking cessation programs. But insist on accountability and in return give them a further break on their share of the health insurance premium. These programs work, can be completely cost neutral to offer and the result can be a healthier more productive workforce with enhanced job satisfaction plus a stable or possibly even lower premium level next year. And you don’t have to invent the wheel yourself; just engage a company such as Orriant that organizes these programs to do the work for you, again usually at no incremental cost to your company.
As an individual, here are some steps to personally take. First, sign up for a high deductible policy. Most health insurance today is not insurance in the usual sense of paying a relatively low premium to cover a major event the way auto collision insurance does. Instead, most insurance today is basically “prepaid” health care, i.e., everything including routine care and all prescriptions are covered, perhaps with a co-pay from you. Better to have real insurance, i.e., it covers major expenses such as a hospitalization, surgery, or very expensive medications for cancer treatment, etc while you pay directly for the routine stuff up to a limit that you pick, say $1000-2000 per year. Best if you can use tax advantaged funds in an MSA or HSA for those expenses. (Medicare does not have high deductible policies but both your Medigap insurer and your Medicare Part D prescription plan probably do have them.) The premiums for a high deductible policy are much less and it does one other important thing. It encourages you as a patient to challenge your doctor’s recommendations. Maybe that prescription could be changed to a less expense option. Or the MRI could be saved until an observation period elapses, etc.
Second be sure you have a primary care physician (PCP). Tell him or her that you have a high deductible policy so you will be paying directly for most care. Then tell the PCP that you want to negotiate a typical professional-client relationship that works for each of you. You will pay for a visit but you want the visit to be long enough and in enough depth that your issues can be carefully reviewed and considered. Maybe ten minutes is plenty for a check to see if a blood pressure medication is doing the job but you need much more time for certain other encounters. Discuss price up front. Expect (insist) to get the time and attention you need given that you are paying at the door for the service.
Ask that the PCP spend some real time each year addressing preventive medicine. How can you stay well and avoid disease today and tomorrow? Perhaps the PCP will need to refer you to a nutritionist or a personal fitness trainer. If so, ask him to call that person and discuss what your needs are; it will make a real difference in what services you get. And the PCP should monitor your progress, perhaps just by telephone or email but with a definite timetable that the two of you agree to up front.
If you have a chronic illness, say type 2 diabetes, then you need to tell your PCP that you expect him or her to carefully coordinate your care. The same principle as with prevention holds here as well. The PCP should directly call any specialist or other provider to explain what the consult is aimed at determining and should request a return call after the consult. Your PCP should discuss any test, procedure or imaging study with you in detail: Why does he suggest it? What will he do with the results? Is it important or “just to be complete?” The same concept prevails with prescriptions; ask lots of questions.
Understand that most PCPs don’t do extensive prevention or good care coordination today because insurance pays so little that they simply can’t spend the time required. It is different when you are paying the bill yourself. Ask for, expect and if necessary demand the service that you need – it’s your money and your health!
High deductible policies have been shown to be effective in getting us to monitor our own care better, to challenge our providers to explain recommendations and to substantially reduce overall costs. Prevention, when done thoroughly and correctly, offers a major reward down the road, often with a quick payback in better health. And coordination of the care of patients with chronic illnesses is absolutely critical to better quality, to an improved patient experience and to markedly lower costs of care.
Third, check to see of your company has wellness programs. If so, sign up. It will save you money, lead to better health and you will feel better as a result. There is absolutely no downside.
A reasonable question would be why doesn’t the system work this way now? I will save an explanation for a future post on KevinMD.com. For now, don’t be angry, do something. You really can have better health at lower cost.
Stephen C. Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and consults for the US Army, medical startups and Fortune 500 companies. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery, published by Potomac Books.