An Entrepreneurial Approach to Your Health Care
One of the prime reasons I founded the Public Forum Institute was a strong belief in the role ordinary citizens can play in addressing chronic stalemates on vital national policy issues. After moderating hundreds of congressionally-chaired health policy forums over the years, I conclude it will be other developments outside of top-down reform that drive improvements in health care. It seems inevitable that with so many people’s income dependent on our health care industry, even the most well-meaning politicians face a never-ending path of discourse in their efforts to improve health care without disrupting such a large chunk of the American economy. The revolution in consumer data may be just one of those new game changers.
Today, patients run little of the health care show. They are passive actors reacting to various hurdles from insurers, doctors, and hospitals. This is ironic given that one-third of health care patients choose what course of treatment to pursue. Today, doctors' preferences still prevail which, despite some recent slowing, is helping push U.S. health care spending to 17% of GDP with most nations being closer to 10% and Singapore only 4%. And what you and I spend on health care is about 2.5 percentage points higher than the general rate of inflation. Doctors should be equipped to explain more choices, and patients need to be better empowered to become the entrepreneurs of their own care.
These days, CVS might know before you that your daughter is pregnant. The sophistication of personal data collection is scary, but technology, just as it allayed our concerns over whether it would be safe to use services like eBay years ago, is rolling out equally fast to keep the misuse of voluntarily-provided data to a minimum. To have an impact on health causes and cures, we need more sophisticated data that combines personal health information with genomic data and information about habits, work life, personal lifestyles and where we live—and I think Americans are willing to help.
So how do we reshape the system to one with more shared decision making? I recently attended the The Atlantic's fourth annual Health Care Forum in Washington, DC, where a report was released that offers a roadmap to creating such a system. "Valuing Health Care: Improving Productivity and Quality" argues that patients need additional information about the business of their health, particularly information about the underlying costs of treatments and the relative effectiveness of medical care, so that they can make cost-effective choices. This new proposal, as the study´s co-editor put in an article on the Huffington Post, would empower patients with more information, more options and more control over their care. To-date, initiatives that increase access to information have produced better results at lower cost. For example, studies have found that "patient decision aids" (e.g. DVD guides, questionnaires, etc.) resulted in patients being 20 percent less likely, on average, to choose more invasive options with outcomes that were just as good.
How would this system be implemented? Based on the recommendations of a task force of 31 experts from related fields, this Kauffman Foundation roadmap focuses on incremental reforms to leverage medical data, which would cumulatively reduce costs regardless of whether and how President Obama´s health care reform is finally implemented. These recommendations would not only empower patients (that is only one section of the report), but also enable smart data sharing between researchers, health industry and health care providers to cross-check or cross-link information and create cost-effective health care solutions. For entrepreneurs in other industries, this is no longer complex work. Specifically, the report recommends the following to harness the value of data:
- Unleashing the power of information by breaking down silos and encouraging data sharing between research centers, medical offices, pharmaceutical companies, insurance firms and others; and that a new corps of data entrepreneurs be incentivized to collect and analyze existing medical data to discover and then disseminate new therapies.
- Funding more translational, cross-cutting research, with larger average grants made available to larger teams, many of them with participants from multiple institutions; and requiring collaboration across research institutions.
- Reforming medical malpractice systems to streamline new drug approvals and remove counter-productive restrictions on health insurance premiums.
- Empowering patients by, among other means, providing unbiased information on treatment options' benefits and drawbacks, and helping them make choices about the relevant lifestyle implications and risk-reward tradeoffs.
A fundamental question remains as to whether Americans would participate in such efforts. Dr. Susan Love, president of the Dr. Susan Love Research Foundation seems to have shown they would with her 350,000 volunteer-strong “Army of Women Program.” And my own experience concludes the same. When I moderated town halls around the country about potential NIH research on genes, the environment and public health, a large majority at all six town halls said they would participate in a study that would collect both genetic and non-genetic information on half a million volunteers who would be followed for 10 years in order to study the links between genetics and environmental factors and common diseases.
The uncertainties surrounding the Affordable Care Act, now under the eye of the Supreme Court, seem to have allowed policymakers and their constituents to stand back and watch while that issue is being resolved. However, we cannot stand paralyzed in our efforts to rein in the unsustainable growth of health costs—particularly since it is not bringing correspondingly better health care quality. The key to smarter American health care is patients, researchers and health care providers making better-informed health care choices.
For additional information, you can read the "Valuing Health Care: Improving Productivity and Quality" report or watch a video explanation.