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The Balanced Pursuit of Self-Interest

The balanced pursuit of self-interest is so much a part of our daily lives that we take it for granted.  If you want to buy a product or service, you seek out someone who has what you want at a price that’s acceptable to both of you.  I call this ‘balanced’ because the only condition under which the transaction takes places is when both parties feel the terms are acceptable.  You have alternatives, and so does the seller.  Both can walk away from the deal if the terms are not acceptable, or, better yet, if another alternative is more acceptable.  This is the essence of a free market economy, and technology has brought incredible levels of transparency to our every day buying decisions.

Imagine that you and your partner decide to finally make two decisions that have been lingering for years; you’re going to purchase the antique clock you’ve always wanted to put over the mantel, and you’re going to get the rotator cuff surgery you’ve been putting off.  One of you will research each purchase decision. If you draw the straw to purchase the antique clock, you’d open your web browser and, in about 15 minutes, you’d know pretty much every one of the antique clocks fitting your description that were available for sale around the world.  You would know the asking price (or could submit a bid), and you’d be able to compare the price, condition, and other variables to help inform your choice.  You’d know the history of the seller including past buyer satisfaction (or lack thereof).  If you bought through a commercial channel like eBay, you’d know that you’d have recourse if the transaction wasn’t to your satisfaction.  Chances are you’d make your choice with a high degree of confidence and, when the clock arrived, you’d be happy. And so would the seller.  Chances are, no surprises.  Call it a ‘win/win’.

This is how virtually every one of our daily decisions is made – willing sellers and buyers brought together for mutually beneficial transactions.

 

Why the Consumption of Sick Care products and services is different

So what if you were the unlucky partner responsible for researching who and where to go to for a rotator cuff surgery? Whoa. How would we know what our range of choices was? And if we identified multiple choices, how would we judge and compare the relative quality of each? And how much each would cost? How would we know if what we received was of the highest possible quality, or even if we’d received what was promised?   And even if we knew when to be dissatisfied, where would we go for recourse? How could we use our good (or bad) experience to inform other consumers, and how could we provide dissatisfaction feedback to encourage our chosen provider to improve?

The unfortunate truth is that today you’d find very few answers for the questions above, and what you could find would be inconsistent and of poor utility in informing your decision. Of all the things that our existing healthcare system has been called, a ‘free market economy’ isn’t one of them. The lack of transparency and misalignment of financial incentives amongst the stakeholders are two of the primary impediments to high quality and high value healthcare products and services.

Why? My answers are sad and simple.

1. Most purchasing decisions in our current healthcare system are not made by the same people who pay for them. This results in a complete lack of demand for the information that normally drives value-based decision making, and allows sellers to escalate prices with little to no market pressures to control them. It also incentivizes sellers to resist quality and pricing transparency. And finally, it results in a system where most transactions between stakeholders are ‘win/lose’. One benefits at the other’s expense.

2.  Under our current Fee for Service revenue model, providers are heavily incentivized to do more. More diagnostic tests, more medications, more procedures – regardless of whether doing more helps the patient or not. This model literally encourages waste instead of minimizing it.

So – should the moral of the story be, if you’re ever confronted with a situation like choosing the antique clock/rotator cuff responsibility, grab the antique clock quickly?

No – the moral of the story is …

You deserve a chance to collaborate with your providers and be engaged in choosing the treatment alternative that is right for you.

You deserve to pursue and your own self-interest.  To understand the motives of other players in the game of healthcare, and why they behave the way they do.

You deserve a chance to learn from the patient satisfaction stories of others prior to making decisions, and to share your satisfaction from your own experience afterwards.

You deserve choices, including accurate and, when available, evidence based information on the chances that a treatment will help or harm you.  And you deserve to know what happens if you do nothing (let the body heal itself), or make lifestyle changes.

You deserve the chance to avoid waste and overpayment.  And at least a chance of estimating the costs of services you choose to consume.

Most important, you deserve a chance to stack the odds for high quality care in your favor.

 

Putting this into perspective …

Take a peek here to understand just how different the Old (current) Game of healthcare is relative to other consumer experiences such as booking airline travel, eating at a restaurant, or understanding a hotel bill.

 

A Framework for Consuming Sick Care Products and Services

There is no reason we shouldn’t make value based consumption decisions in the sick care model any differently than we do in any of our other purchase decisions.

Specifically –

 

Define Success

Members start their process by first deciding what the best possible outcome for them will be. This Personalized Goal Setting considers what is possible and realistic given current circumstances, as well as the Member’s values and beliefs.

 

 

Shop and Compare Options

ChooseWell can help Members aggregate research, experiences and tools already available in the public domain on provider options, treatment options, and comparative effectiveness. Similar support can be provided to aggregate available patient satisfaction, clinical and financial outcomes data for various providers. Members can then learn from others’ experiences when possible and better understand available options.

Choose

Clients choose the option most consistent with their goals for treatment, values, and beliefs and own the choice. Depending on the situation, arriving at the best available choice may also require them to Communicate, Collaborate, and Inform their providers. ChooseWell can provide customizable letters or emails to help our Clients communicate expectations for care, and increase the chances that those expectations are aligned.

Prepare, Consume, and Comply

ChooseWell prompts Clients to be the ‘perfect patient’ with help in preparing for their chosen treatments and complying with treatment plans, post treatment follow-up, and related self-care.

Assess and Share

ChooseWell provides a structured framework for helping Members assess whether goals were achieved and expectations were met.  For example, Patient Satisfaction, Clinical Outcomes, and Financial Outcomes are all measured differently and at different times relative to receiving the treatment. ChooseWell then facilitates sharing the feedback with providers and soliciting their comments – especially if the feedback is in any way critical.   ChooseWell then facilitates sharing Client feedback via existing venues (ie Angie’s List, Yelp, CAHPS, and others) with the goal of communicating the lessons learned from the experience as broadly as possible and helping inform the future decisions of others.

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Next: We’re betting you don’t even know who your true opponents are in the game of sick care.  Let us introduce you to The Cost Beast and the Quality of Life Serpent, and teach you a little something about how to kick their butts.

 

Remember:  We coach, support, educate, and empower.  We illuminate options you may not have known you had.  But we don't decide what's right for you in your unique circumstances; only you can do that.  And we don't provide medical, financial, or legal advice; nor do we replace the valuable counsel of those who do.