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On the Third Hand: Consumerism

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The words we use affect what we can think, and, from time to time, I’ve tried to resist use of terms that seemed to be designed to put fences around thought.

One example is the term “health reform,” when applied to a specific policy, program or proposal.

Most of us would say we want to reform the U.S. health care system in ways that would make care better and more efficient. But, in reality, one interest group’s “health reform bill” is usually going to be another group’s health system change poison.

So, when I’ve had a chance, I’ve tried to avoid referring to the bills that created the Patient Protection and Affordable Care Act of 2010 (PPACA), or PPACA’s ancestors, siblings or nieces and nephews, as “health reform bills.”

For similar reasons, I’ve always tried to avoid using the term “consumer-directed health plan” (CDHP), or anything like it, outside of direct quotes or proper names. To me, it’s seemed as if the term CDHP has referred directly to efforts to put patients in charge of personal health accounts. Whether those patients would really be directing their own health care would depend on what the patients were like and what their coverage was like. So, I’ve always tried to use the term “personal health account-based program,” not CDHP.

Today, I was looking at e-mails from companies talking about how great they are at promoting “patient engagement” and patient “consumerism”: Making consumers better health care shoppers.

Right. Because we can see from the PPACA public health exchange experiment how wonderful consumers are at choosing standardized health plans from a fairly small menu of health plans without live-human help. Uh, wait: Consumers aren’t wonderful at that!

But maybe consumers are better at shopping for high-quality, cost-effective diabetes care from a directory that gives 100 endocrinologists’ names, addresses, languages spoken, and star-based quality ratings. Because we’re all born knowing how to shop for endocrinologists, right? And however that star rating system works, it surely encompasses everything anyone really needs to know about a board-certified endocrinologist, right?

Uh, maybe not.

On the one hand: The idea that patients should take charge of helping to hold down the cost of their care seems to me to be absolutely correct.

On the other hand: One of the whole problems with health care consumerism movement is that it’s weak on performance measures of its own. The firms promoting consumerism services occasionally refer to use-based statistics. They’ll talk about how many consumers looked at a health care cost estimation tool, for example. But I haven’t noticed any companies providing standardized, commonly accepted measures of consumerism effort effectiveness. 

When patients who say they want to be good health care consumers have a health savings account (HSA), how good are they at holding down the cost of their prescription drugs, preventive care, routine sick care and chronic care when compared with similar efficiency-minded consumers who don’t have a chance to own an HSA?

How are both of those groups of patients at holding down costs when compared with patients who refuse to think about cost when getting care?

And how does access to certain tools, such as cost comparison tools, affect the patients’ risk-adjusted and attitude-adjusted claim costs over the course of a year?

And, moving beyond early claim costs, what happens to each of those groups’ level of satisfaction with the care they’re getting? What happens to those groups’ health status indicators?

If health care consumerism companies had measures showing that the users of the consumer support services were getting cheaper, better, more satisfying care, then the companies could make a better case for the proposition that they’re really helping consumers shop for care, not just cutting back on employer and health plan assistance.

On the third hand, this could lead to an infinite barber-shop-mirror-type series of ratings of ratings of ratings.

If someone starts to give consumerism efforts star ratings, or the like, then, of course, we’ll soon have to have star ratings for the organizations rating the consumerism programs…

But, if companies want to win acceptance for health care consumerism programs, they need to give employers an easier way to compare health care consumerism programs on quantitative, apples-to-apples basis.

See also: HHS: NCQA, URAC May Be First Exchange Plan Accreditors