Modernizing our health care system starts with embracing complexity, not trying to eliminate it
Modernizing our health care system starts with embracing ... unknown Modernizing our health care system starts with embracing ...Fast Company
BY DAVID VIVERO 5 MINUTE READ
Anyone who has had to navigate a health issue in recent years knows firsthand that health care in the United States is expensive and complex. Despite valiant efforts by health care regulators and the private sector, that complexity isn’t going away. With innovation occurring rapidly across such a vast, diverse system of care options, it’s no wonder only 12% of Americans “have a sufficient level of health literacy to navigate our complex health system, engage in complex medical discussions, and fully participate in managing their health.”
The inertia of health care innovation, particularly around the accelerated use of digital health tools, is too strong—and frankly too necessary—to be restrained. Instead, the industry should use technology that integrates these new solutions throughout the health care ecosystem and gives patients the experience they deserve. I believe that starts with meeting patients where they are in their care journeys with easy and intuitive access to helpful information when making critical decisions.
Health literacy describes the degree to which individuals can find, understand, and use information and services to make health-related decisions and take action on their care. When navigating any other major purchase, many people spend time shopping around to find the best product for their needs at the price point that fits their budget. For an individual to make a good choice, they need access to clear, actionable information. Unfortunately, accessible health care information often is hard to come by, which has led to gaps in understanding that can be detrimental to health outcomes.
The Transparency in Coverage Rule includes requirements that went into effect on Jan. 1, 2023, and aims to rectify some of this confusion. Health plan sponsors and carriers must publish pricing information and provide all plan members a shoppable tool to compare individualized cost estimates for 500 common medical procedures with wide pricing variation across providers. The scope of the tool will expand to include all covered items and services in 2024. In my opinion, this marks a significant and long overdue step by regulators toward patient empowerment and health literacy. However, the addition of more data isn’t a solution in and of itself. This should go further to provide context for such cost, put it in the context of quality information, and present it to patients in a way they can understand and use.
REGULATIONS ARE A GOOD START, BUT LET’S GO FURTHER
Currently, the TIC Rule only mandates pricing information be searchable by CPT, a coding language used by medical professionals to identify medical services and procedures, or by “descriptive terms” like “rapid flu shot.” While this sounds like it’d be helpful, there is no guidance within the rule about what this means. As a result, the language used often ends up being vague and it can be hard to hold health plans accountable to make substantive changes. A clear example can be seen in a search for the price of “ACL surgery” in a compliant tool. This phrase may not yield results, but a search for “anterior cruciate ligament surgery” could yield the information a patient is looking for. If information isn’t accessible and understandable by those making health care decisions for themselves, or on behalf of others, its value is incredibly diminished.
More information also doesn’t necessarily equate to better decision-making. In many settings, simply offering pricing data with little to no context can overwhelm a person and lead to poorer decisions. Likewise, people may falsely equate higher cost with higher quality, and may choose high-priced care despite the reality that it is largely unrelated to improved health outcomes. Unless plan sponsors take the initiative to contextualize the influx of cost information with comprehensive, objective, outcomes-driven quality data, they risk spending huge amounts of money on high cost, and often unnecessary, care. So far, this has proven to be a big ask. The vast amount of health care data being generated, coupled with complex contracts insurers must abide by, hinders organizations from providing this additional information in a timely and accurate manner.ADVERTISEMENT
BETTER HEALTH LITERACY CAN BEGET BETTER CARE
Helping consumers make more informed health decisions has wide-reaching impacts. With better information about nearby, available providers, individuals who would have gravitated towards the emergency room may be more likely to select an urgent care clinic or make a primary care appointment. This can generate cost savings that have a ripple effect across the health care system, including the estimated $8.3 billion wasted on unnecessary emergency department usage. Likewise, focusing on the best quality care for patients’ conditions can help avoid unnecessary treatments and delays, resulting in faster recovery times and lower risk of complications. This can lead to fewer long-term health and financial impacts for the patient and can tangibly improve their quality of life.
LOOKING TO THE FUTURE
So, where do we go from here? The health care industry is only increasing in complexity and cost. Instead of pouring more resources into attempts to streamline these myriad aspects, I believe a better use of time is to leverage the vast technological capabilities to meet the system where it is today and propel it into the future. Partnerships between health care organizations and purpose-built technology that puts patients first can contextualize and simplify this growing complexity. Moreover, it can deliver innovations to consumers even faster at a time when they have a growing desire to be active participants in their buying decisions.
We are standing at the crossroads that will determine the shape of our future health care system—where we go next is up to us. Luckily, we already have the technology and capabilities to leverage health data and increase health literacy, from permitting access to greater price and quality of care information to delivering that information through responsive platforms that make health care navigation intuitive for everyone. By pioneering new ways to integrate with health care’s latest innovations—like telehealth and individualized remote patient monitoring services—that address corresponding complexities, we can focus our efforts on supporting the most important player in the health care system: the patient.
David Vivero is the CEO of Amino Health, a digital healthcare guidance navigation experience helping patients find high-quality care.