Health Advisors

But that doesn't mean turning our back on consumerism and locking in the old paternalistic, top-down driven system. People do need expert help in navigating the growing complexities of treatment options, and the health sector is beginning to respond by offering health coaches and disease and chronic care management programs.

But that's just the beginning: The new information economy will offer even more options, including health care advisers, to help people make better health care and health spending decisions.

Today, when people are seriously ill or have a child with multiple medical needs, they find they must become actively involved in informing themselves about the nature of the illness and about treatment options. They rely on their doctors of course, but also on information from disease groups, from real and virtual discussion groups, and on research from medical libraries and trusted websites, to become experts themselves.

Also, many people seek the security of having expert advice available through "concierge medicine." Here, people agree to pay a physician a fixed fee for ready access to appointments, attention to wellness care, help in locating specialists, and expert advice in the event of a medical problem.

Millions - tens of millions - of people would like to have that kind of access, but so far only a small number do.

Yet this kind of trusted expert health adviser will be an emerging force in the new world of consumer-directed health care -- trusted agents that people will call on for routine health care advice and for help in making complex medical decisions.

And information technologies will make this expertise available to anyone with an Internet connection. New companies will allow millions of people to get information that is clear and understandable, and even provide access to one-on-one consultations.

Several new companies provide medical decision support for individuals and companies, such as Health Dialog, which helps patients understand treatment options and choose what's best for them.

The Health Dialog website says: "In an increasingly consumer directed healthcare environment, it is critical that individuals have the information and support they need to become more involved in their healthcare. Health Dialog is built upon the idea that when individuals are more actively engaged in managing their care with their physicians, they are more satisfied with their care, quality goes up, and costs go down."

Health Dialog uses information from the Foundation for Informed Medical Decision Making which reinforces our point on its website: "When patients get sick, they sometimes face treatment decisions that can be confusing and frightening? Very often doctors make these decisions for patients, and many patients prefer that model?

"However, a growing body of research shows that when patients are well informed and play a significant role in deciding how they are going to treat or manage their health conditions?patients feel better about the decision process. Their decisions are more likely to match up with their preferences, values and concerns. These patients are more likely to stick with the regimens the treatment requires, and they often end up rating their health after treatment as better."

It's called empowerment.

Don Kemper, chairman and CEO of Healthwise in Boise, Idaho, has worked for years to help people understand the crucial importance of "information therapy" as a vital and integral part of medical care. He says that writing prescriptions and ordering surgery or chemotherapy must be accompanied by high-quality information for the patient in a clear and understandable format.

Kemper argues: "Empirical research suggests that appropriately prescribed, decision-focused, evidence-based health information empowers consumers, enabling them to participate as active partners in their own care and improve their health outcomes."

And this is just the very tip of the iceberg. Quality and price data are also coming from thousands of sources. The marketplace will soon be filled with countless options for people to become smarter consumers of health care. And new companies will aggregate and translate this data to become branded sources of reliable, quality information. A whole new discipline of medical professionals also is likely to emerge - the health adviser - to help people seeking one-on-one expertise.

Information needs can be solved by an information economy. Technology will allow that information to be accessed instantly at little or no cost. Patients will get smarter, and they will force the health care economy to become more efficient and patient centered.

This new era is not only coming, it's here.

Grace-Marie Turner

RECENT NEWS ARTICLES AND STUDIES:

• The factors fueling rising healthcare costs 2006
• Before we go 'single payer,' insurance reforms we should try
• A primer on price controls
• Proceed with caution: The unintended consequences of expanding VA access
• Patient-centered care for underserved populations: Definition and best practices
• Health savings accounts: Answering the critics

THE FACTORS FUELING RISING HEALTHCARE COSTS 2006
Source: PricewaterhouseCoopers, 01/06
PricewaterhouseCoopers (PwC) has released an important follow up to its 2002 study on the underlying drivers of increasing health care costs. The study, commissioned by America's Health Insurance Plans, finds that the overall increase in health insurance premiums was 8.8% between 2004 and 2005. PwC breaks this down and attributes 27% of the increase to general inflation, 43% to increased utilization, and 30% to health care price increases in excess of inflation. "A review of the cost increases by type of service indicates that the estimated increase in outpatient costs (13.6%) contributed to almost a quarter of overall premium increases in 2005," according to the report. "Other services such as physician, inpatient hospital, prescription drugs, and other medical services contributed to the balance of premium increases fairly evenly."
Full text: www.ahip.org

BEFORE WE GO 'SINGLE PAYER,' INSURANCE REFORMS WE SHOULD TRY
Author: Michael Kinsley
Source: The Washington Post, 03/17/06
Michael Kinsley, a columnist who generally offers a somewhat liberal perspective, challenges calls by New York Times columnist Paul Krugman for a "single payer" health care system. "Everybody can't subsidize everybody," writes Kinsley. "Or, to put it another way, society cannot give the average citizen better health care than the average citizen would choose to buy on his or her own." Kinsley observes that Krugman believes rationing could be avoided, but argues it would be inevitable and explicit in a single-payer system. Kinsley asks instead: "Should people be allowed to opt out of rationing if they can afford it?" Then he concludes: "They say, let's try single-payer first. So I say: Let's try some more modest reforms before plunging into single-payer."
Full text: www.washingtonpost.com

A PRIMER ON PRICE CONTROLS
Author: Merrill Matthews, Ph.D.
Source: Institute for Policy Innovation, 02/06
Merrill Matthews of the Institute for Policy Innovation wonders why politicians are once again considering imposing price controls on products ranging from gasoline to prescription drugs. "We have been down the price control path so many times with so many products and services that you'd think the politicians would have come to realize that price controls - whether direct or indirect - stifle competition, keep prices artificially high and destroy innovation," writes Matthews. He describes six reasons and gives examples why price controls don't work: 1) prices are information; 2) price controls undermine competition; 3) they hurt the poor; 4) they distort markets; 5) they undermine accountability; and 6) they destroy innovation.
Full text: www.ipi.org

PROCEED WITH CAUTION: THE UNINTENDED CONSEQUENCES OF EXPANDING VA ACCESS
Author: Nina Owcharenko
Source: The Heritage Foundation, 03/17/06
The government should consider alternatives to help more of the nation's veterans before expanding the Veterans Affairs (VA) medical system, warns Nina Owcharenko of The Heritage Foundation. Some are calling for the VA to be expanded beyond its present mission to provide care to veterans with non-service-related conditions. Medicare and Medicaid reimburse private providers, while the VA's hospitals and other facilities are owned and run by the federal government and its budget is set by Congress. "Incorporating a large pool of new beneficiaries with less-specialized medical needs into the system would alter the political and budget calculus of the VA system," writes Owcharenko. "Because beneficiaries with general needs would substantially outnumber beneficiaries with specialized needs, future attempts to control cost growth would likely restrict access to specialized care." She recommends providing subsidies for private insurance if Congress decides that benefits should be expanded to additional categories of veterans.
Full text: www.heritage.org

PATIENT-CENTERED CARE FOR UNDERSERVED POPULATIONS: DEFINITION AND BEST PRACTICES
Authors: Sharon Silow-Carroll, Tanya Alteras, Larry Stepnick
Source: Economic and Social Research Institute, 01/06
There is growing awareness that consumer-centered health care can help achieve better outcomes and patient satisfaction, and the Economic and Social Research Institute has produced a list of recommendations about how to apply this new philosophy to "underserved populations? such as low-income individuals, uninsured persons, immigrants, racial and ethnic minorities, and the elderly." The study, commissioned by the W. K. Kellogg Foundation, lists core components of patient-centered care, including educating patients to "expand their role in decision-making, health-related behaviors, and self-management." It also suggests changes in institutions to measure patient satisfaction and to create commitments from top management to patient centered systems. And it lists barriers, including financial constraints and "staff unwilling to change the 'old school' provider/patient relationship."
Full text: www.esresearch.org

A commentary in The New York Times, entitled "The doctor will see you for exactly seven minutes," complains that the doctor-patient relationship has become frayed. While arguing that turning "doctors into shopkeepers who regard patients as customers is unacceptable," Professor Peter Salgo of Columbia University nonetheless says that patients must take charge: "Evaluate what it is you expect from your doctor, then ask for it. If you are unhappy with your doctor, fire him. If you cannot get more than a seven-minute face-to-face encounter with your doctor, he needs fewer patients. The true power in the health care economy rests not with the doctors and certainly not with the backroom business staff. It rests with you." [GMT: Now if only we could get tax policy changes to empower patients to vote with their feet, we'd be on our way.]
Full text: www.nytimes.com

HEALTH SAVINGS ACCOUNTS: ANSWERING THE CRITICS, PARTS I-III
Authors: John C. Goodman and Devon M. Herrick
Source: National Center for Policy Analysis, 03/21/06
NCPA takes on the critics of HSAs point by point to answer claims that HSAs only benefit the young ("In fact, nearly 60 percent of adults in these plans are 40 years of age or older"); that people will skimp on preventive care ("those with consumer-driven plans were 20 percent more likely to report interest in wellness programs, 25 percent more likely to adopt healthy behaviors, and 30 percent more likely to schedule an annual checkup"); and that HSAs will leave doctors and hospitals with more bad debts ("In a new pilot program, the insurer UnitedHealth guarantees the patient's share of the bill in return for a discount on fees from providers").
Full text - Part I: www.ncpa.org
Full text - Part II: www.ncpa.org
Full text - Part III: www.ncpa.org

Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at http://www.galen.org/.

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