Information is the answer
ABC News is running Prescription for Change, a week-long series focusing on what ails the US health care system and what to do about it. As part of the event they asked me to write an opinion piece, which is published on the ABC News website under the headline More, Better Information Key in Fixing Healthcare. Matthew Holt of the Health Care Blog also contributed an article, entitled Why is Fixing American Healthcare So Difficult?
Here’s my original piece:
The US health care system is a mess by any measure. Costs are far higher than anywhere else in the world but life expectancy and infant mortality are worse than average. To add insult to injury, customer service is often abysmal.
It doesn’â€™t have to be this way. Other sectors of the US service economy –such as retail, financial services, and lodging– are the envy of the world. Companies like Vanguard, Target and Hampton Inns offer higher quality, better customer service and lower prices than you’ll find in other countries. The US health care system could be like that, too, but the archaic culture of medical providers, distortion of the market by the third-party payment system, and resistance to trading off costs and benefits complicate reform.
The best hope for reforming US health care lies in utilizing information. We need to generate more and better information, make better use of the information we have, and be willing to use information to make tough choices.
The good news is that it is starting to happen.
Generating more and better information
The kind of information we take for granted in other sectors is unavailable in health care:
- How good is your doctor, really?
- Which specialist is best for your condition?
- Is that academic medical center with the great reputation better than the community hospital down the street?
- How likely are you to die from a medical error?
- How much does an operation cost at one hospital compared to another?
- Does that drug you were prescribed work? What were the other options for treatment?
- How much does the drug really cost (not just the co-pay)?
- Is the drug any better than a generic?
- How does your genetic makeup affect the treatment you should get?
These questions are beginning to be answerable. Consortia like Massachusetts Health Quality Partners and Integrated Healthcare Association along with private companies such as HealthGrades provide objective information on quality and patient experience. (They still can’t quite say “â€œcustomer satisfaction.”) Medicare’â€™s Hospital Compare website has information about key quality indicators. Various “â€œtransparency”â€ initiatives are underway to provide information on costs. Consumer Reports rates drugs and Wal-Mart is showing just how inexpensive generics can be. Genetic profiling is farther off, but groups like the Brain Resource Company are starting to make personalized medicine a reality.
Making better use of information
It’s not enough to make information available. We have to become better users of information and better communicators. We should also analyze and act on data that are currently ignored. Empowered consumers are taking the lead: doing research on the internet, establishing personal health records, demanding a greater role in their care, even negotiating prices. Now we need medical professionals to step up.
Many physicians are lousy communicators. Doctors are hardworking and dedicated, but generally don’â€™t use email, don’â€™t keep records electronically, rely on treatments they’â€™re comfortable with rather than using evidence-based medicine, and are insufficiently skeptical of information from biased sources (like drug reps). Physicians rarely explain alternative treatments; many do a poor job communicating diagnoses, laboratory findings and information about drugs. Primary care physicians and specialists often drop the ball in communicating with each other about patients they are treating, leaving the patient or caregiver to try to close the loop on their own. And most physicians have no idea what anything costs.
Pharmacists are rarely better. They spend six years in school learning more about drugs than most doctors will ever know, then disappear to the back of the pharmacy to count pills. Pharmacies are convenient and accessible; their pharmacists are a vast untapped information source.
The introduction of electronic health records and electronic prescribing are helping, but are only part of the solution. We need health information exchanges, like the ones piloted by the Massachusetts eHealth Collaborative, to share patient data. We need secure, efficient platforms such as RelayHealth for doctor/patient messaging. We need decision support tools like SimulConsult to organize clinical findings to help diagnose rare diseases, sparing patients the misery of going from doctor to doctor in search of a name and treatment for their condition. We need more patient communities such as Patients Like Me and treatment planning tools such as NexCura.
We should make better use of information from existing diagnostic tools. Advanced analysis software from companies such as AMID mines digital data from inexpensive ultrasounds, reducing the need for expensive MRIs and PET scans. iCardiac Technologies analyzes ECGs already collected for clinical trials, identifying cardiac safety problems early in drug development, before the next Vioxx comes to market.
Using information to make tough choices
Better availability of information will improve quality and customer service, but while information technology cheerleaders promise that big cost savings will inevitably follow adoption, that’â€™s by no means certain. Some efficiencies will be gained by eliminating transcription costs and reducing duplication of tests, but better information may actually lead to higher spending. After all, with more information about their conditions, patients may seek additional treatment.
Information can be used to hold down health care costs, but that requires political will. In the UK, the ironically named NICE (National Institute for Health and Clinical Excellence) evaluates treatments based on data and decides if benefits outweigh costs. When the answer is no, as it often is, the National Health Service won’t cover the treatment. In Germany, whole classes of drugs are evaluated to determine whether on-patent products are more effective than generics. If not, branded products are reimbursed at the same (low) level as generics.
If we choose as a society to use information for hard decisions, costs will be contained. But the model will be different from the UK and Germany. We’â€™ll use incentives and cost sharing, not outright bans and price controls. Examples are emerging in the public and private sectors.
Within a decade there will be plenty of good information available and we’â€™ll have learned to use it well. Then we’ll finally be headed toward a health care system worthy of respect.