What Will Consumers Choose?

This month’s cover story is all about consumer-directed health care and its vast array of I.T.—and policy--implications. During the course of over a dozen interviews, a couple of clear trends emerged during my reporting. First, there is little agreement in the industry that shifting more financial burden to consumers—the heart of “consumer-directed” health plans—will result in either reducing costs or improving outcomes. While my sources generally agreed that divorcing consumers from the real costs of care serves no one well, many questioned whether consumers could ever be adequately informed to carry out such a role. But, in a second trend, forward-looking hospitals and medical groups are moving ahead anyway, attempting to loop patients in by providing a number of interactive, transactional tools, including direct access to electronic records and electronic messaging with physicians. Truth is, most CIOs, CEOs, CMOs, and other senior executives in the industry have little time to ponder the theoretical merits of consumer-directed care. They are strapped running their organizations day to day.

For my story, I also talked to a real patient—Gary Miner, a diabetic who works as a technology consultant. Most of our stories are based on interviews with hospital executives, consultants, and the occasional industry analyst. But I figured to get in the real spirit of the topic, I needed to include a consumer. Gary was a great source, but I was unable to squeeze in all of his thoughts in the magazine article due to space limitations. He made one point that really stuck with me: American are too fixated on pills to solve their problems. Gary uses an online monitoring service that dispatches his glucose scores to both his personal health record and an attentive group of friends, who are on standby in case of need. He emphasized that he does not depend on his physician to monitor his diabetes, that the responsibility is his. “I like the idea of being the center of my health care and taking responsibility for it. It is ridiculous to think doctors will keep us healthy and we have no responsibility.”

Gary went on to chide other diabetics who apparently have given up on their disease. The majority of people with type 2 diabetes could get it under control by losing weight, but instead, they want a pill, he contended. That’s the kind of straight talk you might not always get from a health care provider whose first line of action is the prescription pad.

It reminded me of a talk I had with a physician a few years back, who had been instrumental in launching a PHR service for consumers. “Americans are in denial about their health,” he said. At the same time, he saw the value of looping them in directly with their caregivers. Surely, without such connectivity—both electronically and personally—we won’t get very far in cultivating patients to be the responsible, informed citizens that the consumer-directed model assumes they are.