Payers in the Patient Value Chain – Can We Do Better?

I am very fortunate to have excellent healthcare insurance, with one of the country’s largest health plans, through my husband’s employer.  My coverage is also one of the first new value-based purchasing plans in the country. How I got a value-based purchasing is a long story; let me just say, the folks in Wisconsin were not alone last year!

Now, with value-based healthcare, my husband and I will be held accountable for adherence to certain health guidelines around our wellness and care, i.e. get an annual physical. I understand the need for our country to control the costs of care.  And as an educated consumer, I can appreciate taking responsibility and working with my providers and our health plan as partners on the new road to reform healthcare.

One day, I opened my mail to find with a form from my husband’s employer. The form requested that we document and return for them what I call, “Patient Compliant – Being a Good Patient,” information on our recent wellness care visits for our last physical.

Now, I am thinking to myself, as an experienced health IT professional,

  • Why in the world is the employer asking me to complete this form?
  • Doesn’t this major national health insurer already have the information in its claims database?
  • Doesn’t the health insurer, using data analytics, access this data and report it back to the customers, the employers?
  • Doesn’t this payer already have and run these types of reports?
  • Why isn’t my husband’s employer sharing this data with employees versus asking me for information already accessible to the employer or the payer?

On another visit to the mail box, I received a bill from my husband’s physician. I needed to determine:

  • Do I owe this physician a co-pay or not; and
  • What are these charges for on this bill?

I called the insurer and reviewed it, after waiting on-hold, and then, moving on to our dedicated customer account manager (15 minutes later). The representative was very nice and most helpful.

I asked: “Would this information be available to me online”?  “Oh,yes,” I learned.

However, when the representative checked, the service/link didn’t work.

I also asked:  “Did the plan had a portal or personal health record I could use to help me in tracking our patient health and financial information”?

The representative told me, “No, not at this time. “

I thought, “Hmmm…We (my husband’s employer) rank as a major account with this health plan. I have a dedicated phone service representative, but no online tools to help me, the patient. What if I was chronically ill? How would I, or my family, ever manage all of this information”?

I have worked for three payers, two provider organizations and two health IT firms before coming to work at HIMSS. In essence, I have dedicated my entire career to healthcare and health IT.

As a patient and family member I know we can do better!

We need to change the current paradigm among healthcare payers; providers and patients all must realize that patients indeed are partners in healthcare today. As patients, we need the tools to help us in management of our wellness, care and financial health.

I am calling on all healthcare professionals and health IT professionals to support the change, and shift the current pattern. Please give my family and me a chance to engage in my healthcare with health IT.

Join me at the HIMSS13 Patient Engagement through HIT Forum on March 5 in New Orleans to continue the discussion.

I will also be participating in this week’s #HITsm chat to discuss trends in patient engagement and how it will the intersect with the rest of HIMSS13 – always a great opportunity to engage with other patient advocates and influencers.

What topics on patient engagement and health IT that are most interest to you?  Share them here on the HIMSS Blog.

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4 Responses to Payers in the Patient Value Chain – Can We Do Better?

  1. I wish I could join you, Mary – won’t be at HIMSS, but I’ll be cheering from here. My efforts in healthcare include calling for, and helping work toward, price transparency and data sharing in healthcare. How can we have shared decision-making or value-based purchasing efforts that mean anything *without* access to cost information and our data? Solve that problem, and we’ve solved the chaotic conundrum that is US healthcare.

  2. dvanleeu17 says:

    I’m most interested in Patient-Generated data and Care Team-Generated data – entry, comments, and correction. How can patients and care givers add information important to them? Such as, what works to manage my pain? What doesn’t work? What works to manage my fear and anxiety? What doesn’t work. If I’m confused or out of it, who on my team speaks for me? What are the health goals I’m working on today?

  3. Casey, you will be in our thoughts while in NOLA. I agree we need more transparancey for healthcare so we may be informed and educate consumers on the cost of their care. This will be a topic for all of us to address moving forward. I know the folks in Mass are tackeling this specifically my friends at HFMA hosted a session featuring a Ma HMO that is providing price transparancey to their patients. l

  4. Deborah Wells says:

    It sounds like your employer and payer are putting the cart before the horse. “First take responsibility for managing your health, then someday maybe we’ll give you the tools to do so effectively.” Before patients can or will engage productively with the healthcare system, using the system has to become user-friendly and convenient. Your experience sounds all too familiar.

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