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Why does Amazon knows me better than my doctor?

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Presented by Capstrat Senior Vice President, Paul Mahoney at HealthCampRDU on May 14, 2010.

Presented by Capstrat Senior Vice President, Paul Mahoney at HealthCampRDU on May 14, 2010.


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  • Amazon knows me really well. What I like, what I bought last. Things I’m probably wiling to take a look at.
  • 45 people thought Jon Mecham’s book was really good.
  • 45 people thought Jon Mecham’s book was really good.
  • THREE DAYS after my son has already been treated for a grand mal seizure, we received a voicemail message from the neurologist’s office:
  • My family recently got our first dog. If medical care is so different, then why does my veterinarian do a much better job?
  • No question where this must happen: ONLINE.
  • Wendy’s is open late –but the internet NEVER closes.
  • Here’s my ten bucks. Care me up, baby. Spare NOTHING.
  • Docs have legitimate concerns – ex-spouses, ex-employees, competitors, a single, crazy patient can unfairly criticism them. And HIPPA makes it hard for them to respond in some cases.Trial lawyers mining such information for potential customers? Medical Justice developed an agreement that physicians can ask patients to sign all intellectual property rights of anything they post to their physician. The doctorcan then sue the ISP for copyright infringement.
  • Not surprisingly, asking people to sign away their right to complain didn’t exactly build confidence in doctors’ commitment to service. In the PR business, we call this BLOWBACK.
  • College professors also did a great deal of harrumphing when ratings first came out. But now the most engaged profs are actually posting video rebuttals online – with great titles like “Am too the bomb.”Doctors need to get engaged too. It’s a conversation. Top-down won’t work any more.
  • Insurers would seem to have an interest in helping their customers shop for bargains. After all, network discounts are all based on trading volume for reduced prices. And they’ve put a lot of effort into getting useful tools on their websites. As we saw, the traction isn’t there yet.Consumers have no idea how widely prices vary, or how to find the lower cost options. Many people would be shocked at the variance in prices – which is a clear sign that the free market isn’t working. If there is one hospital system in your country, they’re in the catbird seat. Only 18 counties out of 100 in NC have direct hospital competition. Traveling one county over could save you a lot of money. Maybe you don’t want to – but don’t you want the choice?
  • But network discounts are their “secret source” proprietary information that they don’t want competitors to have. Publicizing the variability is pay is also likely to create problems with hospitals and doctors who have been accepting considerably less for similar services. Personally: I think transparency is inevitable – and ultimately desirable.
  • The democratization of information is having an influence – consumers are getting more empowered.
  •  New insurance site just won a Webby – www.whatstherealcost.orgRegence Blue Cross Blue Shield (Oregon) Clever, fun way to get consumers to think about a series of questions:Is this necessary?Are there cheaper alternatives?What does this cost? 
  • United Healthcare Treatment Cost Estimator application – big advance over earlier “average fee” approaches. Actually the procedure you need, done by your doctor in your area. What’s your “skin in the game” at hospital 1? At hospital 2? Consumers will probably be reluctant to look to insurers for quality issues, but they making prices transparent should get traction. Just released – hope to get info effectiveness.   
  • Shared medical appointments – group visitsNot appropriate for some diseases: STDs, erectile dysfunctionWould work well for others with strong educational function: cholesterol mgmt; weight loss, diabetesSee others improvingSocial support/ I’m not “different”
  • Crazy need for routine info via email.
  • Huge advances in technology could make health care resources more efficiently distributed – using technology to bring the expertise to where its needed. For years, radiologists and others feared this would lead to outsource to other states or even countries like India. Will protectionism or globalism win out?
  • While most of the health reform bill is actually additional regulations on insurers, there are some aspects of reform that could impact. Though controversial, comparative effectiveness studies could transform how we deliver care. For years we’ve asked whether the green pill is better than the purple pill. What if doing nothing is better than both? There has been no financial motivation to ask that question until now.Will we really pay for quality not volume? Every effort to change how care has been delivered – particularly if it impacts physician autonomy – faces an uncertain future. But this time, something has to give.
  • Insurers would have an interest in helping their customers shop for bargains. Consumers need to know that prices vary widely, and how to find the lower cost options. Many people would be shocked at the variance in prices – which is a clear sign that the free market isn’t working. If there is one hospital system in your country, they’re in the catbird seat. Only 18 counties out of 100 in NC have direct hospital competition.
  • Transcript

    • 1. Paul Mahoney
      Capstrat
      May 14, 2010
      Why Does Amazon Know Me Better Than My Doctor?
    • 2. Amazon Rocks
      Amazon knows everything about me.
    • 3. Amazon Rocks
      Amazon records and spits back past encounters with a click.
    • 4. Amazon Rocks
      Amazon willingly shares other consumers’ experience.
    • 5. Amazon Rocks
      Pricing is totally transparent.
    • 6. Health care… Not so much
    • 7. Health care..Not so much
      I fill out the same information EACH VISIT FOR 15 YEARS
      • Date of birth
      • 8. Social security number
      • 9. Allergies
      • 10. Medical history
    • Health care..Not so much
      I haven’t had a physical in two-and-a-half years. And no one has called to how high my cholesterol is or what I weigh.
    • 11. Health care… Not so much.
      THREE DAYS after being seen for seizure, a voicemail:
      “You must be referred by a medical doctor.”
    • 12. Health care… Not so much
      When I do get medical information, it rarely has the detail I want.
      What I expect:
      Blood test results -
      LDL 201
      HDL 115
      Triglycerides 300
      Ratio 5:1
      Lipid particle size etc.
      Etc.
    • 13. Health care..Not so much
      What I actually get back:
      Voicemail: “Tests are normal”
    • 14. Health care… Not so much.
      Asking for detailed info – or God forbid, old records – is seen as “being difficult.”
    • 15. Health care… Not so much.
      Complications after surgery?
      Call to surgeon gets recording:
      “If this is a life threatening emergency, call 911.”
    • 16. Is medical care just different?
    • 17. Works for dogs.
      Vet calls after surgery – “Is Murphy doing okay?”
      Follow ups up proactively on on heart medicine, tick/flea treatments, routine vaccinations, exams.
      Happy to provide records upon request.
      Medicines available everywhere. Cheaply.
    • 18. Q: Why do dogs get better service than people?
      A: Because we accept what we get.
    • 19. So what do we do?
    • 20. What we can do
      Own our experience
      Collectivism
      Befriend the imperfect
      Speak up when it’s bad
    • 21. Collectivism - online
      Pew Internet & American Life Project: 10/29/06
    • 22. Collectivism -- time
      Average time with primary care physician:
      15.7 minutes1
      Average time on Facebook/Twitter:
      5.5 hours/week2
      1. Time Allocation in Primary Care Office Visits, Health Services Research, 2007
      2. Neilsen, January 2010
    • 23. Collectivism – always open
      What do you consider the single most appealing factor about health communities?
      Capstrat Poll, April, 2010
    • 24. What are the barriers?
    • 25. Barriers - familiarity
      Think back to the last time you needed information on a health issue. Which of the following sources did you use?
      52%
      45%
      38%
      37%
      29%
      18%
      12%
      6%
      Capstrat/Public Policy national poll, April 2010
    • 26. Barriers – trust, influence
      What’s the single most influential source when you need to make a health decision?
      44%
      22%
      9%
      8%
      8%
      4%
      2%
      2%
      1%
    • 27. Barriers – consumers
      Consumers entitlement
      Most hated HMOs – but now see $10 copayment as a God-given right.
      Comparative shopping, informed purchases = “insurance hassles.”
      Historical amnesia: Health care used to free, right?
      May change with more “skin in the game.”
    • 28. Barriers – consumers
      Consumers are reluctant to accept responsibility.
      Lifestyle change is hard.
      Relying on medicine to make us well despite poor choices won’t work as the nation ages.
    • 29.
    • 30. Barriers – Dr. Harrumph
      “When I read your article describing [online ratings of] physicians, I was disgusted. As a specialist .. I can assure you that nobody employed by BCBS or Zagat is qualified to rate me…”
    • 31. Barriers - doctors
    • 32. Barriers - doctors
    • 33. Barriers - doctors
    • 34. Barriers – insurers
      What about insurers?
      Their data can help customers shop for bargains.
      Prices vary widely by region, specialty, even among cross-town practices.
    • 35. Barriers – insurers
      Problem: Network discounts = insurers “secret sauce”
      Publishing rates could aid competitors and certainly create problems with lowest paid providers.
    • 36. Signs of hope
      Online collaboration off the ground, not widespread
    • 37. Progress – online information
      Pew Internet & American Life Project: Online Health Search 2006
    • 38. American Medical News: by Pamela Dolan, Posted January 4, 2010.
    • 39. Progress – insurers getting in the game
      whatstherealcost.com
      Won Webby for Regence Blue Cross in Oregon.
      Interactive games, simple questions to ask:
      -- What does this cost?
      -- Is there a cheaper alternative?
      -- Is this really necessary?
    • 40. Progress – insurers getting in the game
      United Healthcare Treatment Cost Estimator
      Physician-specific pricing
      400 markets
      116 diseases,
      90 procedures
      500 individual services
      Customers' own financial responsibility
      Let consumers their portion online
    • 41. The Next Wave
      New, different and promising?
    • 42. The next wave – group care
      Shared medical appointments
      Good fit for diseases with educational component
      -- Weight loss
      -- Diabetes
      Doctor travels to rural region?
    • 43. The next wave – leverage technology
      Medical counsel via email
      • After hours, vacation, holidays
      • Routine: “4 year old has a fever”
      Access to records critical
      Valuable in rural locations.
    • 46. The next wave – remote technologies
      Telehealth/telemedicine
      • Phone consultations
      • Video conferencing
      Electronic record review
      • Remote robotics
      Plus in rural locations (ECU)
    • 47. The next wave – health care reform
      Millions more “retail” customers
      Comparative effectiveness
      Vast amounts of publicly available data, analysis
      Pay for quality, not volume
      (maybe)
    • 48. The next wave -- reimbursements
      Changing outmoded reimbursements system critical to fostering innovations.
      Huge political resistance to using research to change payments.
      Will we have health care reform – or just health insurance reform?
    • 49. Thank you
    • 50. Questions for discussion
      When will consumers take charge of health care?
      Five years? Ten? Twenty?
      Does paying an increasing slice of income toward health care make it more likely we will demand quality?
      Does paying indirectly – through taxes or reduced wages – make us less motivated?
      Will shortage of primary care docs make “bad service” persist?