When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich).
The more I learn as a physician, the more I realize how little I know.
The great thing about the extensive travel I’ve been enduring lately is that I learn to see the world differently. This week I participated on a panel at SXSW (called: A Dr, Patient, & Insurer Walk Into A Social Network) where I had the opportunity to share my thoughts as a doctor alongside a patient advocate/technologist and an insurer.
The technologist sees the world like this:
We envision a world where information exchange between patients, doctors, pharmaceutical companies, researchers and the healthcare industry can be free and open; where, in doing so, people do not have to fear discrimination, stigmatization or regulation; and where the free flow of information helps everyone. We envision a future where every patient benefits from the collective experience of all, and where the risk and reward of each possible choice is transparent and known.
The Insurer sees the world like this:
We believe we can help create a better health care system. This belief drives our daily decisions as one of the nation’s leading health care benefits companies. We work hard to provide our members with information and resources to help them make informed decisions about their health.
Health care payers (insurance companies) are acquiring more information and more companies to collect quality measures. Technology companies are, too. It turns out insurance companies may be an incredible partner for patients as time unfolds. Although tension exists at times when your insurance company blocks a procedure or hounds you about a bill, insurers are becoming better at providing you information to live healthier, longer. In the future, the insurers may really help you get information about your health status and connect you with resources, education, and exceptional clinicians. Good thing is, technologists will improve the tools we have to get that information, reflect on it with our doctors and clinicians, and share it with our caring network–our family and friends. My job as a physician will only improve as technologists and insurers learn and do more. I’ll be held more accountable, I’ll be advised on my performance, and I’ll be better connected with my patients’ data. This is the future I see. The way my boys will get health care as adults will look very different (I hope).
This was driven home recently when I returned to clinic and found a note from an insurer in my inbox. The insurer wanted to let me know that a patient in their network hadn’t received a screening lab indicated. The letter was respectful, short, and helpful. It alerted me to their recommendation (the patient had an elevated BMI and needed a fasting lipid panel–a cholesterol screen), it provided me their take on the AAP guidelines and recommendations, and also included a link to a journal article in the New England Journal of Medicine on further data and recommendations.
I went to the chart. I looked up the patient. I saw that within the last 6 months the patient had been in to see me. We’d discussed this health concern and I’d ordered fasting labs (exactly what the insurer recommended) but the family hadn’t returned to follow up. I hadn’t even missed this, but I didn’t do a good enough job explaining why the family needed the testing to get them back in. Further, new research from 2011 finds that children may not need to be fasting prior to this lab screening anyway! This experience may change the way I practice.
My EMR didn’t alert me that the labs didn’t get done. My patient didn’t alert me. My patient’s insurer did. We’ve called the family back to get them in to obtain the recommended screening. All this because of an insurer and some technology.
Health (care) can look very different. We just need to re-learn how we value each other as patients/clinicians/insurers, open up lines of communication, and keep working hard to find trust where it is earned. We might just save money doing so.
Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.
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