Instead of giving the traditional speech about how the national costs of health care are increasing an average of 8 percent per year, I told the group what was happening among co-workers and members covered under our own health care plan.
I kicked off the enrollment meetings by handing out copies of monthly claims and drug utilization reports. All of the information was presented anonymously. Employees received data from our claims history reports that outlined the company’s claim cost by diagnosis and procedure.
I shared employees’ prescription drug purchasing and utilization patterns. They saw the total number of heart attacks, catastrophic injuries, costs of ER visits, cost of physician visits and costs of all outpatient procedures. I showed them the percentage of covered employees identified as smokers, overweight and high risk.
I told them the story of an employee going to the ER for a "hangnail" that cost over $1,000. I provided simple numbers illustrating drug purchasing behavior and the cost impact on our group by having a low generic utilization rate.
And after the data was presented, I did my best "consumer-driven" health care pitch in an attempt to draw a simplified correlation between access to information and using that information to be better consumers of health care.
Perfect, right? Wrong. I assumed that because there were consumer sites for other large purchases like buying a car or a house, there were similar sites for health care.
Looking for a new car? On Sites like Vehix.com or Cars.com, you can find expert advice, compare different manufacturers and models, read buying guides and search listings for new and used cars. Buying a new house? Zillow.com, an online real estate service, provides you with a slew of information—all the things you would want to review before signing on the dotted line and buying a house. You can find estimated housing valuations, comparable pricing and neighborhood information.
But if you need to compare prescription drug costs with local pharmacies, there is little information. Want to compare the cost of an outpatient procedure in two community hospitals? Nothing.
It never hit me that all of the educating and small group meetings had limited impact because of the scarcity of resources to help employees when they really needed it—usually during a health-related event or episode.
I preached to employees about data and using information before they made a health care purchase, yet at the time of their prescription purchase, doctor visit or scheduled surgery, the employee had nowhere to compare pricing, physicians or quality of services.
Enter Change:healthcare. Recently relaunched, the company began by providing a service that lets users enter their medical bills and track actual costs, including out-of-pocket charges, co-pays and deductibles. The new site includes information channels that allow consumers to compare the cost and performance of local and national health care providers, insurers and pharmacies, all with a focused effort to fill the information void for health care consumers.
Critical to the Change:healthcare database is the aggregation of employer claims data. The company’s strategy is to sell its service to employer groups and collect their claims history to build a national repository of health care purchasing information. It is a bold move. Unlike the public information used to seed sites like Zillow and Vehix, Change:healthcare hopes to partner with employers, access employee claim history, make the data anonymous and integrate it within their database.
Should covered employees feel open enough to allow a third party access to employee claims data? Will employees be notified of an employer’s partnership with companies such as Change:healthcare? Is employee privacy really being safeguarded? Privacy concerns are important and we should tread lightly when taking individual claims data and extrapolating information for open review. But if a company has guaranteed heightened privacy measures and is committed to ensuring that privacy standards are upheld, I believe it is time we embrace an open platform for general health care purchasing information.
Internet sites such as DailyStrength and PatientsLikeMe demonstrate that health care information can be shared without compromising a user’s privacy expectations. In fact, these sites show that more people want to share their health care experiences, struggles and wisdom with one another in an open, community environment.
Daily Strength, for example, is a social network that provides a place for people with a wide variety of medical, psychological and life conditions to discuss their struggles and the treatments. The site has more than 50,000 members and 500 support groups for every health issue and life challenge.
PatientsLikeMe uses a social networking platform and takes it much further. On the site, patients enter very specific data regarding individual symptoms, treatments and therapies. Patients can then select other patients with a similar diagnosis and compare their treatments and outcomes. The site currently has more than 7,000 patients and continues to develop disease-specific groups.
It will be interesting to see just how far employers and benefit managers will go in an effort to educate and promote employee knowledge of health care costs. Change:healthcare has begun pilot projects with several employers and expects to continue to build its database with claims data from these covered groups. With guarantees from participating employers and Change:healthcare that the data used will not be exploited and the privacy of consumers will be protected, I champion the effort to bring greater transparency and trustworthy health care information to all of us.