Consumerism will continue to address these trends in a positive fashion for employers and their employees. There are many examples of this positive effect of consumerism. The Land O’Lakes, Inc experience is just one of them: http://newsroom.cigna.com/article_display.cfm?article_id=1144

Now that the legislation has passed, Consumerism will still bring Lower Cost, Improved Quality, Better Access.

While no-one wants to see healthcare costs continuing to increase, you can prepare and protect yourself against these changes when you use Compass as your guide. We are only the only service with the market intelligence and consumer savvy to help you get ahead of your healthcare decision making. Compass gives you the tools to know how to spend your money wisely while accessing the quality care you need.

http://www.cnn.com/2009/HEALTH/09/16/health.medical.bills/index.html

The problem is that the entire article missed the one crucial step that is important before going for any type of healthcare service: be an educated consumer. If you know how much the procedure will cost, where to get it for less, and what types of add-on drive additional cost, you will be prepared to manage your healthcare bill before it ever arrives and protect yourself from potentially devastating costs.

Unfortunately, this article is a regression to the type of article written 3-5 years ago. The field of advocacy is changing dramatically from the “find a doctor” / “fight a bill” to a comprehensive professional service that helps people not only navigate the health system and deal with problems but sophisticated pricing and quality data as well that allows you to become an empowered consumer. While the old world of patient advocacy will continue to exist, I would encourage patients and consumers to seek out this new level of professional experience to take control of their health care.

I liked the article because it pointed out that our culture of “more information is better” is not always true and can lead to unnecessary services when lower cost treatments could have had the same or better outcome.  I think it also emphasizes a philosophy where a patient builds up to to the most invasive treatments instead of immediately jumping to that treatment on the basis of what is technically inconclusive data. 

We are starting to see this philosophy more and more in the consumers we help. 

“Let me try medicines.  If that doesn’t work, then I will try non-invasive treatment and low intensity surgery.  Finally, I will have the major procedure if nothing else works.”

The important point is that treatment is immediately commenced and the opportunity for success in both medicines and non-invasive treatments is given a chance.  Since researchers have found that lower-intensity treatments are often just as effective, if not more so, than invasive surgery this type of behavior change often lowers cost while minimizing treatment impact on the patient.

The problem is that this dynamic does not necessarily lend itself to “bending the cost curve”.   Clearly, more access to care with better insurance for a population that is an underutilizer of care right now will lead to increased national healthcare expenditure.  Over the long term, better care should divert more intensive procedures / costs but as we discussed in a different blog the net effect of more care now vs less care in the future does not necessarily result in cost savings even if it acheives a societal good.

Having worked closely with well intentioned hospitals and doctors for many years, I strongly believe that reimbursement rates should support the scope and value of care that is provided.  Our goal at Compass is to empower patients to better define their personal values for providers so providers know where they need to compete and become more efficient.   Consumer involvement is often dependent on having choices and a financial stake in the process.  This is why I believe that reform can be successful from a cost perspective in many forms as long as it creates avenues to control costs by promoting the role of the consumer in the healthcare decision-making process.

The point is that high deductible health plans and the economy are pushing people away from expensive procedures because those hit procedures are starting to hit patient pocket books in a way that matters.  This trend just emphasizes the point that the path to behavior change is through the pocketbook and the responsible way to manage that change is by teaching people to become good healthcare consumers.

Mr. Laffer simply points out that any plan that does tie patients to their healthcare costs will ultimately create unfettered demand and promote runaway costs.  Nothing in the healthcare reform lexicon today seems to focus on this fact and thus reform discussions as they exist will only further the existing cost problem.