A few stumbling blocks to better healthcare
Dr. Wendy Sue Swanson, a pediatrician in Seattle, is brimming with ideas for how she could use technology to improve the practice of medicine. She's not thinking about exotic devices or personalized therapies; for Swanson, it's mainly about using communication tools like YouTube to answer the basic questions all parents ask so that she can focus her time with patients on their unique medical problems.
The problem, Swanson said at the South by Southwest conference Sunday, is that insurers won't pay for the videos she creates to educate patients or the blog posts she writes about important new developments in pediatric care. No matter that these steps would lead to healthier patients who place fewer demands on the healthcare system.
She does them anyway, but the idea of communicating online with patients is anathema to her fellow doctors. "There's an overwhelming climate of fear" among physicians, she said, about the liability they may incur or the privacy violations they might commit if they respond to emails or write blog posts about medicine.
Swanson's panel at SXSW was a reminder that healthcare reform is a work in progress. While politicians and litigators fight over the provisions of the law Democrats pushed through Congress in 2010, the industry itself is still trying to overcome some of the basic hurdles to creating a more effective, efficient and affordable healthcare system.
One of the keys to that effort is enabling primary-care physicians like Swanson to spend more time understanding their patients' health needs and managing their care. The 2010 law, however, will extend insurance to millions more people, thereby increasing the demands on doctors' time. Swanson wants to use online videos and tablet computers in her waiting room to instruct patients on routine matters -- e.g., the issues surrounding vaccinations -- so the time they spend with her in an examination room is meaningful. She'd like to see some pilot projects done, but adds, "It has to be paid for, and that's what we're trying to figure out."
Her comments drew a sympathetic response from Michael Golinkoff, head of clinical specialty operations for insurer Aetna Inc.'s national care-management unit. Golinkoff wants to increase the amount of information flowing to doctors and patients, in part to "help an empowered patient to be a more active participant in their healthcare." Patients need to see the "continuity" between the lifestyle choices they make and their health, he said. The problem today is getting patients to see that connection and to change the lifestyles that bring on chronic illness.
Another thing insurers can do, Golinkoff said, is help patients tap into a community of people with the same ailment. That's what panelist James Heywood is doing with his company, PatientsLikeMe, whose website lets people read and share their experiences with different prescription medicines, therapies and symptoms.
Heywood wants to see more information flowing too, particularly about the effectiveness of treatments and the profit margins for the doctors who perform them. When heart surgeons tells you that you need a bypass, "the fact that they're making like a car's worth of personal income off of this, they don't have to disclose to you." The current system has so little transparency, he said, patients can't help but be suspicious about doctors. "We have to figure out how to get out of this war where nobody can trust anybody and into some new model," he said.
Golinkoff pointed to accountable care organizations, a new approach promoted by the 2010 law, as a possibility. Primary-care physicians, specialists and hospitals form such groups to coordinate care in the hope of saving money by improving results. Although the industry is still waiting to see how well they work, Golinkoff said, these groups align physicians' interests with their patients' and encourage investments in wellness.
Heywood wasn't so sanguine. The potential problem of accountable care organizations, he said, is that the budgets they impose may create a new bad incentive: instead of being encouraged to perform costly treatments, physicians may have a financial motive to choose cheaper but less effective alternatives.
-- Jon Healey in Austin, Texas