Consumerism in healthcare has been hailed by many including ourselves as one of the key components in solving the healthcare crisis in the U.S.

“…one of…”

Pushing cost to the patient is merely the first step. Without transparency, consumerism has the potentially devastating affects on the gains that wellness and disease management have begun to make.

Under Consumer Directed Health Plans (CDHP), the patient is responsible for more of the costs. They are often shocked to find that the cost of an office visit is $70, $80, $100 or more. They are distraught to discover that a diabetes maintenance drug runs them $750/month. So while CDHP help to make consumers accountable for the costs they incur, it provides a negative reinforcement as well.

Remembering that the last office visit cost them $80, patients may opt not to go for their annual physical. Aware that the medication was $750 last time, the patient halves the dosage or forgoes the prescription. Not knowing what the cost of a different service is going to be, but having been hit hard for other healthcare expenses, the patient simply avoids or delays care. None of these scenarios bodes well for wellness or disease management.

As a consumer, the patient needs to be educated on how the costs and how the healthcare system works. They need to understand that the annual physical may be covered under wellcare in their plan and comes at little or no cost. They need to know that the same $750 prescription can be had for $450 at a different pharmacy directly across the street. They need to know the cost of services when referred to a specialist before they go, lest they decide they cannot afford the risk of incurring a large expense.

Consumerism without cost transparency and education of the patient/consumer threatens to undo all of the positives that healthcare has been working so hard on in the form of wellness and disease management.

The answer lies in transparency in the system. Make healthcare transparent and the consumers will ferret out the inefficiencies in the system, make rational decisions about trade-offs in quality versus cost, and in the end, the patient/consumer will be the solution to improving the U.S. healthcare system.

Step 1 is Consumerism.

Step 2 is transparency about cost and understanding the health plan.

Step 3 is the consumer stepping in to make rational decisions about what defines quality and what warrants reasonable cost in the market.

Just saw the CNN report on 13 million uninsured 20-somethings in this country. New to the job force and turning down their health insurance.

What are they thinking?!?! Do they believe that they can just go out and buy what they need in terms of medical goods and services on the free market? Good grief! This is America for goodness sakes.

So what are they doing in lieu of buying insurance?

Radical things like minding their health– watching what they eat, working out, bundling up before they go out in the cold, washing their hands (oh, these kids – they’re like modern day hippies shunning the norms of society).

They go to the doctor only when absolutely necessary instead of for every little ache and pain. They go to retail clinics (like Minute Clinic and The Little Clinic) where they know the costs BEFORE they buy (oh my, what are these kids coming to wanting to know the price before they blindly incur the expense). They look things up on the internet (It may be MY chronic disease but shouldn’t the doctor know more about it than me? He treats it, and I only live with it…every single day of my life).

But why should these 13 million have insurance? In case something happens.

Hellooooo – they’re 20-somethings and invincible.

But seriously, why should they? Because it underwrites the rates of the older portion of the population. If they don’t get healthcare, they don’t offset the risk pool – they don’t underwrite the older segment of the population. And we know what that means – our rates will go up because they aren’t contributing monetarily (and taking less out than they put in) as we expect them to do.

But we can still get them. In New Jersey, children can stay on their parents insurance to age 30! Thirty!!!! In many other states it’s only 24 or so.

So now I’ll set aside the sarcasm.

What we are seeing is the revolution. The new generation is taking a stand. We have a product – health insurance – AND THEY ARE NOT BUYING! The business world should get the message here. These folks are going to opt for surgery overseas, retail clinics and internet consults. They are going to cost shop prescriptions and doctors. They are going to demand affordable access to care and they are going to want to know the price AHEAD of time. And they are going to return health insurance to truly being insurance – a safety net for catastrophic situations instead of the all you can eat buffet for $20 we have bad for soooo long – too long.

Do NOT think that it is the sage old regime of healthcare executives and politicos in D.C. who are going to change healthcare. It is the 20-somethings. They alone are able to break out of the old ways of thinking. It has been that way generation after generation. THEY have the new ideas. THEY are taking a more rational approach. They are getting organized and THEY are not content to go along with the system as it has been.

Yes, they are 13 million without health insurance…and growing. THEY will change healthcare.

Consumerism, just like transparency, is a current industry buzz word.  It is thrown around like everyone knows exactly what “healthcare consumerism” means.  However, consumerism often refers to the “derogatory” idea of society being preoccupied with the acquisition of consumer goods. Since healthcare consumerism is intended to represent a more positive movement, I am going to lay it all out on the table.

Consumerism, in relation to healthcare, is about moving past the perception that someone else is responsible to make decisions for us. We need to shift our thinking to be more actively engaged in our health and healthcare decisions.

Think about it - active participation and education prior to decision-making occurs in almost every other industry and consumer purchase… e.g. automobiles, electronics, home buying. Why are we so inclined to remain a bystander when it comes to healthcare? We need to move past the era of the passive patient.

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Great article from a freelance writer in The Morning Call. Richard has some of the ledgers from NY and Pennsylvania banks the 1950s to 1960s showing how household expenses were distributed. Of particular note is that the family paid all of their medical bills in cash. When someone came down with a more serious illness, there were more and more payments finally totally a whopping $1084 for a fairly serious medical condition. It offers a great idea of household life during those times prior to privatized medicine and reminds us as we see the shift to consumerism in healthcare that history always repeats itself.

Once again I had the privilege this morning to hear Sen. Bill Frist speak, this time at a breakfast held at Lipscomb University.  Though last time the topic was highly focus, today the slate was clear and anything to do with health care was on the table.  Although our time was limited, Frist managed to cover a lot of important topics and share his vast amount of experience and knowledge with us in the crowd.

The conversation began with a reminder that the US, compared to other countries, ranks poorly when it come to life expectancy and infant mortality, despite spending twice as much as other comparable countries.  Why is that?  Well consider what makes up health and life expectancy: 40% Life style and Behavior, 30% Genetics, 15% Socioeconomic status, 10% Health Services and Technology, 5% Environment.  Unless you have been living under a rock, its no shock…  we live in a country where our life style choices are not the greatest, a large portion of our country is obese and many people do not regularly exercise.  Add poor lifestyle choices to our lack of desire to change our behaviors, its no wonder we rank so low.

Anyways, from there we managed to discuss cost shifting, Medicare and the pending 10.6% reimbursement cut,  and the uninsured among other things.

My most important take away was his belief in consumerism and the public sectors ability to affect change.  In most all markets, with very few exceptions, competition and consumerism drive down or at the very least maintain costs.

Transparency… the new industry buzz word… connects right into this and refers to the idea that information regarding cost, quality, outcomes, and experience should be readily available to all consumers of healthcare (cost and quality being the top two, considering they are what we are having the hardest time controlling).

By making the industry more transparent, especially how much a physician is really being reimbursed for their services and how much a procedure will cost them before having it done, consumers have a better idea of the true cost and quality of the care they receive.

Wonder what the result is?? Well it’s believed that transparency in the industry will make consumers more inclined to take responsibility and accountability for their own health and health care. Now here’s the reality,  not everyone is going to care about how much their health care cost - Just like not everyone is going to care about “global warming”.

However the industry just really needs to see an emergence of “the prudent shopper”… the group of people that begin talk, begin taking note, and begin to care about their health care and its cost.

If you think you might be the next “prudent shopper” of health care, visit www.changehealthcare.com and see what you think… tell us what you think! We are moving into the world of transparency and engaging consumers… be part of that change.  That’s my advice.

Transparency, accountability, and competition… I must say - I am always happy to keep my feet moving, rather than be left behind.