The current and anticipated health care environment presents a win-lose proposition to patients. With 20 million people insured under the Affordable Care Act, the health system has been more utilized. People are getting access. That is good. What is not good is that the healthcare system is often not prepared for the influx and the patient experience suffers.
On the other hand, there are the fear-based predictions of what is to come. The most notable concern I have is removal of a mandate to buy insurance. We already see people opting to not buy and incur an IRS penalty. If they have no "stick" to induce them, more will opt out. That increases the risk for insurers and drives premiums up. It also leads to more people being uninsured and using the health system inappropriately. When that happens the patient experience deteriorates too.
I am on the board of a local Clinic and at a recent meeting we talked about the rising premiums here in NC and how people who could have afforded insurance last year may not this year and will be using our clinic services. These are the people that will fall through the cracks.
Navigating the health care system is hard enough already. Transitions in care are often worse. In this kind of environment, it is essential that people learn how to advocate for themselves. Here are some ways to get started.
Care and Cost
There are two aspects to our healthcare – the care itself and the cost of care.
According to Trisha Torrey, founder of The Alliance of Professional Health Advocates: Advocating for your own healthcare boils down to doing the research, asking the questions, getting second opinions, asking for more information when something seems askew.
Choosing Providers - Use Common Sense; It's Your Most Important Job
There has been a blind trust in place when it comes to consumers and the healthcare system. The most important job you have as a patient is to choose the right provider. We take time to research a car purchase, a house purchase, even our smartphone purchase but how much research do we put into finding a healthcare professional? Many often choose because the provider is nearby; or heard the physician was nice (not necessarily competent); or simply have no choice because the doctor is in the insurance network.
I picked my physician by witnessing how he took care of my mom. I tell this story often when speaking to groups. I had just moved mom from Florida after my sister passed. It was her first visit to her new doctor. Being diligent, we already had all of her records transferred to the provider. He came in and it was apparent he read them all. He talked briefly about her care then knelt down next to her and simply asked "Tell me what's going on?" That ensued a 45-minute conversation that had little to do with clinical care and everything to do with the state of her life that was impacting her health. My sister, her first born, had just passed. She had to move away from Florida and her friends, quickly. She was living in an independent community where she knew no one. After she spoke, her doctor simply counseled her to go back to her community, grieve, make new friends, and come back in a month to look at how she was doing. Under his care, mom reduced her medications, saw few specialists, and had a better quality of life with fewer interactions with the health system. Why? Because her doctor was a great listener and that made him an even better practitioner.
You may not have the opportunity that I did to witness the care. If you don't consider that some providers set aside times to be interviewed by prospective patients. The fact that a provider does that should clue you in that perhaps he or she is a good listener too. Still, there are things you can do and ask to give yourself some level of comfort on your choice.
- Go to sites like Health Grades to see how a physician is rated.
- When calling the office, find out the usual things - are they accepting new patients; do they accept your insurance, hours, availability online and after hours.
- Is the physician board certified?
- Ask about his/her philosophy of care - are they aggressive in ordering tests, prescribing? Are they about prevention or more about treatment?
- Investigate whether they have any legal or disciplinary actions pending. These sites can be helpful: Administrators in Medicine; the American Board of Medical Specialties; the American Medical Association.
As Torrey points out:
Patients tend to relinquish their common sense for healthcare – even those who would never do it in any other aspect of their care.
Once you have found a provider, it is important that each visit have meaning. Most of my visits are routine. However with mom they were not because of her advancing age and multiple conditions. That is when it's important to have someone else at the visit. While that person can be a family caregiver, it could also be a friend who is a nurse. A second set of eyes and ears are important to document things and to ask questions. And keep in mind that research has shown that just one in three physicians listens to caregiver input and just one in six inquire about the caregiver's health. These are important indicators for knowing when you have found a good physician.
Second Opinions / Using Your Gut
Getting second and third opinions on serious matters is appropriate. Don't worry about offending your physician's ego. Most of all, trust your gut. If something does not feel right, if you are not comfortable with a treatment plan, or if you feel you have been mistreated or diagnosed - get other opinions. Consensus is always better.
Know the Price
Just as important as your choice of physicians is your choice of health plans. The field is narrowing and we have less choice. This year I had one - Blue Cross - because the other insurers are abandoning the Affordable Care Act. Still we need to know what we are buying. Often we shrug and resign ourselves that we have no control over price. Or we just assume insurance will pay so why question. Yet with high deductible health plans, unless something is seriously wrong, most of the cost of care is coming out of your pocket. The lower premium you pay comes with a cost! You need to know how much of the care is covered and what is covered after meeting your deductible. That is when it is prudent to shop. A doctor may order a CT scan through the hospital that could cost $1,000, when a freestanding CT center across the street may cost only $299.
There are apps for various aspects of being an empowered patient. But no one is perfect. Keep in mind that often they are not private and most apps do not help you track or manage your health. Most only provide reference information. By some estimates there are 40,000 apps on the Itunes app store! This Harvard article can help. They advise:
Call in the Professionals
- Take a few apps for a test drive.
- Ask for recommendations.
- Look for health apps sponsored or created by established health advocacy groups, medical organizations, or universities.
- Check out a website called Wellocracy.
- Read reviews at MedicalApps.
According to Torrey, one problem with being a patient or caregiver is that we are often sick or exhausted – so we don't make important decisions with the same clarity we otherwise would. Enter professional and independent advocates. Want to know more, check out Every Patient's Advocate. A patient advocate can guide you through the healthcare maze. And for older people, a geriatric care manager can not only manage your clinical navigation but all of the other logistical and social determinants of care that impact health.