Tuesday, February 16, 2016

What Does the Patient/Consumer/Beneficiary/Person (pick your word) Care about when Accessing Care?

A new survey commissioned by Accolade (I am Chief Medical Officer and a founder of Accolade) performed by Harris Interactive (the Harris Poll people) attempts to answer that question.  From a medical vantage point, it may seem like a simple, obvious question. The person accessing care wants to get better!  However, the answer is much more complex.  People, when ill, tend to worry about more than those aches, pains and other symptoms. 

The title asks one question but implies a second question.  What does the person care about is the first.  The second is whether the person accessing care is a “patient” a “consumer,” a “beneficiary,” or some combination of all of those?  While physicians and nurses clearly prefer to see those in need as patients, the most used and perhaps overused term in the health industry these days is consumer.  This often appears to be aspirational as programs and companies are formed to try and find the magic formula with which to induce patients to purchase health case as if it were any other consumer item.  I question whether the emotional nature of illness, and the impact created by the potential for catastrophe inherent in medical issues will ever allow the patient to truly be a consumer.  “Consumers” traditionally are focused on cost and feature comparisons such as deciding whether to get leather seats in a new car.  I don’t believe that when you or someone you love is ill, you ever are a true consumer as implied by that example.  However, at the same time patients are rarely if ever only worried about the cure which use of the term patient may imply.  They are worried about their family, their finances and how their illness will affect all aspects of their life.   People, therefore must be helped to understand the value potential in each health service and see clearly how those services relate to their life issues.  That may fit into the term “consumer” even more than it does into the term “patient.”

I date myself a bit by using the term “beneficiary” as this is the traditional way insurance companies have described those who enroll in their health plans.  I rarely hear that term used in today’s world.  “Consumer” has replaced “beneficiary” except in legal documents.  People “benefit” from the access to care and the financial security that health insurance and health plans offer hence the term beneficiary.  Fundamentally beneficiary communicates the ability to gain access to care and to guard against financial catastrophe rather than reflect the care itself or guard against medical catastrophe. 

I admit to struggling with the right word to use as I jump between the different but co-dependent worlds of health care delivery, health benefits, and the business of health.  For the person in need, the distinction between these worlds means very little and actually just reflects some of the challenges of obtaining needed care in today’s world.  This is reflected in this survey.  It asks questions that approach the issues with the knowledge that each respondent is a complex person with multiple concerns that overlap into all these areas. 

The Accolade Consumer Healthcare Experience Index Poll surveyed 2.046 adults over the age of 18 of whom 1,536 have health insurance through their employer, private insurance or Medicare.  What was clear from the poll is that the experience of accessing care is seen as a daunting task for those in need.  While they trust their physician for health information with 74% saying that they prefer to get information from their physician, they are frustrated by a lack of coordination and challenged by the benefits rules and the costs.  Overall, 53% stated that the hassle of “understanding what care will cost me” and “coordinating all aspects of care” was the major problem that they faced when ill.  It is interesting how strong the fear of these issues is, even perhaps surpassing the simple question of getting accurate diagnosis and treatment. 

67% of those surveyed said that they wanted their health care providers to understand their life circumstances more in order to address their illnesses in a better way.  People understand, perhaps even more than many health professionals that coping with an illness while coping with all the challenges of everyday life are intertwined.  The idea of a physician treating a disease without good knowledge of their other needs and responsibilities whether they are related to work, family or finance is a source of frustration.  80% told the surveyors that they would want a single person to trust to be with them and help them navigate the systems and navigate the challenges of their lives when they require care and they appear to recognize that person is not likely to be their physician.  These numbers reflect a widespread concern with the impact the disease has on a person’s life and family and not only a concern with the biology of the illness.

Much of this comports with ideas a group of us had some nine years ago when we, led by Tom Spann as founding CEO started dreaming of a better way to help people through the health care system and the health benefits system.  We had to rethink the consumer and the patient and the beneficiary and think about how to create not just a company, but a new profession, that of Health Assistant, supported by the right information technology and the right management systems.  The Health Assistant has to be part insurance expert, part social worker, part financial advisor, part coordinator, part health educator and most importantly a trusted friend.  While training and experience is needed, equally important are the management processes, the right content that is always kept up to date on the technology platform, the right pay structures and metrics for the Health Assistants, and a sense of purpose and responsibility towards those being helped.   The technology has to support and drive all of those functions while avoiding the trend to become a checklist that harms the human interaction that is core to the function.  We have done that.  We have proved that we can help people in a very positive way and help the health care system as well with our approach. Data from this poll only confirms our initial dream and makes us want to work even harder to continuously improve our systems, training and approach in order to bring this type of support to everyone.  

Friday, February 12, 2016

The Place of Passion in the Business of Health Care

I learned early in my business career, after being in medical practice that the way business people and medical people communicate is very different.  Besides having fundamentally different languages, clinical people tend to be more emotional in their approach to communication than people in the business world.  Sometimes clinicians can get a bit too emotional as they take the passion and concern that is needed when helping a sick patient into the business meeting.  On the opposite end of the spectrum are business people who are often in health care due to their profound desire to help others.  They can bring a hard-nosed focus on budget and margin and sometimes appear to be uncaring of the human impact of those numbers despite their commitment to helping.  Both sides have to understand and accommodate the emotional communication style of the other if our current health care world in which business, management and care are all intermingled has any hope to achieve higher quality and lower costs.   
Physicians and nurses know that passion is helpful when speaking with patients.  The patients and their families want to know you care, and that you share their sadness, their anger and their fear as they enter evaluation and therapy for problems large and small.  At the same time, the patient wants to feel that the health professional caring for them is the rock they can lean on and not be overly emotional.  The gifted doctor communicates emotions without inflaming them and is able to walk the difficult line of sharing sadness and happiness while also appearing objective and professional.
In the board room and in business meetings, physician often feel the need to communicate the emotions of the patients to the managers in order to underline the importance of the business decisions on patients’ lives.  In this way, physicians often feel when working with business people and managers that they must play the role of emotional middle-men (and women) communicating the patient feelings and reactions to the business professionals. 

In the business world however, the emotional speaker may be discounted and de-emphasized in the internal negotiating that often reflects productive business decision-making.  That emotionality may be thought of as reflective of less than fully rational deliberations and the one displaying the emotion may therefore be less credible than the one who can make a “business case” in a totally dispassionate way.  There is often a belief in business and management that rational analysis is inherently devoid of emotions. 

In the past few years, research on decision making and emotions have led to what Jennifer Lerner, one of the leading lights in this field (Prof Lerner is an advisor to Accolade), calls a “revolution” with the “potential to create a paradigm shift in decision theories.”  In an article published in the Annual Review of Psychology, she and her colleagues write, “emotions constitute potent, pervasive, predictable, sometimes harmful and sometimes beneficial drivers of decision making.”  While anger and fear tend to be thought of as impairing good decisions, even these types of emotions in the right situations can be useful.  In the preface to his book, “Feeling Smart,” Eyal Winter cites a study that shows when we are moderately angry our ability to distinguish between relevant and irrelevant claims in disputed issues is sharpened. 

At Accolade, in our early formative years, I sometimes took on the role of playing a difficult person calling Accolade with medical problems as part of our certification of new personnel.  During one of these certification calls, I played an unpleasant person, who was angry at everything.  The person I was testing, a talented business health professional was accurate, dispassionate and correct in everything he was saying.  In my role as the patient with the problems, his professional attitude made my character more angry as it made me feel as though he did not understand the urgency of my need.  I stopped my role playing and admonished him to stop being so damn professional!  He had to show emotions and allow himself to be more human to me as the angry person in order to build my trust and allow for positive influence.  At the same time he could not reflect my anger to the point of inflaming an already difficult situation.  He had to understand, acknowledge and direct both his and my (in my actor role) emotions in such a way as to create better paths towards high value solutions.  These same observations hold true for discussions within organizations as well as discussions with patients and other stakeholders. 

The issue of how we reconcile the differences in emotional communication between clinical health professionals and managerial health professionals in order to develop systems that are optimal for patients is critical.  We must, when designing health delivery and care management systems, build them in ways that encourage the understanding of emotions in order to foster better decision making by all involved.  Unless the people on both the clinical and managerial sides of health care can come together and communicate well, the chance of developing better ways to build  structures and processes that encourage doctors, nurses, patients and families to work together for maximum effectiveness and efficiency is significantly hampered. 
In health care especially, the decisions that doctors, patients and families must make when someone is sick are perhaps more fraught with emotions than almost any other decisions.  Our management systems must reflect, acknowledge, and proactively address this reality.  These realities must be understood and used in the same way that objective data, both quantitative and qualitative is understood and used.  Failure to do so, whether in care management decisions or business decisions will result in poor results for the patient and the organization. 

At Accolade, we take an approach which involves acknowledging the emotions, understanding them and then either attempting to encourage them, minimize their impact, or direct them in a more useful way.  Internally, as a company combining smart people from the clinical and business worlds, we constantly work to understand the different emotional communication styles that all of our dedicated professionals bring to the table.  In the same vein, for care delivery systems, equal focus on the providers’ emotions while working with patients is also critical.  As Winter says, “our emotions are more rational than we think” and in health care, we must bring the same rigor to their evaluation, study and to the impact they make on medical decisions as we do for staging and treatment of cancers and other diseases.  We are human.  Emotions are part of the human condition.  Let’s stop making believe they are not important or not relevant to care and to good management and address them constructively.