The Economic Need for Improving Patient Decision Making

As the New York Times says, “It’s back.” Healthcare spending, which had moderated for the past few years, is beginning to rise once again.  The rise in healthcare spending is being driven by more visits to doctors’ offices, more hospitalizations, and more prescription medication use.

Healthcare spending can be thought of as having two components: a unit cost component (such as the cost of an office visit or a day in the hospital) and the volume of services (such as the number of office visits or days in the hospital). The volume of services is driven by the number of people using healthcare services and by the number of services each person receives. If it is successful, the Affordable Care Act, will increase the volume of services by increasing the number of people with better access to the healthcare system.  That will drive a national increase in healthcare spending. There is, however, an opportunity to impact the volume of services by decreasing the number of unnecessary services each individual receives. In studies that were initially done by the RAND Corporation – and have been replicated over and over – researchers found that as much as one-third of medical costs are unnecessary.

Each individual service in healthcare is driven by doctors’ and patients’ decisions. While many see medical decision-making as being a physician endeavor, the truth is that patients make many more decisions than doctors. Think about all the decisions made in relation to health and healthcare:

Who Makes the Decisions?
	Doctor	Patient
Staying Healthy	NO	YES
Deciding to Seek Medical Help	NO	YES
Diagnosing	YES	YES
Treating an Illness	YES	YES
Complying with Therapy	NO	YES

Many of the projects and demonstrations that are part of the Affordable Care Act are focused on physician decision-making. However, influencing patient decision-making can have a profound positive effect, in terms of better quality care and lower costs. When you gain people’s trust, respect their values and beliefs, and help them to come to better decisions, the result is lower costs -- often dramatically lower costs --, and better care. In addition, patients end up being happier with their care experience, which in today’s world is otherwise an experience filled with fear and confusion.

How is this done? There is not one answer -- and I would not be so arrogant as to suggest that there is. When you look at the innovations (including our own efforts at Accolade) in the area, they have certain commonalities. I would divide them into the following categories:

• Building patient – professional trust early
• Understanding and accounting for the dynamic nature of illness, rather than approaching it as a unique disease at a single point in time
• Understanding the isolating nature of illness and the power of having a trusted professional at the ill person’s side
• Taking people’s beliefs and values into account and affording them the respect they deserve
• Understanding the social, psychological, economic and spiritual nature of illness
• Giving health professionals the time, systems and training to truly engage with patients and families and not only to treat the disease pathology

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So while the Affordable Care Act will, we hope, give more people access to insurance and may increase the volume of services, we at Accolade are dedicated to making sure that each individual we help makes decisions that are the most likely to be necessary and helpful. In that way, we can minimize unnecessary services and lower the total cost of care in the process.