Shared Savings With The Patient

Shared savings is always an interesting idea. It is often something that companies look at in a business to business relationship. What about health plan or employer with the patient? Is this an avenue to drive smarter decisions?

The whole theory behind consumer directed health care is making the consumer more responsible and aware of cost. [Although I will continue to argue that the original premise years ago was about driving quality of care not simply cost effectiveness.] But, clarity around the total long-term cost of a healthcare decision is not always readily apparent. In a best case scenario, I may understand the cost of a provider compared to another provider, but do I understand their comparable outcomes and those implications on longer terms costs…NO.

Pay-for-performance is something being tried (not for the first time) in healthcare. But, I don’t hear anyone talking about incentivizing the patients. If they go to the clinic instead of the Emergency Room, why not give them 25% of the savings generated. If they use self-service (i.e., the Internet) versus calling a live agent, why not give them points towards a healthy reward? There are a few innovative models being tried, but it is certainly not the focus. The focus is on making them pay the first X thousand dollars out of pocket with limited information. Transparency and access to data in a real-time setting is critical. I should be able to text message Google and say compare price of Dr. Smith versus Dr. Adams or Hospital A versus Hospital B and provide me with their comparable outcomes for my disease.

Perhaps the bigger question is whether or not incentives can be a key element in any structural re-design of healthcare. We know that providers clearly aren’t aligned to provide preventative care in most cases. If they treat you and educate you to not get sick, you don’t come into the office and you don’t need surgery. It’s great for the health plan, but it reduces provider (i.e., MDs and hospitals) revenue and drug company revenue. I am sure I am not the only one who sees that that is a problem.