Why Price * X = Healthcare Value is Unsolvable- X, Quality remains an unknown

Price x Quality = Value a the fundamental question for almost every buying decision. You pay a little less, you get less quality.  You pay more, you get more.  So why can't solve this equation for healthcare? 

I had the opportunity last week to host a panel on price transparency at Health 2.0. This meeting has been advocating for patient empowerment through technology for many years.  Several companies including Vitals.com, Healthgrades, HealthSparc & 
BetterDoctor presented.

For the insured, price transparency is relatively easy with a little effort. The cost of the procedure can be defined based on certain parameters -in or out of network, whether you have the procedure done at a hospital or an outpatient center all go into the price calculation.

Quality is much harder to define. To date, companies have relied largely on patient ratings of physicians.  However, with the new release of the Medicare database, other factors being are being considered. How often a physician is doing a particular procedure, how good are the other physicians referring to that particular physician, and what is the hospital rating where the procedure is being done are all being incorporated into the websites. 

Although this makes sense, this process is only surrogate for quality. For example patient rating (patient satisfaction) largely reflects the buying experience, how much the patient liked the doctor or their office staff rather than their outcome.  In fact studies have shown that sometimes satisfaction negatively correlates with outcome.  Patient satisfiers such as prescriptions for narcotics and unnecessary surgeries (often easier for the doctor), are not good for your health. Physician’s may be particularly attentive (another patient satisfier) after there has been an error. Physician volumes may be indicative of a truly good practitioner, or may relate to their affability or availability.

These websites should be a concern for healthcare practitioners.  Without real patient outcomes data, ratings run the risk of becoming a popularity contest rather than a rating system for good care.  During the Health 2.0 an audience member asked the panel what physicians, particularly recently trained physicians, should do. Panelist recommended physicians pay attention to their profile and patient feedback about their care early in their careers. Perhaps med schools should have classes in web marketing?

My personal bias would be to give physicians the information regarding their own referral networks first.  This would tend to shift referral pattens.  I may refer to a friend, but if they finished 3rd out of 4 colleagues in the same geography, I might reconsider my decision.  This decision would also be contextual.  Doctors tend to know why results from a colleague may not be as good as other practitioners.

I don't mean to be negative. In fact, I applaud these efforts. However, we are at the beginning of our journey to better understand the “value” in healthcare.  Having price transparency is a good start..  Ultimately, to solve the equation better measures of quality need to be determined.  Until we can this type outcome information (likely a mixture of data from providers and patients months after treatment) ratings will remain more about personality than value.  Until then, let the buyer beware.

There's a wide chasm between wellness and healthcare

There's a lot of talk about shifting our focus from healthcare to wellness. Great idea. After all, it's far cheaper to prevent disease rather than treat it. If only it were that simple.

Wellness conjures up visions of youth, spas, and sunshine. Wellness is for the healthy and the privileged. Wellness is for the super-fit, all those kale eating triathletes Silicon Valley millionaires looking to optimize their health.

Healthcare is something else entirely. It brings up visions of doctors and hospitals, cancer and pain. Nobody wants healthcare. It's not fun, sunny or desirable. It requires an admission of frailty and mortality, all things most of us look to deny.

It's almost as if the 2 words are ying and yang, an us and them, the well and the diseased. This misperception has lead to stupendous market failures. I've seen countless healthcare entrepreneurs suggest their product is the next big thing, something everyone will want only only to hear a resounding thud, a small niche market with little or no adoption.

The fact is most people who need care... have failed wellness. Challenged by either socio-economic, genetic factors, or attitude, wellness might as well be a foreign language for many people suffering with chronic healthcare issues. And the people who care about wellness, aren't typically sick.

If we are really going to impact on those who need it most, we need to have an honest discussion around the issues related illness, & the often associated feelings of helplessness and depression. This means not simply masking disease with quick fix pills and surgery, nor seeing people as weak if they don't cheerfully adopt the wellness lifestyle. Rather, we need to address deep rooted (and expensive) psychosocial co-morbidities that co-travel with the reasons for healthcare.

I'm all for wellness. But to truly have an impact we need to have an honest conversation around  what it means to be "them," the majority of Americans living with chronic disease.