Ratings-based financial incentives continue to gain momentum
November 15, 2013
At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.
November 15, 2013
Often, health care purchasing in America is not tied to quality. That's in large part due to the lack of widely accepted quality metrics. As a result, patients often select their care based on personal recommendations or other proxies for quality (e.g. perhaps they feel that academic medical centers are better quality). Hospitals themselves have a difficult time differentiating themselves on quality. Even if they wanted to publicly post their quality metrics, other hospitals in the area might not have an incentive to follow suit since they can easily dispute the usefulness of such metrics. As a result, hospitals will advertise on things like having the latest equipment which might be perceived as a proxy for quality, but is actually a poor substitute.
Over the last couple of decades, a variety of pay-for-performance schemes have been gaining momentum. Recently, Medicare has started to roll out financial incentives based on their quality metrics. Currently, however, the actual extent of the incentives seem pretty limited: only one hospital will lose more than 1 percent of its reimbursements. The stakes get bigger next year, and it will be interesting to see if the numbers get big enough for hospitals to change their behavior.
November 10, 2013
There is conventional wisdom all around us. Some times, such wisdom is held in such regard that no one really challenges it. Other times, people take a closer look and find some surprising results. Having worked on a patient health record before, I have personally heard about doctors' concerns about what might happen if patients actually saw their doctors' notes (gasp). While patients are generally entitled to a copy of their medical records under HIPAA, I've met doctors and administrators who have been less than thrilled about making that process easy.
Clinicians at Beth Israel Deaconess Medical Center and Harvard Medical School ran a pilot program where primary care doctors actively shared their notes with their patients. The result? "Perhaps the most telling statistics of all: Not one of the 105 primary care doctors elected to stop providing access to notes after the experimental period ended." This is a remarkable departure from the general sentiment that I encountered earlier.
What might be next? Maybe the idea that doctors will never post prices? How about their publicly posting outcomes-based quality data? The path might be long, but we can still hope.
November 01, 2013
The Wall Street Journal ran an interesting article on how some doctors are surprised to be inaccurately listed as accepting certain insurance plans. The author of the article wrote, "Exchange officials blame the insurance industry, where inaccurate and out-of-date provider lists are nothing new." Interestingly, we've encountered something similar. We found a doctor listed on an insurance company's website, and we thought it odd since we hadn't heard of that insurer in this area. We proceeded to call the doctor's office and the person who answered the phone said that he hadn't heard of that insurance company. This can have implications for those who might be switching health plans: such patients might be sorely disappointed to find out that a doctor they were expecting to accept their new insurance doesn't actually accept it. While industry insiders might know about the long-running inaccuracies of insurance databases, the general public might not.
What's particularly interesting about that article is how even the doctors' specialty information was listed incorrectly -- to the extent that CoveredCalifornia removed such information from their website. Needless to say, looking for a new doctor is much harder without the specialty information. Hopefully, the databases that insurance companies have will become more accurate on both counts.
For those who are curious, we generally figure out which doctors accept which insurance plans by checking with the website of the medical group. We believe this is more accurate (the provider's office is largely the one that would have to handle patient outrage of being billed extra for their being "out-of-network" despite being told otherwise). However, the downside is that not all provider directories will list insurance information. We expect that the situation will improve over time, especially as more information becomes available online.
October 26, 2013
This week, we rolled out some user interface changes. We fixed a latent bug that appeared on iOS devices, where we would get the size of the screen wrong and the content would be hard to understand. Additionally, we spent quite a bit of time trying to more accurately figure out the geographic boundaries for a search so that providers whose locations fall outside the map wouldn't be included and providers with locations inside the map would always be included. We've made substantial progress on that one, but haven't fixed it entirely. So, if you conduct a search on our site and subsequently select a filter, you might see a different number of providers than initially shown.
Beyond the bug fixing, we are looking for some design help to update certain elements of our search results. If you know of any talented designers who can take on additional work, please let us know.
October 19, 2013
This week, I received a letter from my health insurance company indicating that they will be cancelling my policy. Of course, not to fear, I can buy a new replacement policy that conforms with the Affordable Care Act regulations. What they didn't mention is that my new premium will be roughly double of my current premium (assuming no subsidies) and the deductible will be higher. Apparently, this is reasonably common. This comes at a time when some companies are transitioning their employees to the health insurance exchanges.
As I mulled over this news, I realized that while the transition may be rocky, there might be long-term systemic benefits specifically because more patients become more aware of the health costs. First, as consumers select insurance plans, many will question whether they need the levels of coverage that they might have enjoyed previously, paying only a modest co-payment when visiting the doctor. Subsequently, as increasing numbers of consumers adopt high-deductible plans, more and more of them will want to know the prices of procedures. Increased numbers of price-sensitive consumers might finally make it viable for providers to compete on price; in turn, this competitive pressure might actually affect the rate of health care costs. It's far too early to tell, and the short-term will certainly see some bumps, but these higher prices and higher deductibles just might be setting the foundation for a more competitive marketplace.