I work with a variety of healthcare brands in my day job, so when the MGH Institute of Health Professionals and the Upsilon Lambda Chapter of Sigma Theta Tau International (Honor Society of Nursing) hosted a talk entitled "Can the Media Help Fix Health Care?" at their campus in the Charlestown Navy Yard recently, I was eager to attend.
Award-wining WBUR health reporter Martha Bebinger (right) led the discussion among an audience of mostly clinicians that highlighted several key issues that healthcare providers and marketers need to consider.
1) Shopping for health insurance isn’t – and may never be – like shopping for traditional consumer goods.
We talk about this a lot with our clients at PARTNERS+simons, particularly on website redesign projects. While it’s true that consumer expectations for how to shop from and engage with a business are being set by large, consumer brands (e.g., Amazon, Zappos, Apple), the reality is that shopping for insurance is a fundamentally different type of purchase. Access to price and quality data is spotty at best, and the ability to customize or configure products is limited by the regulatory environment. Add to that the complex nature of the product itself, the perceived low value for the money, and shoppers with a 12% health literacy rate, and you can see that this is much different from shopping for books, shoes or cell phones.
On her CommonHealth blog this week, Bebinger shared “The 26 Steps I Took To (Try To) Comparison Shop For A Bone Density Test.” She simply wanted to compare prices for this exam at three different labs, and she failed, because despite the hope of transparency promised by the ACA, cost data is not easily accessible (if at all) and requires consumers to wrangle with a myriad of websites, phone calls, and industry speak like “CPT Codes” (the Current Procedural Terminology used to designate a procedure).
Likewise, quality and safety data is difficult to find and assess, as there are no industry standards on how to measure or report it. Outcomes can vary widely depending on the procedure, the precision of the machine, the experience of the people administering the procedure/test, and the body being tested. There is no industry standard that accounts for these variables.
We need to create a culture where it is ok to collect and use these kinds of measures, and Bebinger is hopeful that by covering experiences like her own in the media, we will start moving in that direction.
2) Health Plans need to revamp their phone, web, and mobile experiences to begin to address these challenges.
MA law requires managed care health insurance carriers to “establish a toll-free telephone number and website whereby insured members can obtain the estimated or maximum allowed charge and the out-of-pocket cost that the insured member shall be responsible to pay for a proposed admission, procedure or service” within 2 business days of requesting it. Harvard Pilgrim members can use a tool called NowiKnow to shop for care, Tufts Health Plan says it will launch its own online shopping tool, EmpowerMe, in July, and BCBSMA says it, too, will have an online shopping tool ready for October when insurers are supposed to be able to give patients requested prices in real time. Nationally, Aetna has figured out how to do it.
WBUR runs an online community called Healthcare Savvy designed for patients trying to figure out how to shop for healthcare. At the time of this writing, it was suffering it’s own technical difficulties.
3) It is critical that we use the language of the public, and find ways they can personally relate to our products and services.
As a journalist, Bebinger spends a lot of time translating healthcare topics into language that the general public can (and wants to) understand. She urges healthcare practitioners, legislators, and marketers to get off of the system level and down to the patient level. The cost, quality, and safety measures mentioned above are 3 major disconnects with consumers not only because of lack of availability but also because consumers don’t understand how to read/evaluate them when they are available.
Similarly, NPs confess that they are “caught in the medical model,” using the coding technology and limited by time constraints that don’t support their holistic model. They are hopeful that the switch from fee for service to outcomes-based billing will help the situation, but they have not seen any real changes on this front yet.
Bebinger doubts that healthy people will ever see enough value in these policies to pay for them, especially if we keep talking about them the way we do. She cited cases wherepeople were gaming the system (signing up for coverage in time to get a specific medical procedure and then drop it) and noted the 15% of enrollees who failed to make their second payment were responsible for 70% of the costs.
She urged the audience to present their messages/stories in a way that makes it personal for the reader/listener (and acknowledged this is the best way to pitch her a story). “Scope of Practice” isn’t a phrase that patients know or care about, but hearing a specific success story about a person’s experience with their NP (backed up with sufficient data) may get them to pay attention. This theme of telling human stories and finding ways to emotionally connect with people, was very consistent throughout the talk.
Lastly, Journalists need to steer clear of creating alarm (e.g., “death panels”), reporting errors, and not having the courage to explore the stories that are difficult to tell.
4) As scope of practice rules begin to change, there is an opportunity to educate consumers on alternative care options.
There’s still a lot of speculation around whether the ACA will create a shortage of Primary Care Physicians as predicted. Regardless of that outcome, people don’t currently understand the roles of Nurse Practitioners and Physicians Assistants and how they could support broader coverage.
The AMA and other medical societies have been pushing back on expanded scope of practice to NPs. As it stands, scope of practice is currently determined at a state level, with some states being very liberal (NH allows NPs to run their own practices) while others are not (AL doesn’t allow NPs to write a script). Unfortunately, the ACA doesn’t address this.
The fact is, there is no variation in how NPs are trained from state-to-state, and the healthcare system has become so complex that NPs now get more education than they did in the past. Nursing organizations want the public to know that NPs provide affordable, safe, high-quality outcomes; is there a role that the media can play so that the general public will be more accepting of these options? The Robert Wood Johnson Foundation is currently doing a study comparing NP expanded scope of practice with outcomes that will hopefully support their case. There have been studies in the past showing that NPs have better outcomes with chronic disease management cases than MDs because they take a more holistic approach, but it hasn’t been widely publicized.
Overall, it was a really interesting conversation from both a professional standpoint and a personal one, as health care - and health reform - affects all of us.
