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December 06, 2007

"Consumer-Directed Health Care: a 360 degree view"

This is the working title for a book by Kim Slocum, a healthcare policy consultant who comes from the biopharmaceutical industry. He was part of the panel in a Webinar yesterday produced by Healthcare IT News and sponsored by IBM Global Business Services, as part of their Healthcare 2015 initiative. (2015 is the year they propose that "healthcare systems around the world will become unsustainable" if major changes are not implemented soon.)

During the prepared section of the Webinar, these experts presented the current thinking in the technology, 3rd-party payer, clinical, and biopharm sectors. But, it was during the open panel discussion that consumer-directed health care (CDHC) topic was addressed. Kim was well prepared and had plenty of statistics and observations, and it stemmed from the research he had done for his upcoming book.

I called him immediately after the Webinar was finished, and enjoyed hearing even more ideas. For his book, he collected the studies that he considered to be the least biased or tainted with conflict of financial interest by looking for the work done by "voyeuristic eunuchs." (I guess this is the same of "disinterested parties" but what do I know about publishing.) His sources include the Kaiser Family Foundation, the Commonwealth Fund, Harris Interactive, and the Health Affairs journal.

I won't get to all the points he mentioned both in the Webinar and our phone conversation in this post, but I will touch on them as I blog more on this topic.

One factor to consider with CDHC is how the consumers will use resources to make important decisions about their health care. Kim cited an article produced by the Hastings Center called "How Do Patients Know?" In essence, patient want to speak to a doctor to get their information. As Kim put it during the Webinar, the US isn't about to send its 300 million citizens to medical school. Compounding this, he said, is that the average American has a high school education, and 50% are health illiterate or health innumerate, having a reading level of grade 6-8, while most healthcare communication is written for grade 12.

There is a concept called the Medical Home (pdf file) that seeks to pair individual patients or families when possible with primary care physicians as their guides so that they people can have a strategy for longitudinal care rather than addressing isolated bouts of illness.

However, there is still the need for funding, clear of support by commercial interests, to produce all this medical media written in a very simple and clear manner. Slocum calls this "iPod health care" with "libertarian paternalism."This metaphor is meant to describe a system where people have access to simplified information which will be easy to navigate and understand, but won't require any special knowledge or preparation. If anyone seeks a deeper understanding on a particular topic, he or she will be able to augment their knowledge.

This “libertarian paternalism” is all about protecting those who do minimal research—a kind of benign default—but they will have the freedom to seek more data to personalize their medical care if they chose to do so.

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