Most people recognize that their choice of medical providers is controlled by their insurance company, and in turn, their specific health plan. In my previous article, I explained how the exploding growth of high deductible health plans (HDHPs) is rationalizing the insurance market, and quickly forcing a reevaluation of the role payers play in outpatient care.
One of the most important benefits we gain as consumers by directly paying for our care - in addition to much lower rates - is choice. As more and more providers realize the financial benefits of cash-paying patients, the larger the cash-accepting “network” grows, and before long, we can see any doctor we want - provided we’re willing to pay the going rate.
But insurance networks represent just one of the two dimensions by which we have historically been controlled. The other is data. And, while everyone in healthcare laments the lack of system interoperability, I’m not sure that I’ve ever heard anyone name the spade appropriately.
Health data is siloed, inaccessible, and non-standardized BY DESIGN. Simply put, It allows provider-based networks to create switching costs. So, while my insurance company gives me a narrow network of doctors who I can see, provider systems - acting as rational businesses - do their best to make sure I only see their even smaller subset of doctors.
This really isn’t that unusual. Businesses do this kind of thing all the time. For example, I have a 2009 Volkswagen GTI which I always take to the dealership to be serviced. Why? A simple oil change costs me $75. I’m sure it would cost half that much at Jiffy Lube.
The main reason I take my car to the dealership is that I want all of my service information in one place, and I don’t even have access to it (sound familiar?). Perhaps I rationalize a bit to myself that they are VW experts and can do a much better job than anyone else. This might be true for the engine, but probably not much else. Don’t even get me started on tires.
The truth is that we have allowed this to happen because we have been so unengaged not only as patients but as healthcare consumers. The good news is that the more we begin paying directly for our own care, the smarter we get about owning our own information.
I suspect that as we begin demanding access to and control of our own data, the responsibility for maintaining longitudinal support of our information will switch from providers to individuals.
In this new model, healthcare providers will perform services purely on a transactional basis. They will perform a procedure, run tests, prescribe a med, and then they will turn over the associated data to individuals who will store it securely in the cloud. As consumers, we can then manage, maintain, and share our information as simply as we would any other document on Dropbox.
Furthermore, we can then augment our health provider generated data with the host of new information that will eventually flow from wearable and other monitoring devices. (Really, your doctor doesn’t want this stuff - so stop trying to make her look at it!)
Eventually, we will be able to pay to plug our cloud-based data store into a predictive analytics engine like Watson that will start generating all kinds of insights… all of which we will almost certainly ignore, yet it will be cool nevertheless.
Imagine: no more Epic, no more Meaningful Use, no more restrictive silos.
I don’t know about you, but I’m ready for my healthcare Dropbox.
(PS - Dropbox, give me a call)