Physician Patient

Consumer Power in Minnesota Health Care: It’s Simply a Question of Political Will Since Technology is Not Holding Us Back

The Wedge of Health Freedom allows consumers to find independent practice doctors. It’s like a medical market Angie’s List. Created by the CCHF, the Wedge is endorsed by the Association of American of Physicians and Surgeons (AAPS) and us at MPPA. See http://www.cchfreedom.org/issue.php/40#.V5-3U73POJk

Most Minnesotans want a true health care marketplace which invites competition for their patient loyalty among all of Minnesota’s medical practices, including the independent, private practices which are listed on the Wedge, and for a needed expansion of choices for health insurance from Minnesota insurance companies. MNsure has not been working, except as a pathway for patients to enroll in Medicaid (medical assistance) or MinnesotaCare http://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/programs-and-services/minnesotacare.jsp. The current federal health law, the ACA or Obamacare, discourages varied offerings of insurance products except in broad categories. Premiums and deductibles are on the rise, and alarmed Minnesotans agree that “one size fits all” does not work for providing medical services, insurance coverage, or medication benefits.

The political challenge in 2016: Change government laws and regulations in Minnesota and nationally to permit and encourage accurate, transparent, Web accessible cost and service(s) information for medical care, insurance products (costs and benefits), and pharmaceuticals. In this age of smart phones and personal computers, patients and families want and must have much more control control over to whom and for what money for their health care goes. Consumer Power is the missing link to 2016 health care reform in Minnesota and in America.

This can be more than a pipe dream. As a “non-techy,” I’m learning that existing technology called application-programming interfaces (API) makes possible all kinds of data connectedness. I’m told that an application-programming interface is a set of programming instructions and standards for accessing other Web-based software applications. Obviously, APIs can be a powerful tool for getting Americans to real time consumer-directed health care.

Here is a technical expert, Xerox information chief Tamara St. Claire, who says (below) that APIs can improve communication between physicians, cut through the maze of third party insurance, state and federal government, clinic pay-for-performance (P4P) “provider” rules and requirements, and encourage (business) opportunities for IT to enable consumer-directed health with APIs. http://thehealthcareblog.com/blog/2016/07/27/the-new-api-economy-now-with-interooperability/ So, an age of consumer-directed health care can be a realty.

But, and this is a big but, St. Clare’s utopian vision is unrealistic given the obvious financial conflicts of interest among Minnesota (and US) insurers, providers and health care consumers. The health care industry is comprised of state and federal government funders and providers, insurance corporations, and hospital-clinic systems. All stakeholders in our medical-industrial complex whether for-profit or non-profit benefit by keeping individual health care consumers (patients and families) in the dark about their actual or anticipated health care costs. In 2016, these growing oligopolies and oligopsonies of government, big insurance and consolidated providers hide in a smoke screen of useful consumer health care data.

Patients ask, “What does this care, imaging, test, or procedure cost?” And they are told not to worry because this is a question for their insurance company or government bureaucrat. Or, perhaps even more often, the doctor or other “provider” says, “I don’t know.” Yet, as health care premiums and uncovered bills increase, patients aren’t satisfied by asking: “What does my insurance cover?,” or “What is my co-payment or deductible?” This lack of cost transparency simply isn’t working out for them: their health care is truly Priceless, as John Goodman explains. See http://www.independent.org/priceless/

Back to the API:

Consider Amazon.com: When consumers are given marketplace power, then, a company such as Amazon will gladly release its API to the public for its own business reasons so that other software developers can design products that are powered by its service to customers. Everybody wins. Amazon.com gladly releases its API so that Web site developers can more easily access Amazon’s product information. Then, using the Amazon API, a third party Web site can post direct links to Amazon products with updated prices and an option to “buy now.” (I really like the convenience and efficiency of the Amazon site. Don’t you? BTW: Amazon is actually now profitable!). Imagine quantum leap advantages to patient choices and access to care when patients directly control where a good portion of their health care money goes — this is patient market power “skin in the game.”

However, for Ms. St. Clare’s ideas to become a reality, the Minnesota consumer must have the power to choose and pay directly for her health care services and insurance coverage. That means we should push for government actions which allow money in her pocket and/or credits on her health care spending account (based her employment, income or special needs). Except for paying direct pay (cash) practices such as those on the Wedge, today’s Minnesota health care consumers (patients and families) have little power in the health care marketplace.

Tell Minnesota senators and representatives that you want consumer-directed health care reform in Minnesota. Our politicians will be knocking on your door this election season, and they are listening!

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