We’ve all gotten the memo that change is coming to health care, but few of us really understand what that means. One thing seems clear: We, the consumers, will be asked to take much more responsibility for our own care. Many of the big-ticket new ideas—health care co-ops, patient-centered outcomes research and the digital health care revolution—rely heavily on the patient. Consider:
• Health insurance co-ops are a compromise for reformers who wanted a public-health option. The Affordable Care Act set aside money to fund nonprofit insurers called Consumer Operated and Oriented Plans, or co-ops. They’re supposed to give individuals and small businesses less-expensive options by creating competition for corporate health plans. They are to insurance companies what credit unions are to banks.
A coalition of hospitality-union health-plan providers started Nevada’s co-op. They received nearly $66 million in May 2012, and the Nevada Health Co-Op is now taking online reservations for coverage. On January 1, when all U.S. residents will be required to have health coverage, the co-op will offer its plans on the Silver State Health Insurance Exchange, competing with private companies in a regulated, online marketplace. Guidelines require the co-op to be consumer-owned-and-operated by 2015.
• The public can also get involved in the quality of health care via the Patient-Centered Outcomes Research Institute (PCORI). Speaking at a March research symposium in Las Vegas, PCORI executive director Joe V. Selby said the institute takes an approach of shared decision-making between doctor and patient. “It’s all about bringing patients into the research process, using their input to design tests and their feedback to implement results.”
By next year, the institute will distribute $500 million a year for studies on a variety of health care issues. A stakeholder advisory panel will engage physicians and patients, shape research questions and provide expertise. The institute’s website includes a Get Involved section, where the public can suggest research topics and make comments.
• But nothing concerns you quite as much as the digital health care revolution. Personal monitoring will “change the entire medical space,” leading us to “bedless hospitals,” says Eric Topol, director of the Scripps Translation Institute, who spoke at UNLV in April, drawing from his recent book, The Creative Destruction of Medicine.
Topol sees a future in which office visits are replaced by virtual consultations and primary care is taken over by wearable sensors with smartphone apps for interpreting data. If you think that’s unlikely, he says, consider everything we do on our own now—athletes use heart-rate monitors; blood-pressure machines are in every pharmacy; and diabetics measure their own blood-sugar levels. “We’re talking about exponential empowerment,” Topol says. “Emancipation. Liberation.”
Exasperation? Aren’t our lives complicated enough without having to fill out our own medical charts? There’s the rub: People want (deserve, some say) better health care at better prices, but will they do their part to get it? And what if they don’t?
If health co-ops flop, we’ll be back where we started (minus the federal dollars it took to start the program)—a little wiser, but with mainly corporate options for health care. If the Patient-Centered Outcomes Research Institute can’t successfully engage the public, its data could be skewed, producing misleading results and ineffective recommendations. And many nightmare scenarios can be imagined around patients controlling their own medical data (privacy issues, anyone?).
The best-case scenario is one in which competition between nonprofit and for-profit health insurance providers drives down costs; research on patients leads to targeted tweaks that improve access and quality for all; and patients use self-monitoring to eliminate unnecessary tests. But there’s a long way—and a lot of your input—between here and there.