At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.Got questions?
Dr. Ezekiel Emanuel, frequently consulted as an expert on health policy, wrote an opinion piece in the New York Times outlining four suggestions to make health care more affordable. The piece starts out by framing the Democratic presidential candidates as debating the wrong question (what type of national healthcare plan should US adopt versus how do we get healthcare expenses under control). A surprising statistic is that while the US has about 4 percent of the world's population, it accounts for nearly half of the global drug spending. The US has been paying more per dose of medication than others around the world, effectively subsidizing the world's research and development of medication.
Dr. Emanuel takes aim at all the major players in the healthcare industry with a variety of ideas: national negotiations to curb drug pricing, a cap on hospital prices (he blames mergers of hospital systems as the root of soaring prices), and standardization in the insurance industry. Taken as a whole, the healthcare industry is surely not happy about his proposals; taken separately, different parts of the industry might be thrilled at different proposals. Dr. Emanuel lists a fourth option which has been gaining momentum over the last decade: shifting away from fee-for-service compensation for doctors and moving towards value-based payments (in other words, paying for patients' health and good outcomes, rather than paying for amount of work done). These are all sweeping changes that Dr. Emanuel groups as "four simple policies."
Starting in 2014, we integrated procedure information from Medicare. Procedure volume can be a crude but helpful proxy for many surgeries, with research showing that surgeons who have experience performing a procedure often have better outcomes for the procedure. Likewise, patients who need to pay out-of-pocket or who have a high-deductible might be interested in estimates of what a provider might charge. Medicare provides average price submitted by providers for a variety of procedures. To get a sense of how this looks on the search results page, try searching for a procedure like "hip replacement" or "x-ray" in a major city.
Over the last eighteen months, we have re-worked how we stored the data, and for several months, had removed the procedure information from the search results page during the transition. We are pleased to announce that the procedure information is now available on the search results page again, with the ability to sort by procedure volume or price.
WBUR reported on a study showing positive results from a change in provider compensation. The overall idea is that health insurers specify a target level of health spending, and providers who are responsible for patients share in both the savings (when the patients incur less health expenses than the target level) or in the cost (when health expenses exceed the target level). Under a compensation system like this, providers will have incentives to treat patients more holistically, theoretically resulting in lower overall health spending.
Programs like this have been tried before (often known as pay-for-performance), and results have been mixed. Earlier programs often targeted primary care physicians (who can have a bigger-than-expected influence by coordinating care across different specialists); this program appears to target larger multi-specialty medical practices. This program also appears to have an initial component in which insurance companies paid an amount that providers could use to upgrade infrastructure, making them better able to provider higher-quality care.
Although the results from any particular program or study might be unclear, I expect that more physician compensation will be tied to performance metrics as the industry moves more towards value-based medicine.
Kaiser Health News ran an interesting story about some providers using pricing tools to help patients select drugs. The story is a nice one about giving providers and patients a tool at the time of decision (and not when the patients are picking up medications at the pharmacies); if one medication is too expensive, the provider might be able to find a different pharmacy that sells it for less, or potentially prescribe a different (but equivalent) medication altogether. It is a sign of the times that insurers are making these tools available to providers to help patients potentially save (which would in turn help insurers themselves save).
One of the issues with these tools is that it takes providers time to use them, and that likely explains the low adoption rate among doctors who can use Humana's tool. However, some of the larger provider organizations have a financial interest in helping ensure that patients choose more cost-effective solutions: some medical groups share in the medical savings that they help achieve. If the trend towards providers participating in risk-sharing continues, more and more practices might have a stronger incentive to use these pricing tools.
Kaiser Health News reported on three states formulating plans to import medications from Canada. Prior legislation (the 2003 Medicare Modernization Act) allows importation of drugs from Canada, but appears to require verification by the secretary of Health and Human Services. Understandably, the previous secretaries have opposed importation (large downside risk to the officials involved in case something goes wrong, and probably limited upside for the officials if everything goes well). Thus, the support offered by the current president seems significant. It remains to be seen if anything will come of these plans, and whether perhaps a national plan will come into play.
It is ironic that Americans end up paying more for medications that, in many cases, they helped fund the initial research, but it is understandable that pharmaceutical companies want to maximize their profits. Allowing importation of medications from other countries might have the intended effect of lowering drug prices nationally, but might also have the unintended effect of raising prices internationally.