The other day a good friend and I were discussing a bad customer experience that he had recently had at a well known restaurant. In a word, the customer service and resulting experience were awful. Actually, the customer experience was beyond awful it was dreadful. It is surprising given the weight that restaurants place on customer service and word of mouth value. This got me to thinking about the customer service in healthcare. Is there anything more maddening than arriving at a physician’s office on time and then having to wait for an hour or in some cases more because the physician is running late? There are typically no apologies or considerations that you, the consumer, may have other commitments. Actually, there is something more maddening… arriving 5 minutes late to the same physician at the next appointment only to be told “you are late and need to reschedule because the Doctor can no longer see you.” Now how is that for customer service?

I think about this quite a bit right now because the word “consumerism” is rapidly making its way into the vocabulary of the healthcare market. With customer satisfaction scores and Zagat ratings of physician satisfaction, it becomes apparent that the majority of healthcare providers haven’t quite figured out what a consumer of healthcare services may actually look like or expect. If patients are becoming consumers, then healthcare providers need to understand that with that will come a certain set of typical consumer traits, such as the demand for value, better customer service, willingness to switch, and word of mouth impact.

From Kelly Sonora from MastersinHealth.com, 10 Things You Need to Know About the Healthcare Stimulus:

Barack Obama’s American Recovery and Reinvestment Act of 2009 was signed on February 17, and is already beginning to filter out funds to hopefully stimulate the economy. One of the principal goals of the package is to reform the health care system while creating jobs and insuring more Americans. Through measures to support the unemployed, integrate cutting-edge information technology systems into medical networks, and insuring more children, the act may in some way affect how you receive health care. Find out how.

- Health care industry set to go tech: One of Obama’s umbrella strategies for reforming health
care and stimulating the economy involves pumping money into health care technology
systems. He hopes to create a health information network for hospitals, rural and urban
clinics, and other health care centers by making all medical records electronic; making existing
medical technologies more accurate and effective; and reducing errors in medical care. This
technology boost to the health care system will, Obama hopes, save money, create jobs, and
improve the standards and delivery of health care and medical information. The Dallas
Business Journal reports that the stimulus package will invest $19 billion for health information
technology.
- The unemployed will still receive health care benefits, at least temporarily: Obama plans to
ease the burden of health care costs for the unemployed and reduce the number of uninsured
Americans by extending Medicaid benefits to the unemployed, at least for a time. Individuals
who get unemployment checks would also be able to receive Medicaid, as would their spouses
and children who are under the age of 19, reported the New York Times in January. States
will receive federal aid to help ease Medicaid costs. In late February 2009, TheState.com
reported that Obama “released $15 billion in economic stimulus Medicaid funds for states” to
disperse.
- Children’s Health Insurance Program Reauthorization Act of 2009: The Senate and House
reformed the Children’s Health Insurance Program under this legislation, which extends
insurance to nearly 4 million more children by reworking the Social Security Act. The program
will help families of low-income children who do not qualify for Medicaid pay for their health
insurance, and states will still be able to set their own income eligibility requirements. The
program is funded by a tax increase on cigarettes.
- Governors hold power over releasing funds: While the federal government has designed and
approved the health care stimulus package, governors are in charge of actually releasing
funds, creating eligibility requirements when appropriate, and overseeing the implementation of
the stimulus plan in their states. In late February, governors like Louisiana’s Bobby Jindal (R),
opposed many parts of the economic plan and may reject at least some of the money that is
coming to their state from the federal government. The New Orleans Times-Picayune reports
on Nola.com that Jindal will most likely accept the Medicaid supplements, but according to
Medical News Today, other governors are begrudging about accepting funds that are meant to
be used in a specific way. Instead, governors like New Hampshire Gov. John Lynch (D) are
arguing for more flexibility in how they disperse the federal funds.
- Federal government helps states fund COBRA for unemployed: The Consolidated Omnibus
Budget Reconciliation Act (COBRA) gives individuals who are laid off, retired, switching
between jobs, or have dependents at the time they stop working the option to continue their
group health benefits for a limited time. Some beneficiaries may have to pay for the group rate
insurance, however, but the U.S. Department of Labor holds that “COBRA generally requires
that group health plans sponsored by employers with 20 or more employees in the prior year
offer employees and their families the opportunity for a temporary extension of health
coverage.” Under Obama’s stimulus plan, the federal government will provide states with
subsidies to help offset the costs of COBRA. They will pay for up to 65% of COBRA
premiums “for eligible workers who are involuntarily terminated,” according to the accounting
firm Amper, Politziner and Mattia. Qualifying workers include those who have been involuntarily
terminated on and after September 1, 2008, and qualifying employers include those who are
subject to COBRA legislation, as well as small employers who are subject to State Continuation
legislation.
- Job training funding for those entering health care industry: In another measure to stimulate
the economy while improving health care standards, Obama plans to increase job training
opportunities for those entering the health care industry. The stimulus budget has allotted
$750,000,000 “for a program of competitive grants for worker training and placement in high
growth and emerging industry sectors,” $500,000,000 of which will go to renewable energy
programs. The rest will be distributed by the Secretary of Labor “giv[ing] priority to projects
that prepare workers for careers in the health care sector.”
- Preventive care takes precedent: In his address to Congress in February, Barack Obama
outlined the promised benefits of his economic stimulus benefits, highlighting the fact that the
health care reform boasts “the largest investment ever in preventive care, because that is one
of the best ways to keep our people healthy and our costs under control.” According to a
report by NPR, this move would also create jobs, at least in the short term, even if it did not
result in sustainable medical research projects, as hoped.
- A contract for accountability: In order to promote accountability in health care reform and to
make sure that all of this funding is actually helping the economy and the health care industry,
Obama’s plan includes a contract between the federal government and the Institute of
Medicine. The stimulus package outlines that the $1.5 million contract will require the Institute
to “produce and submit a report to the Congress and the Secretary [of Health and Human
Services] by not later than June 30, 2009, that includes recommendations on the national
priorities for comparative effectiveness research” that will eventually be subjected to public
commentary and review.
- Health IT dominates in all areas of medical industry: The stimulus package lists several ways in
which new health care information systems and technologies will help the facilitation of
medical care and the industry as a whole. These include the exchange of patient medical
records and a subsequent reduction in wait times at hospitals and health care facilities; the
increase of telemedicine technologies for those living in rural areas and who do not have
access to cutting edge medical resources; “technologies that help reduce medical errors;”
and “technologies that meet the needs of diverse populations.”
- Total health care stimulus cost: $150 billion: The total cost of all these (and more) health
care reforms under the American Recovery and Reinvestment Act of 2009 is $150 billion,
according to the Dallas Business Journal, including $17 billion for Medicare and Medicaid
incentive programs, $2 billion for technology grants, and $19 billion for a health information
technology.

A recent article by the Denver Post highlights the lengths that organizations are going to in order to motivate individuals to become more active owener of their health. It has been evident for quite awhile now that good health is considered a reward in and of itself by a small proportion of the population. In a monumental effort to shift our country’s culture from that of treatment to that of prevention, Health Plans and Employers are placing emphasis on establishing wellness cultures through the use of wellness programs and incentives to motivate healthier decisions and behavior.

The article in The Denver Post highlights the variety of incentives being used in the marketplace to motivate individuals in taking a more active role in their health. Incentives are a necessary tool in motivating individuals because they answer the key question that most participants want to know - “What’s in it for me?”. A good incentive strategy is built off the fundamental principles of motivation and behavioral science elements. A good incentive strategy must also include a strong communication plan that helps to reinforce a wellness culture, remind individuals of their call to action and reinforce how they are doing.

Even when people want to change, it’s hard to learn new behaviors. Shifting passive health behaviors to more active behavior is going to require a commitment from Employers and Health Plans to encourage and reinforce new behaviors, provide positive consequences and realize that change may happen sooner for some than for others.

Pauline Chen M.D., authored an interesting article in the NY Times, entitled Do Patients Trust Doctors Too Much? It is an interesting question to ask. Dr. Chen’s insight includes the following thoughts:

- In reviewing the physician ratings on Angie’s List there was a strong correlation to high ratings
for physicians based on attentiveness and bedside manner but patients rarely mentioned
medical skills as a criteria of the rating.
- Few patients actually devote any time to researching the medical credentials of a physician.
- Patients spend more time on researching job changes than they do on researching a physician
who is performing surgery on them.
- There are consequences to that type of blind trust.
- A healthy physician/patient relationship requires patients to come to the relationship educated
about their physician, their illness and treatment.

Last night’s presidential debate raised an interesting question – is healthcare a privilege, a right or a responsibility? While the candidates answered definitively one way or the other, I believe that the answer is “both.” Healthcare is a right and as providers, payors, employers and users, we collectively as a nation have a responsibility to ensure that our health system continues to be robust, innovative and utilized appropriately to drive the best care possible for consumers.

Given the state of healthcare from an access, quality and cost standpoint, we have a huge challenge ahead of us. For decades we have fostered a health system culture that has essentially encouraged consumers to not use health services until they are sick. This mindset will require a tremendous shift if we are to get our arms? around healthcare costs and change the conversation on health.

My question, assuming healthcare is a right, is how do we provide consumers with the education, information and incentive to ensure they act more responsibly in their healthcare decisions and utilization? Do we take that right away if consumers intentionally decide to act irresponsibly with their health decisions? I believe that the answer lies in four key areas – education, communication, motivation and accountability. We need to educate consumers about what “healthy” means, what they should do with the health information they are given, how they should navigate the health system appropriately and what information they need to make better decisions and be more responsible with their health decisions.

What is encouraging is that employers and health plans continue to understand and invest in health and wellness programs to further education efforts and assist consumers in beginning to adopt more proactive health behaviors. In order for healthcare to continue to be a right, we must look at health and wellness solutions as a business and health imperative. As consumers, it is our responsibility to use those services as a support structure for making better decisions. Yet the reality is that having the services aren’t enough. In facing the monumental task of trying to change a collective culture that is passive about health, it will be critical for employers and health plans to provide the motivation and incentive to engage consumers in this process.

Whether healthcare is a right or a responsibility the bottom line is that the system needs a massive overhaul and as influencers and users of the system, we all have a collective responsibility in ensuring that our health system continues to work for everyone.