To Screen or Not to Screen, That is the Question
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physicians overcharge the system to make money, in the same way that limitations on screening lead to the charge that insurers are just trying to ration care to increase profits.
Getting all of the medical societies to agree with each other, much less getting them to agree with the insurance carriers, on what constitutes appropriate screening rules is probably harder than getting a legion of cancer-sniffing dogs shrunk down to the size of a disposable breath sensor, the availability of miniature chihuahuas notwithstanding. It is for this reason that enabling consumer access to meaningful health information at the point of care is critically important. The patient is a key part of the decision-making process whether they want to be or not. Here is the decision they are constantly forced to make: “Is my doctor right or is there another way?” There is usually no easy answer to that one and consumers feel frustrated by a lack of clarity about how to get a meaningful second opinion. Patients generally want to trust their physician, but when you are talking about taking a serious life-altering step to avoid the possibility of future illness, blind trust isn’t good enough.
Thus, I sincerely hope that the health reform efforts that lie in front of us spend as much effort on the area of improving patient decision support as they do on setting the rules for cancer screening. It has often been found that, when presented with appropriate and comprehensible information, patients make the less invasive, less costly treatment choice. Therefore, helping patients find the tools to make those choices effectively must be a priority in the implementation of health reform if we are to engage consumers in the national effort to improve the healthcare system clinically and fiscally.
There are a few companies that have focused their energies around educating consumers about what types of screening are useful and appropriate and how best to differentiate between treatment alternatives while maintaining cost-consciousness. A good example is SeeChange Health, a San Francisco, CA value-based health plan that pushes this kind of information to its covered members in a highly personalized way in order to maximize wellness and minimize unnecessary cost.
Another type of example is San Francisco-based DNA Direct and its competitors in the personal genomics space. Think what you might about whether these companies have all the bugs worked out of their systems; at a minimum, the theory behind these organizations is right on point. By giving consumers detail about their own physical make-up and how that relates specifically to understanding one’s own risk of getting specific cancers and other diseases, companies like DNA Direct help consumers better understand their options so they can benefit from better-targeted diagnostic and therapeutic interventions.
The Patient Protection and Affordable Care Act (recently approved healthcare legislation) calls for a significant amount of information to be provided to consumers about health insurance, but has very little within it that specifically mandates the delivery of information to consumers about what treatment most suits each of their unique situations. Nevertheless, there is still time for policymakers, payers and providers to interpret portions of the law in a manner that would provide meaningful decision support tools to consumers so they can begin to wade through the crazy quilt of options presented to them by the healthcare system. Faced with the decision to screen or not to screen, and especially with the cascade of decisions that flow from that first one, consumers need more than a breath test—they must be armed with information that gives them the confidence to exhale.