My latest piece leaned heavily into the metaphor of healthcare equally a circuitous game; I highlighted the convoluted rules, profiled the players involved, and explained how each of them believes they win the game. After publishing the piece, I received a alluvion of responses from people invested in the healthcare space — brokers, doctors, employers, entrepreneurs — who raised smart, thoughtful points of give-and-take. This feedback gave me a good deal of mental fodder as I wrap up this three-part serial.

In this final post, I'm going to include several of those insights as I talk over concrete tactics for the 3 players who have the most potential to better the healthcare system: consumers, employers, and physicians.

The Consumer

Consumers are the group that benefit the most from taking a more than active role in their own care, nevertheless they're the least empowered to do then. Take a look at this story from Kristin Baker Spohn, a brilliant investor who spent her entire career working in healthcare, simply still couldn't navigate the process of correcting a duplicate charge for an ultrasound on her medical beak. Information technology's because, ultimately, the U.S. healthcare system wasn't designed with consumer needs in mind — it was built to maximize the insurance billing procedure. Venture capitalist Bill Gurley captured this idea perfectly in his latest piece , where he wrote:

"I overt sign of a lack of traditional market place forces is any manufacture where basic customer service is non a requirement to stay in business. If yous asked 100 people to name a place where you lot ofttimes wait, fifty-fifty when you lot are on fourth dimension for your appointment, how many would say the md's office? Nosotros are so numb to the hurting, that we rarely object or complain, and the doctor's indifference to the consumer's time is so common and widespread, that it is a frequent meme in jokes and cartoons."

I understand why people are such passive consumers of healthcare; they feel powerless and pocket-sized. Just recently have they become the real payer: you lot see information technology in the growing piles of debt and booming collections businesses at hospitals and the myriad frustrations reporters and other voices, similar Kristin, are observing. However, relying only on the services of the big players (i.east. those hospitals, wellness systems, insurance companies) only gives them more leverage. There are ways to fight back in minor but meaningful ways. Here are a few to start:

  • Deed like yous have options, because you do. Information technology's easy to go complacent when a situation never seems to change. Believing we take choices is the first step toward making better ones. You don't need to be an expert to make a difference in your health issue or your checking account: let's say you lot injure yourself and need to get an MRI. Most people will become to whatever imaging eye because they were referred by a doctor, and they presume the bill will be expensive either way. Instead, try using a transparency app to compare prices. Or do some online inquiry, which would reveal that in certain metro areas, average hospital costs tin can vary by up to 354% . It's piece of work, merely even the nuts tin can salvage you from surprise bills and painful experiences.
  • Ask questions. People tend to be afraid to ask questions in healthcare because it's intimidating to know where to begin. A adept place to commencement is with your health insurance. Now that you've selected a plan for 2018, ask your insurance company or employer about the specifics of your costs, like coinsurance, copays, deductibles, and benefits. You may be surprised to learn nearly certain details or changes that you previously would have skimmed over. Another peachy place for questions is at the doctor's office. Ask about the toll of your procedure or visit. This is especially important if you lot don't have insurance and are paying for an expensive procedure yourself. In that example, some doctors will offering a discount or an involvement-free payment programme if they know you lot're shouldering the cost on your own. Every question yous ask simply builds your wealth of knowledge and is another tool in your toolbox. Start somewhere.
  • Use the benefits you're given. If your employer or health plan is doing it right, the most beneficial parts of your healthcare feel are convenient and often free, and the least effective things are more hard and expensive.  For instance, if you detect yourself existence moved to a high deductible health plan for 2018, you lot likely qualify for a wellness savings account (HSA), which allows you lot to put pre-tax money aside, grow that coin tax-costless, and use it later for qualified medical expenses — again, without paying any taxes – while it rolls over year after year. HSAs are fantastic, but ofttimes lie effectually collecting dust because the education and user experience around them is so poor. Nearly one-half (43%) of all employees enrolled in HSAs in 2017 did not contribute any of their ain money to their accounts. If your employer doesn't match your contributions to your 401(k) and you take the means to, you should contribute your pre-tax income to your HSA first — it has all the features of a 401(1000) but you lot can withdraw cash at any fourth dimension to pay for your care. Also, don't forget that nether most plans, you lot accept a right to free preventive wellness services , such as vaccinations and screenings, that your insurance covers for you. Don't allow the system scare you into avoiding healthcare altogether; yous're letting valuable, maybe life-saving benefits get to waste material!

The Employer

Employers are the gatekeepers to healthcare for more one-half of the American population , giving them a lot of power to create positive change. In fact, I had a benefits consultant comment on my last article saying that he's witnessed a ascent in employers "challenging the healthcare rules" and capturing the attention of hospital networks in the urban center he lives in. This is attestation to the amount of influence the employer has in the game. Hither are a few tactical ideas for employers to consider:

  • Be wary of the hype. At that place are tons of heady innovations out there. Withal, in an effort to sell more products, many B2B products promise fancy buzzwords to capture the attending of employers. For instance, every product boasts A.I., bots, and machine learning these days. Machine learning algorithms like the ones we apply at Amino are merely a means to an end. The real value in our production stems from its ability to polish a low-cal in the black box that is healthcare costs. So when deciding which products will make the cutting, employers should expect beyond the buzzwords and ascertain the genuine value of what they're purchasing — for all parties involved. Volition this save my HR team some administrative hassle? Will this production be "sticky" enough to appoint my employees? How will this help each colleague save on healthcare costs? These are all important questions to be request yourself and the vendor.
  • Meet your employees where they are. Let'due south say you picked a shiny new service to help your employees salvage on healthcare costs. You announce it to the company, dust off your hands, and wait for the toll savings to roll in. That's not enough, because employees and their families won't change their hardened habits for you. And this isn't just a problem for employers; it affects everyone trying to influence consumers to be agile healthcare participants. In early on December, I sat on a panel give-and-take at a D.C. hotel — alongside the leaders of Healthgrades, US News & World Written report, Castle Connolly's Meridian Doctors, and The Leapfrog Group. Each had published vast content over several decades on patient safe, surgical outcomes, physician reputation, and all were frustrated about lower-than-expected consumer use of these measures. I passionately disagreed with their phone call to "change consumer behavior" and "educate these consumers most using data." Champions of transparency, similar self-insured employers, must respect people and their habits enough to run into them where they are. We must become across instruction programs and instead create a delightful (while value-minded) feel they'll want to return to because it best served their firsthand needs. That's why we're seeing the rising of technologies similar telemedicine and mobile-based appointment booking, which create a convenient healthcare feel employees crave instead of trying to corral them into an experience yous desperately desire for them.

The Physician

Doctors are in a tough spot. They oftentimes (and ofttimes inadvertently) bear in ways that don't benefit the patient, just information technology's rarely out of malice. It's because their financial incentives are designed to serve the practice or infirmary where they work. In my last post, I touched briefly on the importance of doctors taking the initiative to tap resources similar Costs of Care to protect their patients' wallets. I have a few more ideas for how doctors can take a more than active role in bettering our healthcare system:

  • Educate your patients. I tin't emphasize plenty how important it is for doctors to be knowledgeable about costs to talk over with their patients — specially because the astounding number of healthcare providers who don't know the cost of their own services. Nevertheless, the education shouldn't only terminate at costs of procedures. I would love to come across more than doctors know more about how healthcare is billed at their facilities so that they tin can double-decker their patients on how to have conversations with the billing section. Explaining exactly what blazon of procedure patients are receiving and the relative cost of alternatives is also crucial, and then their patients feel more empowered to sympathize their bills and make decisions about their care.
  • Be the vocalization of the customer to the health system. At healthy Internet or software companies, the engineers who build systems spend countless hours hearing from their salespeople or straight from customers. The frontlines of healthcare, where patient fears, desires and central questions are shared, are often staffed past physicians. Unfortunately, today's rules are designed primarily to benefit the wellness systems. For example, a physician responded to my last post past sharing that certain hospitals crave doctors to write up explanations whatever fourth dimension they refer patients out of the wellness arrangement. Doctors should button back against this pressure and refer the patient to the best specialist for their status even if it means extra paperwork and scrutiny, and share non-clinical questions and feedback from their patients to administrative staff as opportunities to include customer voices in the strategy of the clinic or hospital.

We all know the answers to fixing the healthcare system lie beyond the confines of this mail, and it'll accept more than than a few people reading this piece to see any tangible results. I'thousand sharing my ideas because we're at a tipping bespeak where consumers, employers, and doctors are starting to wake up to the realities of the healthcare system and want the answers to improve it. If you have any other ideas for how people tin start taking a more than active role in healthcare, I'd dear to hear them. Nosotros volition have a lot to discuss in 2018!