In this four-week series, we’re exploring the role of technology in reversing the runaway growth in U.S. healthcare costs. Last week, we looked at issues preventing us from making progress toward affordable, accessible healthcare. In this third installment, we discuss the progress we are already seeing and some glimmers of hope.
In our last post, we talked about the growing shortage of primary care specialists. With healthcare reform underway, the private sector, the federal government, and state governments all recognize how critical this issue is and are taking action to help.
Traditionally, physicians have been paid for visits, tests, and procedures. Doctor/patient discussions and follow-up by phone, email, or text message, although valuable for the patient's care, are either minimally reimbursed or not reimbursed at all in the current payment system. But in the private sector, some insurance companies are changing the payment game for primary care physicians with programs that reward them for coordinating care with other providers and for going the extra mile to help improve health and outcomes for patients with chronic conditions.
The program emphasizes collaboration across care providers and special attention to chronic conditions, and it provides physicians with demographic and patient data (with the patient's approval) that can help them develop a more comprehensive view of the patient to improve overall care. CareFirst views the program as beneficial to physicians and to patients, as well as a way to reduce healthcare costs.
At the federal government level, the Prevention and Public Health Fund
, a provision to the Affordable Care Act, aims to address the primary care shortage with $250 million, allocated in 2010, to expand the primary care workforce, including primary care doctors, nurses, and physicians’ assistants.
Programs funded by this initiative include: incentive payments for common services; education assistance for primary care physicians; training programs for new primary care physicians, physicians’ assistants, and nurse practitioners; additional primary care residency slots; and subsidies for new clinics led and staffed by nurse practitioners.
States are addressing the problem, too. For example, in Maryland, a state known for geographic disparities in health access, legislation is currently pending that would create health enterprise zones,
which will offer financial incentives to primary care physicians who work in these zones. This may help address geographic access to physicians, but the larger physician shortage still looms.
Addressing pay issues for primary care physicians certainly tackles one of the key reasons why few medical students are choosing primary care as their specialty, and it’s likely to attract more physicians to the profession. But if the educational system lacks the capacity to mint enough physicians to fill the gap, which seems likely, more pay isn’t going to fix the primary care provider shortage. And as the population ages, increasing the burden on primary care physicians, it’s unlikely that growth in the number of primary care providers will keep pace. In fact, a 2003 study found that simply delivering preventive services would take 7.4 hours of a physician’s day. 
Health literacy initiatives show promise
The health literacy barrier and the average patient’s inability to find, understand, and act on health information affect overall health and escalating healthcare costs. We found some efforts underway that show promise in raising health literacy.
In January 2012, the journal Health Affairs
reported several successes that resulted from improved health literacy and that reinforced the importance of clear and simple communications. For example, randomized trials showed that plain-language, pictogram-based medical counseling resulted in fewer dosage errors. And patients had nearly double the colon cancer screening rates when their providers had received skills training for communicating with patients who have low health literacy. The American Medical Association offers resources and tools
to raise awareness of health literacy and to inform providers. And the Agency for Healthcare Research and Quality provides a wealth of dedicated research and provider guidance on health literacy and cultural competency
According to a survey of American Medical Association members by Wolters Kluwer Health
, almost 9 out of every 10 physicians think that greater access to online medical information and resources has improved the quality of care of their patients. This suggests that, even though we have a long way to go in terms of health literacy, increased access to information is already helping consumers.
But we have to remember that not every patient has or wants access to Internet information. There remains a segment of U.S. citizens who do not use the Internet and who don’t believe it has value or is worth their time compared to other priorities. For these people, doctor- or community-based engagement is most likely to be successful.
The National Action Plan to Improve Health Literacy says it best: It will take everyone working together in a linked and coordinated manner to improve access to accurate and actionable health information and usable health services.
Consumer engagement programs
Finally, our last post tackled the epidemic of disengaged consumers who do not feel responsible for their own healthcare.
Some employers are having success focusing on health and wellness, providing easy access to basic testing, and incentivizing employees to address lifestyle issues before health issues develop. Subsidies for gym memberships have been around for a while, but some companies, like the grocery store chain, Safeway, have taken this even further. Safeway’s employee health and wellness programs
help covered employees better understand health risks and provide substantial discounts on health insurance costs for those who succeed at improving specific health indicators. Safeway has seen measurable improvement in employee health indicators as a result of the program.
Even simple triggers can encourage more healthful activities. The City of New York
takes an active approach to improving health among its residents. Recent efforts include media campaigns describing the serious health consequences of light smoking and the potential dangers of ever-increasing restaurant portion sizes. The city also keeps health providers up to date with a City Health Information bulletin
providing practical guidance on public health issues.
One would think that monetary incentives would motivate healthful behaviors, and many programs have taken this approach. But it may not be as simple as that―which behaviors are rewarded, the timing of the rewards, and even competition may make a difference in short- and long-term success, as evidenced by the variety of programs and results discussed in a recent article in The Washington Post
, "Do programs that pay people to lose weight really work?"
But the effort to figure out what works is worthwhile. Some of the efforts we've seen and described here show promise, and we’ve provided only a small sampling. Tell us where you’re seeing progress. Leave a comment below, or chat with us on https://twitter.com/#!/Health_IT
with the hashtag #DigitalDivide.
Next week, we’ll look at how technology can help. While technology alone should never be viewed as a panacea, there are several transformational technology trends that will likely provide us with completely new building blocks to help squarely address some of these issues in ways never before thought possible.