With the first month of the New Year nearly behind us, and new transparency regulations becoming law, Healthcare faces increasing challenges when it comes to consumerism. Using such a framework is appropriate as the persons to whom we provide services of our “goods” do “consume” them; however, compared to consumers of other types of products it is not quite the same.
Even though healthcare is analogous to other industries in various ways, there are some key differences. When a person is a patient, they access health services in times of personal vulnerability and exhibit emotions and fears dissimilar to those purchasing other products or services. The sharing of information is radically different since there are large asymmetries of subject matter knowledge between the clinician and the patient. Additionally, since shared decision-making is critical, so too, are interpersonal relationships.
Transparency has multiple dimensions. Pricing and quality are just two domains that receive an incredible amount of attention. Presently, a primary driver of clinician selection is referrals from others as well as subjective reviews versus objective information.
Historically, paternalism played a significant role in health care delivery. It was exemplified by clinicians failing to elicit the patient’s concerns and viewing the patient as a subject rather than the other part of the partnership concerning decisions about their health and well-being.
Therefore, when we speak of transparency, we must do so within the psychosocial domain and in areas such as cost and quality. This method will enhance trust, improve communications, and create a satisfactory outcome for those we serve. Evidence has shown that when we are transparent regarding information we share, listen with intent, fully understand the individual’s priorities, connect with the person’s story, and explore emotional cues, there is an enhancement of trust and compliance with treatments.
Measuring success in these categories will require us to shift our focus to patient-reported outcomes (PROs) and the objective quality measures to which we have become accustomed. If designed correctly, these patient-reported measures will enhance our diagnostic ability, engage better in shared decision-making, and help measure the quality of the patient-clinician relationship, all of which will lead to better results.
These dynamics will become even more critical as we move to value-based payment models where clinicians’ incentives are designed to reduce waste and suboptimal care. Unfortunately, from the patient’s perspective, no longer providing these services may be viewed negatively. If not done carefully, they may have concerns that clinicians are withholding services due to financial reasons. This situation may erode trust rather than have the intended desire of improving value. Transparency will be important in describing these new models, and even more, acknowledging how some behaviors of the past might not have been correct. We will also face the dilemma of “denying” services, which may be interrupted as “anti-consumer” focused.
As we move forward with the ideals of consumerism, transparency, and value-based payment models, we must remember all these dynamics and manage them all. Let us utilize transparency in a manner that enables us to balance these interdependent factors.