Building Bridges To Patients The rapid entry of new, well capitalized actors into the traditional arena of health care has jarred both providers and insurers, which are mired, as of this writing, in serious economic difficulty. Providers see the Internet as establishing a new channel of communication with their patients, although it remains to be seen how effective that channel will be. Sadly, hospitals' efforts to leverage the Internet have been captive to their marketing departments. Many hospitals' Web sites have a depressingly “Here We Are: Aren't We Wonderful?” quality to them.
In my informal survey, few hospitals have made provision for Internet based scheduling, insurance verification, patient history, and other functions that could ease entry into their systems, or for enabling online updates of the condition of relatives or friends in the hospital. Hospitals that approach the Internet with an eye toward redesigning their core business processes to eliminate wasted time and paper work are probably going to be more satisfied with the results than are those that view it as a public relations device.
On the other hand, the Internet may create more options for health insurers than any other actor in the health system. As with providers, the Internet will enable insurers to eliminate many redundant clerical functions that have clogged communication with physicians and patients. The Internet can speed verification of eligibility and coverage, as well as accelerate electronic payment to providers.
However, a suite of promising consumer applications may enable health plans to alter the perception that they are adversarial to patients' interests. HealthPartners, a Minneapolis based health plan, was one of the first to computerize its provider network information for subscribers including location, professional qualifications, and hours of operation of provider sites and to make it available to subscribers via touch screen computer kiosks. When this information moved to the HealthPartners Web site (www.consumerchoice.com), the plan added consumer satisfaction and cost information and provided (in some of its products) financial incentives for consumers to select providers in the least expensive cost tier.16 HealthPartners executives refer to this as a "farmer's market" strategy.
While these new insurance products have not taken the market by storm, they do provide a glimpse of how electronic commerce can help insurers to regain market leverage in a wide open panel, consumer choice environment. As comparative information on quality and patient safety becomes available, health plans are the ideal purveyors of that information to their subscribers via Internet based “maps” of the health care system. Health plans will hold providers accountable through increasingly dense and invasive comparative quality and cost information. In an open-access market, providers will gain volume not by having it directed to them by health plans through selective contracting, but by being chosen by value conscious consumers.
Many health plans have experimented with disease management programs targeted to high risk populations in their subscriber base (patients suffering from asthma, diabetes, congestive heart failure, and other chronic illnesses). The Internet provides a superb platform for health plans to maintain continuous, low intensity contact with their patients via their home computers.17 The economics may be compelling enough for plans to give patients with these diseases their own home computers and teach them how to use them.
Another significant potential Internet application is assisting patients and families in planning how to address an emerging health threat. A number of years ago John Wennberg and his colleagues at Dartmouth developed a process called "Informed Choice" for patients newly diagnosed with a threatening medical condition (such as prostate cancer) for which multiple treatment options are available. This process encourages patients and physicians to sort out the patient's objectives in treatment.
The Informed Choice process has both markedly increased patients' satisfaction with the care process and reduced the rates of invasive treatment and cost, two compelling reasons why health plans will adopt this or similar approaches.18 Although the technology was initially based on interactive laser discs, it is ideally suited for the Internet. 19 Health plans also may discover that giving subscribers online access to medical advice may reduce the volume of primary care physician visits and help to cut wasted motion in approving payment for services by interacting directly with patients, not physicians. They may also discover that marketing their plans directly to subscribers and businesses via the Internet could help them "disintermediate" the insurance brokers and markedly lower the cost of their product. Direct to consumer channels and applications promise to restructure health insurance and fundamentally alter plans' relationships with their subscribers.