Make Healthcare Simpler and More Patient Friendly

By Aneesh Chopra and Nick Sinai
Walter Shorenstein Media and Democracy Fellows

This January, Aneesh’s father, Ram Chopra, signed up for Medicare. He had some health issues that meant he saw nearly a dozen doctors and specialists in the first three months of 2015, with very little coordination between them. He’s better now, but so much of his journey could have been made simpler.

In the coming months, the Obama administration will finalize three rules that could address a number of confusing issues and create a more competitive marketplace focused on helping folks like Ram make better sense of it all.

First, the Center for Medicare and Medicaid Services (CMS) is considering a shift in the way patients can access their health information. Currently, CMS requires doctors and hospitals to have online portals, where patients can view, download, and transmit their own health information. The problem is that few patients actually use these portals, in part because many of them were built for compliance, rather than to delight users.

CMS is considering shifting to a model where doctors and hospitals would instead be required to have a software interface (an API) for third party apps that the patient chooses. Instead of requiring “retail” functionality for patients on hospital websites, CMS would require “wholesale” interoperability with external apps and services. As we wrote a few weeks back, “wholesale” APIs can be a significant catalyst for innovation by allowing for many competing “retail” services.

Some patients might prefer to see their own health information through an online patient portal. Others might prefer the latest mobile app or service. Aneesh’s dad can’t seem to make up his mind! A shift to wholesale regulation could free up how providers respond to patient requests, and more importantly, better engage folks like Aneesh’s dad in their own care.

Supporting this proposed policy shift is a technical collaboration, the Argonaut Project, which aims to simplify the burdens on doctors and hospitals to make interoperability a reality. You can call your doctor or hospital and encourage them to join as an early adopter so your feedback can be incorporated into how they make data available to the patient’s choice of applications.

Second, CMS is evaluating a rule that would require health plans to publish provider directories in machine readable format, making it easier for consumers to shop for health insurance.

Before Aneesh’s dad signed up for Medicare, he took a long, hard look at Medicare Advantage plans offered by the private sector. The shopping experience was frustrating, because he had to manually sort through his favorite doctors to see if they were in the network or not. Often, that involved calling the practices directly and hearing a noncommittal response (e.g. “we think we are in that plan” or “we don’t accept it”), even though the doctor’s name was in the directory.

Being able to search for just the plans that accept Ram’s doctors would have been helpful in sorting out whether or not he should switch to Medicare Advantage.

Third, CMS is finalizing terms for provider participation in Accountable Care Organizations (ACO), designed to better coordinate care for folks like Aneesh’s dad, and to share in the resulting savings. Today, Ram’s assignment to a primary care physician in an ACO is based upon a calculation by CMS, after the fact. CMS can change that by allowing Ram to “opt in” and designate a primary care doctor in an ACO who might offer improved care coordination services.

If Ram was served by an ACO, Medicare would protect his privacy by offering beneficiaries a choice as to how much care information to share with that ACO. Yet in a bizarre twist, he would have to literally call Medicare on the phone or write a letter in order to communicate his privacy preferences.

Aneesh signed his father up for, which simplifies access to health information. But surprisingly, patients in an ACO can’t use the portal to express their privacy preferences. Allowing patients more choice and control would help strengthen the ACO program and engender greater trust among its beneficiaries.

CMS’s three proposed rules collectively promise to make healthcare simpler and better for millions of Americans.

Reflecting on the experience of Aneesh’s dad earlier this year, we wonder how much more effectively his condition could have been treated with a simpler and more transparent health care system. Likely, Ram would have had fewer tests, found the right providers the first time rather than bouncing from doctor to doctor, and generally reduced the overall anxiety that arises from grappling with complex health conditions. He, and every American, deserve a health system that puts the patient first.

Aneesh Chopra and Nick Sinai
Walter Shorenstein Media and Democracy Fellows
Shorenstein Center for Media, Politics and Public Policy
Harvard Kennedy School