Who is watching out for us (and our health)…post 4 of 4

My wife, Elisa, has a 99-year old grandfather, Charles. Even at 99, he has an endless supply of stories from his time growing up in the Florida Keys and raising a family in South Florida. He’s a tough guy with a history of taking care of things, relying as little as possible on other people to help him. But as with most 99-year old people he now needs all sorts of healthcare help. Charles’ daughter, sons-in-law, daughter-in-law, grandchildren, home health nurses, hospitals, physicians, Medicare, a Medicare gap/supplement insurer, local pharmacies — to name a few — are all at the center of his world now.

But who is doing what? Who does Charles trust to watch out for his health? As it becomes more difficult for him to take care of himself, who does Charles’ family trust?

Over his lifetime, Charles has relied most on Traditional Healthcare — physicians, hospitals, Medicare, and health plans — to take care of serious health problems. He has relied on himself (and his family) for the rest. While it would be unfair to say Charles has lost trust in Traditional Healthcare, he has become more visibly frustrated with the people and organizations supporting his health as problems pile up and he feels worse day to day. At the same time, he’s learned to take advantage of, if not actually trust, Consumer Healthcare — retail pharmacies and grocery stores, specifically. But neither he nor his wife seems to have embraced the concept of Consumer Healthcare. No surprise there. And finally, while Charles and his wife were taught how to take care of things like their diet and simple health problems when they were young, like so many in his generation Charles has relied least on Empowered Healthcare, or organizations focused on helping us gain more control over our personal health. Like many people, he has assumed that Medicare, supplemental health plans, hospitals, physicians and home-health nurses would work together for him. Because Charles has not driven many significant healthcare decisions in his life, he hasn’t felt empowered to fill gaps left when his assumptions about Traditional Healthcare have been proven wrong again and again. So who does Charles trust…and as his family assumes more responsibility for his healthcare, who do they trust?

Contrast Charles with my wife, Elisa, and I. While we have more options, with those options come complexity. As much as possible, Elisa and I understand our alternatives, analyze costs, and increasingly have connected the dots between good health and wellness and our future healthcare needs. We use a constantly changing mix of Consumer and Empowered Healthcare organizations and tools. While this is not a scientific representation, following is roughly how our healthcare trust is shifting over time:

When we think about it…and we think about it more every month…Elisa and I are never quite sure who’s doing what in our complex network of trusted healthcare advisors. As our options increase and we assume more personal responsibility, it’s becoming harder not easier. We still need a few reliable tools or personal advice to give us confidence that we have things under control.

  • We periodically need help deciding how much to budget for healthcare this year, and how to save for our healthcare futures. How much should we plan to spend beyond our health insurance premiums this year? Over the next five years? How does that extra 50% we pay in weekly groceries at Whole Foods translate into future healthcare expenses…if at all? Similarly, for the gym memberships? Regardless of what happens with health reform, there will be very real benefits to us in getting better at this.
  • With the ongoing upheaval in the health insurance world, we would be wise to get a lot better at analyzing our health plan options, but we really could use some help making decisions and analyzing our track record.
  • We could always use some advice when deciding which type of healthcare service or provider to use. Which primary care physician or specialist should we use? Should we stay with the ones we have been using for the past 5 years? Should we use an Empowered Healthcare service like Teladoc for diagnosis of simple problems that pop up in the middle of the night or over the weekend, or for which we are certain a specialist will be required? Should we use urgent care centers which seem to be popping up on every corner? Or should we do like most people and wait until we are able to get an appointment with our primary care physician?
  • We could also use some advice when deciding if or when to follow through on recommendations by Traditional Healthcare providers: a sort of convenient, affordable, and truly independent second opinion. It should not feel like we are questioning the honesty, skill or integrity of physicians by seeking advice of other professionals.
  • We are just gaining confidence in actively negotiating or disputing costs of Traditional Healthcare services, but could really use some support to focus only on winnable battles. This has become more important to us every year as our out-of-pocket expenses increase.
  • While we are making good progress on our own, we could still use some personalized advice in assessing our general health and wellness, preferably in some sort of on-demand basis.

This is a family work in progress, but following is a representation of how Elisa and I have begun covering our healthcare bases with help from others.

There are plenty of healthcare activities for which we don’t expect Traditional or Consumer healthcare organizations to help (as indicated by the white in the grid). We also don’t feel we have any of our bases covered well even if we have some sort of coverage across everything healthcare (as indicated by the yellow). We expect the biggest improvements in Empowered Healthcare tools and services to help us feel more confident in the future (as indicated by the red), but still expect Traditional and Consumer Healthcare to play roles. Elisa and I are in the early days of trying to account for how we will manage who we trust to advise us in our healthcare decisions, with the intent of gaining more control over our health.

We fully expect our approach to shift as our culture (and other western cultures) confronts a pervasive healthcare crisis. While it’s important to highlight what could be better, it’s possibly more important to ask: “What does good (an Empowered Healthcare Consumer) look like?” Honestly, we only have fragmented thoughts. However, composing this ideal person is arguably one of the most important ways I can help our family take full advantage of the amazing healthcare innovations we have seen and will continue to see. My wife, daughters, extended family, friends and colleagues will try to answer this here and on other social media channels in coming months.

David Randall Morris

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passionate about transformation in healthcare, community infrastructure, education, and other common goods

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