DOCtalk by Dr. Gregg 12/7/12

The Center Scepter of Healthcare

I recently attended the Ohio Patient-Centered Primary Care Collaborative (OPCPCC) Fall Conference (which is, I suppose, the OPCPCCFC, for those keeping acronymic records). It was an entire day of people from all across the healthcare spectrum talking about putting the consumer at the center of their healthcare world.

Isn’t it rather strange that we have been dealing for so long with a system of healthcare that has placed everybody but the consumer at the center?

Oh, sure, providers have always needed consumers (i.e., “patients”) in order to have subjects upon which to “practice.” But, we providers of healthcare services traditionally presumed that we held the rights to the center of healthcare provision. Provider training has long included, either overtly or subliminally, the concept that we held the scepter in the Land of Healthcare. (We even built an ivory tower within which to wield it!) We were the ultimate power, the primary axle around which healthcare spun.

But then the costs of healthcare provision grew so awe-inspiringly that it was perhaps unavoidable when the moneymen and their bottom line mentalities began to think that they held the rights to the center of the healthcare world. Thus, in recent decades, there was a fairly successful usurpation of the healthcare focal point by the “moneychangers.” Indeed, the whole healthcare system is built upon the wallets of healthcare consumers, but it is the middlemen who control the ebb and flow of these dollars (i.e., the IRS, CMS, third-party payers, employers, and such). It is they who have usurped the crown. They now own the center spot.

More recently, though, we’ve added yet another middleman to the mix, another axle within the axle around which healthcare delivery revolves: health information technology. Some of these HIT/EHR companies, as handlers or carriers of healthcare data, imagined that they could make a rightful claim to ownership of that data. They did so, of course, knowing that whoever controls the information controls the money. (This concept that controlling the data allows for access to, and control of, the flow of healthcare funds was always apparent to the moneychangers.) The HIT middlemen sought to wedge their healthcare data facilitation role into a stakeholder’s position at the center of the healthcare realm.

However, this additional claim to healthcare’s royal center by the techno-centric junta seems to have brought attention to the notion that a consumer’s healthcare data might actually belong neither to the consumer nor to the provider, but to the middlemen. When HIT tried to stake its claim to this power position, the absurdity of anyone other than the consumer owning ultimate rights to the information about their bodies and their health seems to have become clearer.

In fact, the notion that healthcare providers own a consumer’s health data now seems arrogant with this added clarity. Sure, providers assess the health status and assemble and compile the data, but ultimately the data is intimate to one stakeholder and one stakeholder only – the consumer. Everyone else is but a pretender to the crown.

The patient-centered medical home (PCMH) model that is gaining wider and wider recognition now is basically a returning of the scepter back to the one rightful and true heir to throne of healthcare – the consumer. After all, the individual is the ultimate source for the health we’re all discussing, right? Their lives are the headwaters for this whole industry, no? Aren’t they the real center, the ones about whom we’re all exchanging data and trading futures?

And, by the way, aren’t they – the consumers of healthcare – us?

From the trenches…

“America’s health care system is neither healthy, caring, nor a system.” – Walter Cronkite

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of Today! exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).