The Myth of Health Care Consumerism - Brian Klepper

Last weekend I heard several great presentations at a meeting convened by Jeff Goldsmith, but one contained a point I hadn't heard nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare's Center for Healthcare Improvement, detailed the results of several large sample surveys on consumers' attitudes toward web-based health care information.

One of Dr. Safavi's opening slides came from Solucient's HealthView Plus 2006 data, and was focused on "Quality-Driven Consumers," people who are "likely to research ratings information on hospitals or doctors," and likely to change providers if the one they originally preferred received a low rating. Strikingly contrary to the conventional wisdom, this group makes up only 19%, or one-fifth, of American adults.

The other categories are equally interesting. About one in eleven of us (9%) are "likely to research" but "unlikely to change." This group goes through the motions of investigation but won't switch when they find information counter to their original preference. 

One-third of us (34%) lackadaisically go with the flow. They are "unlikely to research" and "unlikely to change."

And (this is my favorite) nearly two in five of us (38%) are "unlikely to research" but "likely to change," traits one audience member suggested be renamed to "Ignorance On Fire.")

Assuming the trends described here hold up, these data have critical weight for the many health care organizations that are focused on consumer empowerment. If only 19% of America's 200 million adults engage to discover health care information that can be meaningful to their own circumstances, then that changes things considerably. 38 million or so people is still a big number, but it is a lot less than 200 million.

And that raises some questions. Will consumers use Personal Health Records? When they discover they have a particular condition, will most people dive into the available resources to become knowledgeable about it? Will the numbers described by the survey change as technology evolves and we evolve along with it? Is our broad resistance to pursuing information that is in our own interests a passing cultural phenomenon, or is it a steadfast part of the human condition?

The data go on to show that Quality-Driven Consumers are predominantly higher income, boomers, and Gen X adults. My guess is that education, a comfortable technology proficiency, and reasonably good personal management skills are common threads here.

But the subtext of this information is undoubtedly that the most important changes coming in health care will occur not only in the ways that consumers get and act on information, but in the ways that organizations - health care and non-health care businesses - do. Even though health care information can have serious utility for individuals, many of us simply don't appear to be built to chase and use it. Businesses are different though. Most are based on a discipline of following through, and they succeed or fail on their ability to use information effectively.

All of this re-enforces my belief that, while we're in a fascinating, rich early stage of Health 2.0, where many of the sites are focused on consumer empowerment, the bigger play will be for sites that, in an increasingly competitive and value-sensitive marketplace, create value by helping health care purchasers and vendors of all types make better, data-driven decisions.

This will become meaningful as it becomes more and more possible for businesses to buy coverage based on which health plan has the best performance record. Or as health plans really do try to assemble the most efficient (rather than simply the largest) provider network. Or as hospitals focus on identifying the best performing hip for their hip-replacement patients. Or as doctors determine to follow a condition-specific protocol that has a track record of consistently producing the best outcomes at the lowest costs.

Consumer-oriented applications are easier and cheaper to develop and bring to fruition than business-oriented, data-intensive ones. But the imperative to succeed in an intensifying marketplace could ultimately swing the pendulum toward Health 2.0 applications aimed at business. If and when it does, then the resulting transparency, decision-support and impact on market dynamics could drive many of tremendous changes in health care that we've all been looking for.