Why I love my insurance company, but I love my doctor more.


I’ve been thinking a lot lately about my health.  Maybe it’s because I’m (sadly) getting older, or maybe it’s because I just renewed my life insurance policies and I want to be around to see my four kids graduate college, get married and have kids of their own.  (Wow, all of a sudden, I sound like my father!)

All this thinking about my health has gotten me to wonder about who has the best picture of my health.  And I don’t just mean the results of my last physical.  I mean the total, overall inclusive picture of my health – the test results from my physical in November, the diagnosis from the specialist that I saw in December, the fact that I got a flu shot at a retail clinic in January, and the recent prescription I just started to manage my cholesterol.  (I feel obligated at this point to tell you – even though I don’t know you — that you shouldn’t worry about my health.  I’m perfectly fine.)

Amazingly, the only place where I can get this complete picture today is my health insurance company’s online portal.  My primary care physician is on one EMR, the specialist is on another, and the retail clinic is on yet a third EMR system.  They’re not sharing information – in fact, the specialist literally offered to burn my files onto a CD for me to bring to my primary care physician.  The only person besides me who knows what medical care I’ve received is the actuary at my insurance company.  Yet that actuary knows only what care I’ve received and how much it costs – not the outcomes of that care or how (or if) the various treatments are connected.

Now I’m quite happy with my insurance company – the coverage is pretty good, and any question I’ve had has usually been answered promptly.  But I’m just not sure that they should be the only person with the total view of my health.  I want someone who knows me to be monitoring my health, and to have that person be accountable for the overall health of Justin.

Now, my friend Sue blogged about this concept recently, when she wrote about the patient-centered medical home (PCMH).  But I want to take it one step further, and evolve the PCMH into a broader concept – one that I’ll call integrated care.  Integrated care is a patient-centric, outcomes-driven method of delivering healthcare, enabled by linking together information from across the healthcare delivery network, including in-patient, ambulatory, and home-based locations, to generate new insights that improve the quality of care, while eliminating cost and waste from the healthcare system.

Integrated care is the destination to where I believe healthcare is rapidly evolving.  It’s a system where we no longer do fee-for-service, but rather, a primary care physician has the same level of visibility as my insurance company to everything happening to me – except my PCP not only sees the costs; he also sees the results and can use that information to manage my total picture of health.  Getting to this type of system isn’t going to be easy – it’s going to require collaboration at both a practice level and at an IT level.  There are a ton of data privacy issues to be resolved.  But I firmly believe that it’s the right destination for healthcare.

If the goal is to compensate my PCP on the quality of my health – to manage my wellness in addition to my illness – then we have to move to this integrated model, because I’m not always going to see my doctor for a minor medical issue.  Going to a retail clinic might be the most cost-effective solution for both me and the healthcare system.

So, while I’m happy that my insurance company has the total picture of what it costs to manage my health, I’m here to tell them that I don’t think it’s enough.  I want my doctor to have both the cost and the outcome of each medical event, to enable him to do the right thing for both me and the healthcare system. After all, I need him to keep me healthy so that I can come to work each day – I’ve got four college tuitions to save for.


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One thought on “Why I love my insurance company, but I love my doctor more.

  1. Pingback: How much does a knee cost? | GE Health IT Views

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