In my first entry, I pointed out the cross-selling setup within the health care industry, one that is acknowledged by pharma companies, sales reps (see the bulletin boards on CafePharma), and even the medical community (see this article : warning email submission required). I also promised that in Part II, I would suggest an alternate system.
So to deliver on my promise, I give you: the consumer-centric cross-sell system.
One quick note, before we dive into how it would work: We are eventually moving in this direction. If the government won’t take a lead on it, the private sector and technology, in particular, will.
So, how would a consumer-centric system work? A critic might think that I am referring to the often-proposed plan of giving the consumer more choices.
In a way, the system I propose would encompass that. But it would go on to include something even more radical, institutionalized referrals by different stakeholders. To summarize and recap parts of the Part I discussion:
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The cross-sells are controlled by Medicare, HMO, PPO, and other Managed Care organizations (private-sector or government)
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Doctors, specialists, clinics, labs, etc. are within networks, and referrals are usually made in-network. Doctors therefore determine which specialist you should visit (by the virtue of recommendation or sometimes formal referral to a specialist)
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There are significant cost penalties for going outside of the network, even though better services may not be in the network.
Now, there are resources outside of the network that could help a patient in making a better decision. Take, for example:
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Patient support groups (see Yahoo groups for examples)
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Eventually, we may have patient communities given the trend in social networking that we are seeing
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Person-to-person referrals (say, an email from Aunt May or a call from Mom and Dad)
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Corporate or relationship referrals (say the husband of a colleague who is a doctor or a friend who is a surgeon)
Now, imagine if patients made decisions based upon the resources they knew (they were “sold” by people already in their personal or professional networks rather than the CIGNA 800-number…):
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There would be better care (the cream of the medical community would be referred more)
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Doctors would be held liable (preserving reputation among the public is at least as effective a mechanism as being afraid of malpractice lawsuits)
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Costs would go down (less malpractice suits if people chose and trusted their doctors, and with doctors being more accountable)
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Development of an eventual market system, in which members of the medical community would be evaluated similar to those in other professions.
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Mutual fund managers have ratings
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Engineers and independent contractors have ratings
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Businesses have ratings
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Other organizations and professionals (CEOs, firemen, attorneys, etc.) have professional reputations
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Why can’t doctors and hospitals (along with clinics, specialists, surgeons, RNs, PAs, etc.)?
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And along with better care and lower costs, there would be trust again in the patient-doctor relationship
After all, when your house is damaged, you pick a contractor, and the homeowner’s insurance policy (if it’s good) reimburses you regardless of who you picked (as long as they are licenses, bonded, insured, etc…). It doesn’t matter if it’s your cousin Jim or someone you picked out of the Yellow Pages. Why can’t we ask that from our medical system?
