In 2018, Americans collectively spent $3.6 trillion on healthcare. How much would be saved if patients choose their doctors via a data-driven analysis, a method that matches patients with doctors by the success rates of the doctors? The answer, estimated by one expert, is $860 billion a year. And people will have less pain and health issues.
Simple changes can often have monumental impacts. This was the underlying message in the recent “Come to Me Economy” story, and it’s true in many aspects of life, and it includes the simple act of picking a doctor. After all, most people pick their doctors based not on an objective analysis of historical treatment outcomes but on personal recommendations–which can have negative, cascading effects on both the individual and society.
For the individual, those negative effects can include anything from an increased number of unnecessary doctor visits, to the unease that comes with improper treatment, to medical malpractice. When roughly one in 20 patients are exposed to preventable harm, it’s clear medical malpractice is a significant issue.
For society, the negative effects from subjective choosing doctors can range from higher insurance premiums and costs in a healthcare system that rewards medical professionals not for quality and health but for procedures.
All of this because of the tried and true method of picking doctors based on recommendations from family and friends isn’t quite as “true” as an aggregation of doctor-based outcomes.
The Old Way of Choosing Doctors
The predominant means of choosing which doctors to see for diagnosis and treatment has been to ask family and friends if they know anyone good, a subjective method that has endured, ingrained in our culture. In fact, as per a recent New York Times article on choosing a pediatrician, “[t]he best options often come from personal recommendations by family, friends, relatives and colleagues who have kids.”
But this method has birthed a healthcare system that pays medical professionals for procedures performed instead of successes, and it is a process that is flawed from the moment a patient enters the system to their point of exit, as it fosters a culture where unnecessary or wrong procedures and medical malpractice are just the cost of doing business.
Many doctors do needless procedures that fail to address the problem. According to a 2018 report by the Washington Health Alliance, over 45% of medical services surveyed were deemed to be low-value or wasteful.
Meanwhile, a 2017 report by the National Center for Biotechnology Information concluded that “over-treatment” is common, with 70% of physicians surveyed stating “that physicians are more likely to perform unnecessary procedures when they profit from them.” Another study from 2017 found that over 20% of overall medical care was unnecessary.
Clearly, while medical errors, needless procedures and over-treatment can have a dramatic effect on the individual patient, their ramifications can be felt on a much grander scale, with the general public forced to absorb the higher insurance costs and accept other issues that come with institutionalizing bad doctor care.
A Simple Change Can Rewrite the Equation
The “ask around” method of healthcare acquisition is something nearly everyone has utilized, and it has even evolved, with Internet sites like Yelp and online reviews of physicians guiding decisions. But the end result is the same: potential doctors are matched up with patients via a means that is wholly subjective and based on the opinions of others. It doesn’t take into consideration an accurate assessment of the positive outcomes each doctor is responsible for. It also doesn’t conduct that assessment via a massive statistical analysis.
The big data method rewrites the equation, focusing on a broad accounting of all the outcomes, and culling that information to whittle down which doctors have a greater rate of success. In essence, it answers the question of who the best doctors are by looking at the results those doctors produce.
Ultimately, the subjective opinion is removed from the equation completely.
There are a number of companies that have begun exploring this big data angle in healthcare, and they include Kaia Health, Aetion, Clarify and Garner Health. All of them take the approach that the real answers can be found by rewriting the equation, with Garner Health utilizing data-driven analysis to pair patients with doctors who have a track record of positive outcomes.
Better Outcomes, Lower Healthcare Costs
“It turns out what matters most is which doctors people go to see,” says Nick Reber, CEO of Garner Health. “In other words, if your doctor is good, you’re going to be good, and if your doctor is not so good, you won’t be so good.” He adds: “It turns out that people with the same socioeconomic backgrounds, medical circumstances, etc. can have very different outcomes.” It all boils down to the doctor, and the doctor’s history of positive results.
By taking a “big picture” view of all the documented outcomes of various medical procedures, Garner was able to determine that there is often a disconnect between the amount of money spent and the favorability of the outcome.
“Seeing the best doctor translates into a far statistically better outcome,” says Reber. ”One of the reasons this occurs is because this is how doctors get paid. Some doctors actually read the medical literature and know how best to treat conditions, while others make decisions based on money.” He adds: ”Healthcare is totally different than any other industry in the world. If you want the best doctor, that doctor is going to lower the cost of your care, and keep you healthier in the long run. The sad thing is that doctors make a lot more money on cases with complications than cases which don’t.”
Consider the chart below, which visually represents the data of the quality of the doctors (the vertical axis) versus the average cost of care (the horizontal axis). As the data shows, the best doctors are the ones that actually treat patients successfully with fewer visits and fewer extraneous costs (like additional visits, unnecessary procedures, etc.).
Saving Businesses on Healthcare Costs
Healthcare costs affect more than just individuals. They’re also a factor for companies that provide health insurance to their employees. “The high and rapidly growing cost of healthcare is an existential threat to competitiveness of US companies,” says Reber. “When you start a company, you’re paying about ten-thousand dollars a year for each employee. COVID is making that even more acute, both in terms of falling revenues and profits, and the rise in medical costs”
But the big data approach the Garner and others are taking can assuage those expenses, especially on a large scale.
Consider the graphic below. Doctor A is a run-of-the-mill physician, while Doctor B has a significant track record of successful outcomes. Note the amount of unnecessary surgeries performed by both doctors.
“We are a new plan option that provides a concierge service that helps people choose better doctors,” says Reber. ”We try to provide a great experience. If you go, it’s free. If you take our recommendation, we’ll cover all your medical bills.”
How can it be free? Say’s Reber, “Employers are actually paying medical bills, the insurance company is just acting as the administrator. The employers are on the hook and are paying the doctors when you go. Remember, the highest quality of doctor care translates into lowest costs. So employers can now go from covering 80% to 95% because they’re saving 15%.”
“One of the major problems with healthcare dictated by insurance is if you go through your insurance, you can’t find a doctor directly – and you certainly can’t find a good one. With Garner, though, it is a very curated list of doctors that tells you who, why to go with them, their availability.” He adds: “We haven’t seen anyone use this data to improve the quality of care. Data-driven doctor selections dramatically improve patient health while lowering costs. Garner’s data-driven healthcare services deliver results.”
The subjective, recommendation-based method of choosing doctors has had its day. Now it’s time to demystify the choice with a data-driven analysis that gives patients the best care possible, while shaving off $860 billion annually from national healthcare spending. And most importantly, patients will be healthier faster and suffer less pain!
The benefits to both the individual care-seeker and society as a whole demand it.
At Bold Business we love stories of how business’ dramatically improve the world. The laws of common sense and economics could lead to private business doing more to fix healthcare than the federal and state governments combined!
For more on Garner and its outcomes-based analysis, check out GetGarner.com