Arguing for the Patient as the Consumer of Healthcare

Bruce A. Feinberg, DO: I think an argument could be made that the patient is the recipient of care, but they’re not the consumer of care. In fact, from a medical oncologist perspective from someone who has practiced medical oncology for 25 years, my referring doctors were consumers. That’s how I stayed in business and had referrals. My payers were consumers because they were paying for care as an extension of an employer, and the employer was really paying for the care.

 

So how did we get to this point? Is it really a patient-focused evolution? Or is there something different that’s happening?

 

Michael Kolodziej, MD: I think a big part of it is that the cost of care has risen so quickly, and we have become extremely uncomfortable with such a high percentage of the GDP [gross domestic product] being devoted to healthcare. We’re just uncomfortable with that, and we should be uncomfortable with that. I think, though, that the discussion around each stakeholder having a different value construct–some stakeholders being consumers, some stakeholders not being consumers–I don’t think that’s particularly constructive.

 

First of all, I’m not a patient, but I also took care of patients for a very long time. And, although I do believe there may be individual differences, it’s not hard for me to understand, from a more global context, what is important to patients. I talk to enough of them to have a pretty good idea. And there are nuances.

 

I’ve worked for a payer long enough, now, to understand that there are certain global things that payers are interested in. And certainly, I was a physician, so I understand what physicians are interested in. I also understand what innovators are interested in and why pharmaceutical companies are stakeholders in this space too. I actually think it’s a lot more beneficial to take a step back and say, “Okay, we believe each of these [stakeholders] has a slightly nuanced value construct, but there’s actually a lot more in common than there is in conflict,” rather than saying, “I have primacy.” That’s just not constructive.

 

I think the fact of the matter is that a lot of my patients wanted to go on clinical trials, not because they were going to personally benefit, but because they were going to help society. And I think a lot of patients do think about how much things cost, both in terms of the implications for their bank account, and the likelihood that they’ll have bankruptcy, as well as just a sense of how much we are spending on treatments that might have marginal impact. So, I think that it’s come to a head now because we’ve developed this almost adversarial relationship among stakeholders. It’s not constructive.

 

James Gilroy: I think that’s very well said. From my perspective, I think it is the silo mentality that often persists because what you just described is actually very hard to do, right? So, Ted, when you talked about the denominator of drug cost–“let’s look at total direct cost,” “let’s look at indirect cost as well”–I think oftentimes, as a broader community, we gravitate toward what might be the easiest change to enact. The fact of the matter is the whole discussion around value and the whole discussion around the number of stakeholders that are involved in defining it is just not easy.

 

Ted Okon, MBA: I think we got here because, as a society, we are using more healthcare. We’re growing older, we’re not as healthy as we should be, but no one politically wants to touch that at all. So, what do we do?

 

We focus on, in essence, the demand side for healthcare services. And as you said, Mike, it’s growing disproportionately in terms of GDP. As a result, we have to say, “We have to look at value.” That’s the answer–we have to seek value. So, we throw things out from a policy standpoint, but it’s actually hitting only one side of the supply-demand equation. That’s troubling to me because I think no matter what we do, we’re never going to slow it down enough because we still have more and more demand for healthcare services.

 

Michael Kolodziej, MD: That said, the opportunity here is that although there have been some clumsy attempts at defining it, there is a desire to bring in a scientific method–some sort of objective way of measuring inputs. And, I will say, unfortunately, not all stakeholders have been equally represented in those clumsy attempts. Hopefully, that will get fixed.

 

The point is that we know there’s a problem. We know that the path we’re down is not going to lead to a solution. But, the idea that we can bring some sort of intellectual honesty and scientific rigor to assessing these novel therapies, these changes in care delivery, and a way of deciding–does this really make people feel better, live longer, be happier, enjoy more health? We’re there now. That’s a good thing. We have not been there before.