High Quality, Low Cost HealthCare Video Interview Series: e-Patient Dave deBronkart
Dave deBronkart is a cancer survivor, internationally known keynote speaker and author, the spokesperson for patient engagement and a key member of the Society for Participatory Medicine. He is widely regarded for his views on patient rights, healthcare reform, and pricing visibility. Please visit his website and blog and take a look at the information there.
Dave has some definite views on pricing visibility which he talks about on the video below.
To see other videos in this series, please go to this page. And if you have a story to tell that can reduce healthcare costs and raise quality of care, please comment below or email me at firstname.lastname@example.org Thanks!
Video transcript (by TranscriptionStar)
Joan: Hello. I'm Joan Justice with HealthWorks Collective, and I'm here with Dave deBronkart. Dave really needs no introduction, but I'm going to introduce him anyway. Known as e-Patient Dave, Dave is a cancer survivor and internationally known keynote speaker and author, and the leading spokesperson per patient engagement.
Dave have some definite ideas about how patients can help, make healthcare pricing more visible, which in turn would reduce it. So Dave why don’t you go ahead and tell us about your thoughts?
Dave: Well the main thing that people need to realize is that although we're not accustomed to acting like ordinary shoppers who care about value, you know most quality and price were not accustomed to doing it in healthcare. It turns out that the more you dig into it, the more you raise your awareness, the more legitimate, that is. There's wide variation in quality of care, and there's incredible variation in pricing that's all been shielding from us in the past at least those of us who had regular health insurance, but you and I both have high deductible plans now mine is $10,000, so every single thing I have until I have a catastrophe every single thing is stuff that I actually pay for like a normal shopper.
Joan: Right me too. I have $5000 dollars deductible too so.
Dave: And I very quickly found out that as well as a couple of things that it will -- got to focus how can patients help improve healthcare by acting like normal and intelligent shoppers, ask how good is this, and how much is it going to cost and do I have any options.
Joan: Yeah that's the best advice I think you can give anyone, anyone that it goes to the provider for healthcare. And what do you know that the term pricing transparency?
Dave: Well, you know I'm a marketing guy, so choice of words is important to me. I've also had a sort of a hobby being an amateur fan out of culture change, and there's so much about culture change that has to do with changing the language we use for things. Now that somebody who has lived in the healthcare economy for decades, there's this abstract concept of transparency, which is like being able to see true through the shrouds that have hidden information. I'm a much more mundane guy like I went to a Mexican restaurant a couple of months ago with my wife and on the Margarita's page there were no prices listed.
I did not ask the waiter for some transparency. I said how much are these? And we need to do exactly that in healthcare. You know there's a famous health economist named Uwe Reinhardt. Uve that is a German first name, wonderful guy, funny speaker and he wrote a paper published in the journal Health Affairs in 2006 about healthcare pricing, and the headline called it Chaos Behind a Veil of Secrecy. We need to not ask for transparency. We need to say let me say the prices.
Joan: Visibility more in threads of visibility.
Dave: Yeah exactly.
Joan: And where all these pricing visibility lead up all the prices are visible and they're getting more and more visible online?
Dave: Hallelujah, it will add, it will lead to healthcare improving in the consumer terms of like any other normal market that two essential things that you have when you go shopping for television set or a car that you don't have in healthcare. And by the way, I'm not comparing television sets to medical care right in terms of how complex they are.
My life was saved by brilliant doctors and nurses performing the result of brilliant research, but there's still the two things that we don’t have in healthcare are of information on price and quality, and the ability to take our business out elsewhere if we're not happy. So what really bothers me this is not just like a patient rights or consumer rights issue I want the best clinicians, the best hospitals, the best doctors, the best nurses to be recognized for that, in the form of all of us bringing them our business you know today it's not easy to do that. We know that we have an easy way to know who the best ones are much less the best values.
Joan: That's right. What we need is value. The best ones at the best price like best buy.
Dave: Yeah exactly.
Joan: Something like that so and where you do think the biggest challenge in reducing healthcare costs lie?
Dave: Well, the first thing I have the greatest respect for the complexity of the healthcare professions. It's a massive, massive, we can't comprehend how big the -- that the industry is. There was a big report in September from the Institute of Medicine called Best Care at Lower Cost. And it said there's $750 billion of excess spending in American healthcare.
Joan: You mean waste.
Joan: Yeah waste.
Dave: Unnecessary scans, things that are overpriced and to comprehend that amount of money I -- I looked up, so what if Apple Computer went out of business. How many billions would that take out of the economy? What if IBM went out of business? General Motors like eight companies like that all of those combined are less than $750 billion. So the biggest challenge of that I think the challenge is in price visibility because if you ask the people at your local doctor's office or when I had a skin cancer that I had to get treated earlier this year, I asked the dermatology department how much will this cost? They truly didn’t know.
And they go course I couldn't yell at them. Nobody had ever asked them that, so that's where working for us to start asking.
Dave: I think it’s the biggest challenge.
Joan: Good. And what advice would you give patients when shopping for healthcare?
Dave: Number one be aware there are differences in quality and safety okay. There's a hospital safetyscores.org, there are new services they're coming out recently Clear Health Cost Healthcare Blue Book, Castlight Health. Some of them were only available through employers, but in start first of all you know ask your employer if you have, and in -- if they have a service like that, and start asking everyone else ask your insurance company.
I have been amazed to discover that some insurance companies don't want to help me find out our options are. Are they just commission so us are not a problem to them, but ones are. So ask your insurance company can you help me lower my cost and if they say no, you might want to consider finding a different insurance company.
Joan: [Indiscernible] [0:07:30].
Dave: But be aware there are differences in price and quality that maybe I should end by pointing out there's a famous surgeon, a wonderful speaker named, Atul Gawande who at the Medicare Innovation Summit last January, he had his brilliant 60 seconds, I it were a YouTube clip. He said there is a curve on quality of care, substantial differences between the best and worst. There's also a curve on cost of care, substantial differences.
Surprisingly, the two did not match. Now, my first reaction was doesn’t that just make you mad because people don’t have the best price. But he said then that means there is hope because if the best did cost the most, then we would be talking about rationing, but we're not instead we're just -- we just need to find out what works.
Joan: The value.
Joan: Yeah the value, great advice. Thank you so much Dave and I urge anyone thaw's interested in patient engagement and the quality of healthcare and that should be all of us of course to go online and look at some of the excellent resources available, and there's a lot of great information out there. And when you go to your healthcare provider ask to see the pricing.
Dave: Exactly. And do everything you can know to help, to find the best doctors, nurses and hospitals, and tell other people about them, so this can start the function like any other market that rewards the people who do the best job at what customers want.
Joan: Right, thank you so much.
Dave: Thank you so much.
Joan Justice is Executive Director at thePatient Empowerment Network, a global non-for-profit organization dedicated to fortifying the health care consumer with the knowledge and tools to feel more confident playing a central role in decisions that affect their health. Joan has a background in nursing and domestic and international healthcare marketing. Previously, she was the manager of ...