TRYING TO DO BETTER


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Trying to do Better

Next 		A few small centres in the US are experimenting with trying to provide patients with usable current clinical information such as by providing clinical tapes related to particular medical problems. There is a proposal by the Kanter Family Foundation over a number of years to build a health outcomes database through the Agency for Healthcare Research and Quality. The most significant move to start on a solution to the problem is that under way by the Minnesota Health Insurers. As an explicit response to the WIM report they are developing a professional level site which will provide information on the treatment of 50 diseases The information is reviewed annually by a panel of doctors. The diseases selected are the relatively minor slower changing disorders like bladder infections. It does not handle heart disease or cancer for example.

THE SOCIAL ECONOMIC AND POLITICAL PERSPECTIVE

There is a very high degree of unanimity in where the field of professional and consumer health information should be heading. The WIM recommendations summarized it perfectly and that prescription is in agreement with earlier commentators.

Although no one can accurately quantify the amount (except for overview estimates like Donald Berwick’s 1999 figure of US$330 billion) it is agreed there are enormous cost savings and the potential for a huge shift in the quality of medicine.

There have been studies like the Robert Wood Johnson, Blue Cross health insurance, Healthwise Idaho study suggesting that provision of even simple consumer information services can save on emergency room visits (~18%) and GP visits (~30%). That study included a nurse advice line so any inferences can only be very general. Nonetheless it is the direction that all in the industry are headed.

The admitted problem by all is the design, and even WIM provided no advice other than suggesting that the top 15 diseases should have their treatments standardised within five years and that some billion dollars should be spent on researching the area. The key players with most interest in the financial outcome are
  • the health insurance companies, the HMOs and
  • the medical indemnity insurance industry
Some of them have made and are making moves in this direction.
  • Medibank Private in Australia is now funding Cochrane Consumer
  • Aetna Health in the US owns Intelihealth, probably the number three or four consumer site. Like all the sites the consumer enthusiasm for Intellihealth has been completely under whelming and they have taken a series of steps to try to make the site more attractive. They have now ‘badge engineered’ the site using the Harvard Medical school label.
  • The leading effort in the industry at the moment is that funded by all the health insurers in Minnesota. They explicitly recognise the WIM recommendations as their driving model. It is a medical site only. Fifty diseases are being assembled. They are the slow changing diseases (no heart disease no cancers) and a group of doctors meets annually to review the treatment recommendations. Pioneering analysts like Jack Wennberg (ex Harvard professor of medicine - Dartmouth Health Atlas author) say it is a small but important step in the right direction. We at Wisdoc agree.