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Consumers Need to Become CEOs of

Their Own Health and Health Care

Track Session 2.05 Other Key Topics Track: Consumer Driven Healthcare

Elizabeth L BewleyPresident & CEO

Pario Health Instituteebewley@pariohealth.net

(732) 966-7497

Third National Consumer Driven Healthcare SummitOctober 20, 2008

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Where is This Environment Found?

• Personal belongings (e.g., clothing) removed

• Total loss of control over environment

• Limited information

• Physically restrained

• Pain

• Bright lights 24/7, no windows

• Night/day disorientation

• Continual loud noises

• Extreme sleep deprivation

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Where is That Environment Found?

Prison Camp Hospital ICU

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ICU Psychosis• “A form of delirium, or

acute brain failure”1

• “psychotic episode(s)… occurring within 24 hours after entering the ICU in patients with no previous history of psychosis”2

1MedicineNet.com, downloaded 06/18/20082Medilexicon.com, downloaded 06/18/20083Landro, Laura, “Hospitals Combat an Insidious Complication,” Wall Street Journal, 10/17/2007

Triples risk of death within three months; can cause permanent cognitive decline.3

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ICU Psychosis is Preventable

• Simple measures suffice– E.g., dimming the lights

at night

But such measures are rarely taken.

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Why is an ICU Set Up This Way?

• It is not that anyone has bad intentions.

• The experience of the individual being treated has historically not been considered a primary factor.

•The health care system accidentally creates an environment that torturers intentionally create.

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Health care is not individual-centric.

To get good outcomes

at a reasonable cost,

it needs to be.

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Best Health Care in the World?

“The Institute of Medicine reported in 2000 that medical errors cause as many as 98,000 deaths annually… a more realistic number may be as high as 200,000 deaths per year.…”1

1Landro, Laura, “Report To Rank Hospitals on Safety,” The Wall Street Journal, April 22, 20042Mullaney, Tomothy J, “Business, Heal Health Care,” Business Week, August 14, 20063Deaths 9/11 totaled < 3000. See Barry, Dan, “A New Account of September 11 Loss,” New York Times, October 29, 2003, which reports 2,752 dead, or CNN International, “U.S. deaths in Iraq, war on terror surpass 9/11 toll,” September 03, 2006, which reports 2,973. If 200K die from medical errors annually, then 200,000/52 weeks = 3846, more than the 9/11 toll by a wide margin.

“Medical mistakes are

the nation’s third-leading killer”2

Medical errors kill more people every week than terrorists killed 9/11.3

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Best Health Care in the World?

Patients suffer 1.7 million hospital infections a year…

about 99,000 people die1

For comparison, 41,000 die from breast cancer.2

1 “Estimates of Healthcare-Associated Infections,” Centers for Disease Control, http://www.cdc.gov/ncidod/dhqp/hai.html 30 May 2007

2“Breast Cancer Facts & Figures 2007-2008,” downloaded 23 Sep 2008 from American Cancer Society, http://www.cancer.org/downloads/STT/BCFF-Final.pdf

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“There are at least 1.5 million preventable ADEs that occur in the United

States each year…”1

“125,000 people die from Adverse Drug Events each

year”2

Best Health Care in the World?

1”Preventing Medication Errors,” The Institute of Medicine, July 2006

2"Experts Warn On Expense of U.S. Drugs" by Jeff Donn Associated Press, 4/17/2005

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Deaths Caused by Medical Care vs. Total Deaths

• Deaths caused by medical care each year:– Medical error 200K– Hospital-acquired infections 99K– Adverse Drug Events 125K– TOTAL from selected causes 424K

• Total deaths in U.S. in 2006: 2,426K1

• % of total deaths attributable to medical care: 424K

2,426K = 17%

1Heron, Melanie P., et al, “Deaths: Preliminary Data for 2006,” CDC National Vital Statistics Reports, Vol 56, No. 16, 6/11/2008

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Best Health Care in the World?

46th in life expectancy1

1CIA World Factbook 9/4/20082Ibid

42nd in infant survival2

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Best Health Care in the World?

• “The United States ranked last among 19 industrialized countries on a measure of preventable deaths.”1

1Nolte, E. and McKee, C.M., “Measuring the Health of Nations: Updating an Earlier Analysis, Health Affairs, Jan/Feb 20082Peterson, Chris L and Burton, Rachel, “U.S. Health Care Spending: Comparison with Other OECD Countries,” Congressional Research Service, Prepared for Members and Committees of Congress, September 17, 2007

•The United States spends more than twice as much per person on health care as other developed nations do.2

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Why?

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Health care is not individual-centric.

To get good outcomes

at a reasonable cost,

it needs to be.

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When What WorksWho Drives

ResultsWhat

Individuals DoWhat Happens

Early 20th century Clean up water, sewage

Public Health agencies

Nothing

Life expectancy jumps 43% from 47 years in 1900

to 67 years

in 1950 1

1940s – 1980s Acute interventions (penicillin, surgery)

Doctors

Show up

Life expectancy up 12% from

67 yrs in 1950

to 75 years

in 2000 2

Today Prevent/manage chronic conditions

IndividualsBe CEO of their own health and

health care

Otherwise, life expectancy

expected to drop3

1 ElderWeb, 1900-2000: Changes in Life Expectancy in the United States, http://www.elderweb.com/history/?page OD-2838 (17 January 2006.)2 Ibid3 S. Jay Olshansky et al, “Potential Decline in Life Expectancy in the United States in the 21st Century,” New England Journal of Medicine, 17 March 2005.Source: Elizabeth L. Bewley © 2007. All rights reserved.

Individuals’ New Central Role is Not Addressed Well

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“A Gross Failure…”1

• More than 100,000 people have a leg or foot amputated each year2

• “…up to 85% of these procedures [are] unnecessary”3

1Dr. Robert Beaglehole, Director of Chronic Diseases and Health Promotion, World Health Organization, as quoted by Svoboda, Elizabeth, “To Prevent Amputations, Doctors Call for Aggressive Care,” New York Times, Nov 07, 2006 2Svoboda, Elizabeth, “To Prevent Amputations, Doctors Call for Aggressive Care,” New York Times, Nov 07, 2006 3Ibid.

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Sound Bites?

• “The Dietary Guidelines and the Food Guide/My Pyramid encourage us to make wiser food and beverage choices…”1

• “The guidelines… feel like wartime rationing…No one is going to eat like this.”2

•1Higgins, Mary L Meck, “Steps to a Healthier You: A Summary of the 2005 Dietary Guidelines for Americans and the Food Guide/My Pyramid Fact Sheet,” August 2005.•2Grimes, William, “Eating My Spinach: Four Days on the Uncle Sam Diet,” New York Times, 23 Jan 2005.

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Do Individuals Get the Information They Need? Individuals find it hard to…

get their own medical records…

…compare treatment options

…find out treatment costs up front

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When an Individual Is Treated:

• “Does it fix my problem?”

• “Does it cause other problems?”

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Treatment works as intended; however, individual has

troublesome

side effects

Treatment works as intended

Treatment doesn’t work as intended for individual; and causes

troublesome

side effects

Treatment doesn’t work as intended for the individual

When an Individual Is Treated…

Side effects No side effects

Not

eff

ecti

veV

ery

effe

ctiv

e

?

Source: Elizabeth L Bewley © 2008. All rights reserved.

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Do Individuals Get the Information They Need?

• Percent of time doctors tell patients1

– Reason to take the drug: 87% – Name of the drug: 74%– Adverse side effects: 35%– How long to take the drug:

34%1All statistics from: Tarn, Derjung, et al, “Physician Communication When Prescribing New Medications,” Archives of Internal Medicine,September 25, 2006

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Why?

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Health care is not individual-centric.

To get good outcomes

at a reasonable cost,

it needs to be.

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Even Our Choice of Words...

• Patient:  – “Bearing or enduring pain,

difficulty, provocation or annoyance with calmness.” 

– “One who receives medical attention, care, or treatment.”

All quotations from:American Heritage Dictionary of the English Language, Fourth Edition, Houghton Mifflin, New York, 2000.

• What happens when we define people

by their relationship to care providers?

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Ideal Model for Health Care?

Cartoon appears at www.theurbanbrain.com

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Ideal Model for Health Care?

• Consumerism:

– “The movement seeking to protect and inform consumers by such practices as requiring honest packaging...”

– “The theory that a progressively greater consumption of goods is economically beneficial”

– “Attachment to materialistic values or possessions”All quotations from:American Heritage Dictionary of the English Language, Fourth Edition, Houghton Mifflin, New York, 2000.

Consumer:“One that consumes”

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What Can You Do?

• Ask questions• Create a Personal

Health Record

• Become the CEO of your own health and health care!

• Learn how to get good results from the health care system

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http://www.ahrq.gov/questionsaretheanswer/questionBuilder.aspx

Ask Questions

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Examples of Questions from AHRQ’s QuestionBuilder:

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Create a Personal Health Record

http://www.ahrq.gov/consumer/phrvid.htm

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How Do You Get Your Medical Information?

http://ihcrp.georgetown.edu/privacy/records.html

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Learn How To Get Good Results

http://www.ahrq.gov/consumer/guidetoq/

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Learn How To Get Good Results

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When What WorksWho Drives

ResultsWhat

Individuals DoWhat Happens

Early 20th century Clean up water, sewage

Public Health agencies

Nothing

Life expectancy jumps 43% from 47 years in 1900

to 67 years

in 1950 1

1940s – 1980s Acute interventions (penicillin, surgery)

Doctors

Show up

Life expectancy up 12% from

67 yrs in 1950

to 75 years

in 2000 2

Today Prevent/manage chronic conditions

IndividualsBe CEO of their own health and

health care

Otherwise, life expectancy

expected to drop3

1 ElderWeb, 1900-2000: Changes in Life Expectancy in the United States, http://www.elderweb.com/history/?page OD-2838 (17 January 2006.)2 Ibid3 S. Jay Olshansky et al, “Potential Decline in Life Expectancy in the United States in the 21st Century,” New England Journal of Medicine, 17 March 2005.Source: Elizabeth L. Bewley © 2007. All rights reserved.

Become CEO of Your Own Health and Health Care!