When worlds collide: experiencing healthcare as a consumer

Bobbi Coluni is the Leader of Offering Management for the Payer Market at IBM Watson Health.

Over my 25-year healthcare career creating analytic solutions, I’ve experienced critical moments of truth where my personal and professional worlds have collided. In these moments, I see issues I’ve worked on professionally through the eyes of a healthcare consumer, and things look a little different from that vantage point.

I want to share one such experience, and how it is influencing my work now at IBM Watson Health.

Last fall during my annual physical, a biopsy revealed a suspicious spot on my forehead that turned out to be squamous cell skin cancer.

Now, I’ve had skin cancer removed before, so I thought I knew the drill.  But this situation was different — because of the size, I would need reconstructive surgery afterwards.

I was surprised to learn that although the surgeon I found was part of my health system, he actually practiced an hour away. I asked if he operated at my local hospital and to my delight he said yes.  So, I scheduled the procedure close to my home, making my decision based on in-network service and convenience.

The initial surgery went well, but to my surprise I was scheduled for the General Surgery OR at the hospital for the reconstruction instead of the Dermatology Surgical Clinic I had expected. I was in with patients getting spinal fusion and knee replacements, and in an operating room that was equipped to handle far more intense cases than mine.

The outcome was excellent.  But when I analyzed the 6 bills, I almost fell off my chair!  The total charge was over $19,000, with most of it related to the high cost of using the local hospital OR instead of an outpatient clinic. Because of my high deductible health plan, I ended up paying over $6,000 while my health plan paid $3,500.

Here’s the irony: I’ve spent several years of my career developing consumer cost transparency solutions for health plans, so I am wise to the enormous variation in healthcare costs. Still, I made a typical consumer error.  I did not realize my in-network choice meant I would be paying twice as much for the surgery because of the location. If a healthcare professional like me got this surprise, imagine the experience of the average healthcare consumer!

Our healthcare system and health benefits are becoming more complex each year as we balance choice, cost and value.  We know patient engagement matters. Mounting evidence shows that engaged consumers are more satisfied with their care, have better outcomes and lower costs. Judith Hibbard’s research on patient engagement shows that when patients feel knowledgeable and confident about their care, their costs are less – resulting in a 15-20% cost differential between the most and least engaged patients with chronic conditions[1].  The question is… how can we engage people to surface the right information, avoid surprises and make good decisions?

In my professional world I’m excited about the work we are doing to apply augmented intelligence and a chat function to help with consumers’ healthcare decisions. As a learning system, the solution can be trained on health benefits and access personalized information to anticipate questions and provide meaningful guidance and get smarter over time.

These collisions of worlds help keep me focused on innovating in ways that enable consumer engagement, informed decision making, and effective use of healthcare resources.  As an innovator, I’m working to reframe this consumer frustration into gratitude.

For information about IBM Watson Assistant for Health Benefits, visit us here.

[1] Judith Hibbard et al. “What the Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs” Health Affairs. Feb 2013