Health insurance reform has been on my mind. While it's partially because I helped re-launch www.CoverTheUninsured.org, it's also because I recently participated in my employer's annual health benefits briefing.
As usual, jargon bounced off the walls: "in-network services," "co-pays, "deductibles," "out-of-pocket," and my favorite, "Pre-existing Condition Exclusion Period."
I'm overwhelmed by the rules and procedures that the insurance industry expects me to navigate each and every time I seek health care. Walking into the wrong health care provider can be a thousand-dollar mistake.
My confusion is not new. Seven years ago, before my first child was born, my wife and I attended a prospective pediatrician's new-parent orientation. We listened for more than an hour before it was off-handily disclosed that they were no longer accepting new patients for my particular flavor of insurance. As my wife and I sheepishly slinked to the exit, we were followed by half-a-dozen other disappointed expectant couples.
I know I'm not the only one confused. A recent survey showed that Americans lack basic information about health care and how it affects their finances.
Finding quality, affordable health care is a huge challenge for all Americans. Underprivileged families face additional challenges. The District of Columbia, for example, boasts one of the highest insurance rates in the country, but two thirds of its residents rely on Medicaid and finding and getting an appointment with a doctor who takes Medicaid can seem more difficult than winning a radio contest.
The systems are complex, and the information is inadequate.
For starters, I know of no single reliable, comprehensive health care directory. Sure, there are many online directories of doctors from the likes of WebMd and Revolution Health.
But no one is providing critical information such as whether they take specific insurance, or medicaid. The information that is there is limited to doctor names, location. Basic information such as specialties are frequently missing. The insurance companies' own provider directories are filled with mistakes -- the very references we are expected to consult to confirm that we're picking an in-network provider!
And while there are dozens of high-quality iPhone apps for providing detailed, localized information about everything from a restaurant to a taxi service, there are only a few doctor finders. Dozens of user comments for each application attest to their chief limiation: inaccuracies in the underlying data.
It's no secret that the groundwork for health reform has to start with better information for consumers, providers, and the government. The Obama administration realizes it, which is why electronic health insurance records are part of the insurance plan and the stimulus package included over $19 billion for health IT.
The effort to organize the data on millions of patients should be accompanied by organizing the data on health care providers themselves. What's needed is a single format for the exchange of key medical information. Think of it as a rich vCard for doctors, hospitals, clinics, and other providers.
This data format must include:
- Office location
- Office hours
- Web site / contact information
- Staff (names, biographies, credentials and specialties)
- Patient capacity
- Services
- Insurance accepted
- Medicaid policies
The stimulus package need to fund the coordination of the development of this health care provider standard. A partnership of private industry and nonprofit organizations can finish the job.
Once established, this standard could be incorporated into every medical directory site, medical practice management software making it easy for doctors and health care providers to publish and easy for the sites to subscribe to updates. The government might even mandate that insurance companies adopt the the new data standard.
From there, independent developers can take this data and build their own custom applications without further government funding or coordination. I'll get my "Doctor Finder" iPhone app, and everyone will be happy.
Let's break ground on this project immediately.
