The news cycle is moving on, but the killing of Brian Thompson was awful, no matter how one feels about the shortcomings of the American health care system. In a recent New York Times opinion piece, Andrew Witty, president of the UnitedHealth Group, wrote that no one would set out to design the system we now have. We can all agree on that. Our goal in participatory medicine is for \u201cpatients to shift from being mere passengers to responsible drivers of their health, and in which health care professionals encourage and value them as full partners,\u201d using Gilles Frydman\u2019s words. But the patient\/clinician relationship happens in the institutional contexts of health systems and health insurance companies, to name a few, that exert force on that relationship. To be participatory, I think it\u2019s important to be both health and health insurance literate.<\/p>\n
Complexity and a lack of transparency dog the US health system, and institutional interrelationships can be a barrier to being participatory. Referrals out of a health system may not be made because of the health system\u2019s desire not to have patient utilization \u201dleak\u201d into other systems, even though the patient\u2019s insurance policy permits using other health systems. An insurer\u2019s \u201cstep therapy\u201d policies can result in getting suboptimal drugs, when it is clear to the clinician that the drugs being used aren\u2019t achieving the clinically needed result.<\/p>\n
Improvement of the health system won\u2019t happen overnight, so I work to be literate about both my health and my health insurance and understand who is responsible for what.\u00a0 That doesn\u2019t solve all problems, but it can help. I choose my clinicians and my insurer based on their respective satisfaction and performance ratings.\u00a0 I work to understand health system\u2019s and health insurer\u2019s referral policies. I use both my health system\u2019s and health insurer\u2019s patient\/customer service to gather the most information I can. I learn the basic concepts of insurance, reading my policy and talking with customer service to know what to expect about how coverage might be administered, and when my clinicians are knowledgeable, talking with them about whether the care they recommend might be covered. \u00a0Most of all, I need my insurance carrier to be 100% transparent about their policies and the logic behind them. It shouldn\u2019t be this complex, but it is. Until it isn\u2019t I want to be both health and health insurance literate.<\/p>\n
Mary Hennings<\/em> is board chair for SPM.\u00a0 Her professional background is as a senior healthcare executive with 35+ years of broad health care experience. She has expertise in formulating product strategy and new products, and developing and implementing organizational innovations that are aimed at supporting better care, coverage, and customer experiences. She has held leadership roles in both integrated health care delivery and health insurance settings.<\/em><\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" The news cycle is moving on, but the killing of Brian Thompson was awful, no matter how one feels about the shortcomings of the American health care system. In a […]<\/p>\n","protected":false},"author":491,"featured_media":22639,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[281,12,1,8351,62],"tags":[],"coauthors":[8407],"class_list":["post-22959","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ethics","category-found-on-the-net","category-general","category-health-equity","category-reforming-healthcare"],"yoast_head":"\n