By Sydney Howland
When I came into contact with Costs of Care, their mission to educate medical students and empower patients through interactive workshops and personal anecdotes enthralled me. The Costs of Care annual essay contest provides an outlet for discouraged individuals to share their experiences and illustrate opportunities for improving the value of care. These stories, both positive and negative, include unbelievably powerful accounts of a complicated and very much broken system. These essays offer a plethora of untapped resources into what American citizens want and need in their healthcare providers.
This summer I developed a project, in coordination with Costs of Care, to develop an advocacy platform based on these essays. I wanted to translate the stories into actionable deliverables that doctors could use to improve the cost and quality of their care. I hoped that by using personal experiences to suggest new courses of action, I could catalyze a greater call to action for health care providers and policy makers. The end goal was a collective report that leveraged Cost of Care and outlined a strategy for health care savings. I also corresponded with Primary Care Progress, an organization dedicated to revitalizing primary care by fostering robust primary care training. They represent a network of physicians, nurses, physician assistants, and other allied health professionals. Their organization was useful in helping to shape the direction of my project as well as in validating the lessons that came out of the collective data.
I chose to focus on primary care medicine for several reasons. Primary care physicians represent a largely untapped resource for changing the culture within the health care industry. By nature, primary care clinicians build sustained partnerships with patients, thus promoting early stage detection of illness and trust in the system. This continuous relationship allows primary care doctors to help monitor chronic conditions and encourage individuals to make healthy lifestyle choices in order to minimize emergency room usage and catastrophic care, both of which represent huge contributions to US healthcare expenditures. Furthermore, my interests in social determinants of health and population health lead me to seek more interpersonal methods of large-scale reform.
In early June, I gained access to Cost of Care’s essay database. I began sifting through the collective bank of over 300 of essays submitted between 2010 and 2012. I sought out stories that directly correlated, or could be extrapolated, to primary care medicine. The more I read these disheartening accounts, the more motivation I felt to create this final project. The lack of control and overwhelming desperation portrayed in some of these stories represented a need for information, clarity, and reassurance. The essays inspired me to bridge these gaps in communication and to draw attention to potentially large cost-saving techniques.
I sifted through the mass of data and reduced the information to 50 essays that I could work with. From these I gathered several conclusions. I found an overwhelming desire for greater price transparency for patients, prior to making health care decisions. Many described their lack of awareness surrounding the fragmented cost of several procedures as well as the shock upon receiving their medical bills. I also observed a common need to price shop when choosing prescription drugs and surgical procedures because of the inherent variability in prices across different practices and regions. Lastly, I detected a lack of coordination across health care providers resulting in patient confusion and wasteful spending. Many of these problems could be alleviated though specific changes within patient-provider communication, as laid out in my template. I combined the anecdotes from Costs of Care with my own research to create an accurate document for both educational and practical use. My hope is that both doctors and patients alike can use this text to make more cost effective decisions.
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Sydney Howland is a Costs of Care Intern and Public Policy A.B. Candidate at Duke University