Q and A with a doctor:

July 5, 2016

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Empowered consumers ensures lower costs, high quality care

After graduating from medical school, Dr. Richard Popiel served in the National Health Corps. He was assigned to Cook County Hospital in Chicago where he treated a largely underserved population. While he found it immensely gratifying to care for individual patients, Popiel realized that he could also make a profound difference for millions at a time.

He earned a master’s degree in business administration and transitioned from a 20-year front-line physician to health care administrator and policymaker. Today Popiel serves as chief medical officer for Cambia Health Solutions, where he focuses on delivering high quality and affordable health care to more than 2 million members.

Question: Why is managing health care costs more important today than ever?

Answer:  Today we (U.S.) spend over $3 trillion a year on health care. That roughly 18 percent of our GDP (Gross Domestic Product) and about a third of that has no value. It’s related to waste, fraud and abuse, inefficiency, duplication. That’s about 6 percent of the GDP, so 6 percent of our GDP is related to health care that has no value to the individuals that health care service is delivered to.

Question: What’s driving some of the increase in health care costs?

Answer: We have more people in our country and they’re living longer lives and developing chronic conditions. We have more tools and capabilities and treatments to help them…so the aging population is one factor.

Technology is another. Some of the sophisticated health care we’re seeing is mind-boggling and we love it. But it comes at a cost.

We also have an obesity epidemic in this country. We’re addicted to carbs and consuming sugars at a much higher rate than we should and it’s leading to obesity and that’s leading to a variety of conditions.

Question: Why should individual consumers care about rising costs?

Answer: It matters because your premiums, the amount you pay in out-of-pocket costs you experience are tied to this…If people have to spend money on health care, that means they have less to spend on other things…So making health care more affordable, squeezing out costs that don’t add more value or not agreeing to pay for things at extraordinary rates will make people enjoy better lives.

Question: Is there anything we as consumers can do about health care costs?

Answer: Not until fairly recently. If you think of any other industry, through transparent knowledge, you understand the quality and the price of a product or service you’re buying. In health care, it’s been a mystery. It’s been a black box.

One of the great developments that is occurring today is much more transparency about the quality of treatment providers are delivering and the cost they’re delivering it for. So now individuals can, through a variety of mechanisms, make comparisons and choose to go to high-quality, cost-efficient providers.

Question: What to you are the most exciting cost-management tools available to consumers and in health care today?

Answer: There are some really amazing capabilities out there today. If you have a condition like diabetes, or you have a condition like heart failure, you can have Bluetooth-enabled tools that measure your blood sugar or your weight and will automatically send that information to your physician.

Or you can engage in what’s called “telehealth.” Instead of going to an office, you can have a face-to-face virtual conversation with your physician. In fact, there are now diagnostic capabilities that enable diagnostic cares and allow certain diagnostic abilities to take place in your home – like taking your temperature, or looking inside your mouth when you have a cold or sore throat or looking in your child’s ear if they have ear pain and an ear infection.

All of these technologies provide opportunities to render care differently and, in many cases, the care that’s rendered is less costly. It’s the same quality of care. It gets the same outcomes. But you’re not spending as much money.

Question: Aside from technology and greater transparency, what will help people become better health care consumers and, in turn, lower costs?

Answer: You have to train people to act like consumers in an industry where everything –all decisions, choices are made by the health care professionals. That’s not all bad because, as we know, it takes a lot of training to deliver care to individuals. But those accessing care are also consumers. We should be able to engage in conversations informed by information about cost and quality so we can get the best care in the right place at the right time.

When we’re done with this we’ll have a more effective, more affordable and more satisfying health care system in this country.