From Managed Care to ObamaCare to “Smartphone Medicine”

Healthcare Hashtags & Social Media Analytics

Healthcare Hashtags & Social Media Analytics

After suffering through Managed Care and now living through remedial intended ObamaCare, the United States has entered the first truly exciting times of global healthcare.  The innovative spirit prevalent in the United States is due to the convergence of eHealth and mobile health, the emergence of healthcare entrepreneurs combined with the proliferation of global health care social media platforms such that technology has democratized the practice of medicine for healthcare professionals, patients, institutions, pharmaceutical companies and health insurers.  Given the role of the Smartphone in this transformation, I think it is apropos to refer to this pioneering period of healthcare as “Smartphone Medicine.”    

Managed Care

Pardon my candor but Managed Care sucked.  It sucked for patients, doctors and hospitals.  Other than that, it worked just fine.  More seriously, if you did not obtain the appropriate “referral” prior to seeing a specialist (even in an emergency), the cost of seeing that specialist was either not covered by the health insurer or it was reimbursed at a significant lower amount than the actual charges you had to pay.  There were also pre-defined “in-network” physicians and a formulary of drugs, and with few exceptions, your medical universe was defined by various managed care contracts, the negotiation of each you did not participate in.   If you had surgery, it was common for your managed care insurer to have “in-network” contracts with some, but not all, of the anesthesiologists working at that hospital.  However, you had no control over which anesthesiologist treated you. Therefore, the actual cost of your surgery wasn’t determined until the medical bills started piling up in your mailbox. If you tried to politely request a specific anesthesiologist within your managed care health insurance network to somewhat control the cost of your surgery, you were taken as seriously as Kim Kardashian showcasing her acting chops on “The Kardashians” as her audition tape for a new Martin Scorsese Oscar buzz-worthy movie.

If you had a long-standing relationship with your primary care provider, there was no guarantee you’d be able to continue that relationship.  It all depended upon whether or not he or she “participated” in your insurance plan and was considered an “in-network” physician.  Some devious physician staffers would address such telephone queries with the vague declaration that their physician “participated” in your plan but they passively omitted the detail that he or she participated in your plan as an “out-of-network” physician!

Then there were similar passive “omission deceptions” on your health insurer’s website such that you’d be confident the post-operative occupational therapist you chose from your insurer’s website was “in-network” only to find out later her contract had expired and your insurer had not yet updated its website when you made your selection.  Despite this material error by your health insurer, you were nevertheless liable for the total cost of the occupational therapy, as if you purposely chosen someone “out-of-network” due to their unique high level of expertise, and were willing to pay extra for that added benefit.

The physician “con job” referred to above stung me only once when I had a very expensive Crohn’s Disease surgery based on that deceptive representation.  It wasn’t until I formally alleged “Criminal Fraud” in one of the MANY appeals I had to pursue seeking 100% reimbursement of the cost of the surgery (i.e., as if the doctor was, in fact, “in-network” with my health insurer) when I finally prevailed and exposed this misleading representation.  But many smart patients were directly or indirectly taken advantage of by money-hungry or irresponsible doctor offices and health insurers who banked on the arduous hassles of the appeals process being too steep a barrier for the patient to initiate, and keep pursuing, a meaningful appeal seeking reimbursement based on fraudulent representations.

There were also financial limits on how sick you could be, as if knowing these actuarial generated projected financials would impact your decision to, for example, undergo chemotherapy, when it was recommended by your doctors as the only way to save your life, and by doing so you would surpass your lifetime allocation of financial health benefits and be liable for the balance.  Finally, if you had a chronic illness prior to obtaining your managed care health insurance plan, it was probable that any charges accrued in treating that “pre-existing condition” would be excluded from your health insurance coverage.  Since the increasing costs of managing that pre-existing condition was likely the primary reason you sought health insurance, the fine print of many managed care health insurance plans made as much sense as selling Sexual Harassment Insurance to radio personality Howard Stern’s female sidekick, Robin Quivers.

ObamaCare

ObamaCare, a/k/a, The Affordable Care Act (the “Act”), identified the aforementioned Managed Care issues and sought to improve upon them so that more people could obtain more reasonable health insurance coverage at a more affordable price.  ObamaCare also sought to correct the gross inefficiencies present in American healthcare as a result of a Managed Care system which was largely unaccountable to any laws or governmental agency.  The Act utilizes market forces to stabilize the cost of health insurance policies and mandates that all health insurance plans include reasonable wellness provisions.  Finally, as a self-policing measure, ObamaCare created “Accountable Care Organizations” (“ACOs”) to ensure that larger medical practices and institutions routinely examined their costs and expenditures in a practical attempt to eventually reduce the aforementioned gross inefficiencies prevalent throughout the American healthcare system.

The Act seems to be making a substantial improvement in restructuring and regulating what was one of America’s fastest growing but difficult industries in terms of tracking and appeasing its diverse stakeholders.  However, there are political influences which prevent ObamaCare from being universally implemented and that likely affects its projected initial performance.  This largely remedial Initiative was also hampered by a slow and glitch-filled roll-out which has affected its acceptance by Americans as “the law of the land” and, instead, in some parts of the United States it is viewed by many as a law in effect because of the current political party running the country.  That said, even the most skeptical of patients and doctors would have to agree that ObamaCare is better than Managed Care and it has at least identified American Healthcare as a viable and potentially profitable industry.

Practical changes, as opposed to political “considerations,” must be made to the Act, however, to refine it, just like with any other remedial official government measure.  But at least ObamaCare is a start in the right direction and it also has the good fortune of being implemented at the same time technology and electronic medical records have improved convenience and enhanced quality of healthcare experiences and opportunities.  These experiences and opportunities have attracted healthcare and technology entrepreneurs who have combined their efforts to, in essence, create “American Healthcare 2.0” which includes innovative electronic (“eHealth”) and mobile health (“mHealth”) products and services.

Smartphone Medicine

The aforementioned eHealth and mHealth opportunities seem to be driven by the technology enhanced Smartphone because it has become the tool which has democratized the practice of medicine to the point where the doctor-patient relationship is now one of collaboration and mutual respect.  The proliferation of different global health care social media platforms has created empowered patients who conceivable use their Smartphones more to engage in healthcare Tweetchats than in telephone conversations.  Furthermore, there has been an explosion in the number of useful and generally accepted “Medical Apps” available on the different Smartphone operating systems like the Hospital Patient Picture-Sharing Medical “App,” “HospitalPIX,” which was developed by Dr. Jacques Durand (pictured below) [you can click thru the picture and watch my interview with Dr. Durand from this year’s “Doctors 2.0 & You” in Paris, France].

HospitalPIX Medical Smartphone App

Additionally, bold and innovative initiatives like “The Healthcare Hashtag Project,” by the company Symplur  [you can click thru the picture above, before the first paragraph and watch my interview with Thomas Lee of Symplur from this year’s “Doctors 2.0 & You” in Paris, France], have transformed the Twitter experience when it is used for healthcare purposes so that it’s more accessible and more time efficient for healthcare providers and for the healthcare community as a whole.  Since people tend to use their Smartphone to tweet and use Twitter, this is another example of Smartphone Medicine.

Smartphone Medicine enhances the Lifestyle of the Chronically Ill

For a chronic patient like me with the autoimmune illness Crohn’s Disease, using my Smartphone in conjunction with hashtags creates a global support team to whom I can turn with questions about new treatments for Inflammatory Bowel Disease (“IBD”), side effects of new drugs, recommended doctors for a specific procedure, a list of hospitals with IBD Centers and recommended IBD specialists in an area of the world where I might be vacationing, etc.  Moreover, I can load my Smartphone with all of my electronic medical records along with years of blood test results, Operative Reports from my 25+ surgeries and a list of the drugs I am currently taking.  I can also always use my Smartphone to contact my doctors whose information is always only a few strokes away.

The Power of the Hashtag in Smartphone Medicine

In terms of the use of hashtags on Twitter, according to Symplur: “By lowering the learning curve of Twitter with a database of relevant [healthcare] hashtags to follow, we hope to help new and existing users alike to find the [medical] conversations that are of interest and importance.”  Accordingly, whether directly or indirectly as a result of Symplur’s extraordinary success simplifying Smartphone Medicine through the use of hashtags, the hashtag is now routinely used in powerful global social media platforms such as Facebook, Google+, Twitter and Instagram.

Conclusion:

Because of Smartphone Medicine, the Prognosis for Global Healthcare has never been more Promising

The bottom line is that the convenience of Smartphone Medicine is liberating for patients who suffer from chronic, serious or autoimmune conditions which would otherwise require substantial record-keeping in different locations. Thanks to the efforts of companies like Symplur, the hashtag simultaneously encourages the use of global connections and conversations while also arranging them so they are directly on-point and easy to access.  Smartphone Medicine appeals to healthcare professionals because it is innovative, efficient and makes for better educated professionals who then can service their patients to the best of their abilities.  It has certainly been a long, strange trip from Managed Care to ObamaCare to Smartphone Medicine, but isn’t it always about the journey and not the destination?  In that regard, we don’t know what will come next but at least we do know that the prognosis for global healthcare has never been more promising.

Smartphone Medicine

Smartphone Medicine

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