As clinicians, we're constantly striving to improve and nurture a "person-centered" approach to medical care and treatment. That said, when we look beyond the scope of direct patient care, all the way up to the delivery system level, there is still an enormous gap that often leaves patients alone to figure out, and sometimes even fight, the healthcare system we're all a part of.

This ever-growing chasm can lead to a distrusting, or even adversarial, relationship between the patient and everyone they encounter on their journey, including the physician, hospital, and insurer. And, particularly in today's climate of cynicism and distrust, the remedial option of last resort often ends up being grievances and lawsuits.

That's the bad news.

The good news is, the solutions we (and our patients) need can be realized through design. 


Communication Breakdown


In today's health care system, caregivers often feel and act like contracted technicians, especially with non-primary care. Often, the individual didn't know the physician before the need for the service, and the relationship quickly jumps into a serious, often emotional, medical process that sometimes feels transactional.

There's obviously a medical need for their medical expertise or skills, and they swoop in based on a referral request. These physicians provide their recommendation in the form of treatment or perform their recommended procedure. There may be some follow-up care that extends the relationship. But this is the extent of the interpersonal interaction and relationship. Then the financial transactions kick in completely in an impersonal manner often behind-the-scenes. 

The breakdown is right before our eyes, but we can't see the forest from the trees because of how our healthcare system is structured. 


"Dr. Jekyll, Meet Mr. Hyde."

A recent TIME magazine article highlights a few experiences with this process.


While the fear and uncertainty and confusion related to medical care consumes the patient and family, the system adds doubt, confusion, and uncertainty regarding the other aspects of receiving medical care in our current system, which is payment and finance.

By itself, this business model isn't different than what happens when we call and hire an electrician contractor, for example, except for the fact that the electrician himself quotes us the cost before we agree to the service. The patient gets surprised in the form of charges and the caregivers become collection agents. In the process of medical care, the physician or hospital stops being your advocate outside of the direct medical care.

For extended care, the doctors and hospital caregivers provided dedicated care while the financial office accosts the patient like any typical collection agency. How does this create a positive consumer experience?

This Jekyll-Hyde experience for patients creates mixed feelings and often resentment.

On one hand, the patient is appreciative of the specialized service received from medical care providers, but now resents the lack of information, transparency, or even the sense of being misled and deceived regarding the cost of care and the process of payment collection.


The Payer Handoff: Plenty of Blame to Go Around


The patient feeling on the financial side is often polar opposite to the appreciative sentiments regarding medical care. The net result is these opposite feelings cancel each other out. When the negative feelings from the financial side exceed the perceived value of the medical care, then the net perception is entirely at the negative end. In either scenario, the consumer experience and satisfaction leans towards negative regardless of how good the medical care.

For many individuals, negative experiences with insurance companieseither their own or the "horror stories" of otherscan lead to tension and a feeling of pressure to choose between worrying about the treatment of the illness versus personal finance.

While caregivers charge forward providing care, murky financial considerations such as coverage eligibility or in-network vs. out-of-network status are often looming question marks left solely to the patient to figure out and assume final responsibility for.  

Physicians and hospitals can completely mitigate this by being a little more proactive and whole-person focused during the process of care and on the financial side. If caregivers want to ensure a persistent positive perception of their care experience, they must also minimize the negative influence of the related business transaction and experience.

Why should caregivers care about consumer perception? It's because we have entered an era of value-based healthcare and consumerism.

As transparency becomes the norm, this information will start to be available before patients are faced with making a final choice. Choices and preferences will be declared up-front and bad experiences will be known by all in this time of social media and experience sharing. At the end of the day, patients will view specialists as high-cost contractors. Those who provide excellent experiences, outcomes, and value will prosper. Those who do not, will not. 

Transparency leads to trust. And trust is key to positive patient experiences. 

Clinicians' evolution in thinking regarding "whole-person" health and well-being must extend to the socioeconomic realities of the communities we serve. Physicians and hospitals assume a fiduciary responsibility for patients under their care, at least clinically. That responsibility should extend to the whole care process within our current medical care system, which includes the financial transaction related to care.

Put the interest of the patient first and they will feel like they have a medical advocate on their side that is looking out for their whole person well-being.


Dr. Ian Chuang, MD, Institute Fellow, Senior Vice President, Healthcare Informatics & Chief Medical Officer, Netsmart