I thought I knew healthcare, then I became a patient

By Steve Kipp
Thursday, December 21, 2017
Steve in the hospital

I sit propped up on a hospital bed in Room 18, in the emergency room at Swedish First Hill in Seattle, the reluctant star in a scene cut straight from the television drama Grey's Anatomy

People rush in and out of my room, ask me questions; someone tells me what the squiggly lines on my EKG mean. I glimpse a police officer walking past my room, an unruly patient down the hall cries out incoherently.

Less than two hours earlier, I suffered a stroke.  The clot shot like a BB into my brain. I lost sight momentarily in my right eye then my right arm and leg tingled and felt disconnected from my body.  I walked like I had drop foot, my ankle weak and watery feeling. 

One minute I am eating a chicken leg. The next I am participating in what must have looked like really bad Kabuki theater to my wife as I am flailing my arms and legs up and down, screaming that nothing is working properly.

Then my brain shut down its circuit breakers, protecting itself from further damage and plunging me into a thickening fog. I could walk. I could talk. I could even put my shoes on. But ask me the month, the year, the make of car I drove or who the President was and I didn't have a clue.

In a matter of minutes, I had officially become a patient, my hospital room booked and waiting for me.

Strokes happen

As the Vice President of Corporate Communications for Premera Blue Cross, I counsel executives on communication issues on a variety of healthcare subjects but I am no doctor.

I knew nothing about strokes, prior to having one. To me, strokes happened to overweight people who smoked too much, didn't exercise and stuffed themselves full of fast food.

I worked out nearly my entire life, beginning in 4th grade when I ran laps around the block after school. I was the captain of my high school cross country team, completed the Boston Marathon and raced bicycles. Heck, I even took Pilates three days a week, completing a class the morning of my stroke. My arteries run clear, my cholesterol is low, my pulse beats in the lazy, slow cadence of an athlete. No way was I a stroke victim.

In other words, I was just like every other patient. I never thought I would become one.

Health plans are like mom and dad

At Premera, our work centers on solving what we dub the four problems of healthcare: people don't get the right care; they get too much care in the form of tests they don't need; the care they do get costs way too much; and, even after all that, the customer experience is terrible.

Premera employs dozens of doctors, nurses and pharmacists. They review claims, work with patients and doctors and set protocols. For example, if you are a doctor who prescribes opioids at rates far greater than your peers, we know that and will do something about it. 

It doesn't always make us friends. In fact, health plans are like mom and dad. Sometimes, we have to tell the kids we aren't going to pay for that brand new bicycle no matter how much they want it.

All of which is to say, as a patient, scared and alone in a hospital room, I didn't give a damn about the four problems of healthcare or how much things cost. Somewhere between the EKG, Cat Scan and MRI, I embraced my role as patient. I wanted the doctors to fix me; and, if that meant ordering more tests, consulting more specialists and booking one more day in the hospital, then so be it. 

Sure, I thought about costs and wondered if I really needed one more MRI. But lost in the throes of my stroke, I was grateful for the team of people clustered at my bedside, trying to make me better. 

Say what you will about modern medicine--it is too costly, too reliant on expensive technologies and too inefficient--the reality is it is pretty awesome when all those resources are marshalled on your behalf. 

Of course, I had no idea if the doctors treating me were good or bad, the tests they prescribed were necessary or if another hospital would have treated me differently. 

I learned later that stroke treatments are pretty standard. Your chances of making a full recovery are more dependent on getting treatment quickly than on the hospital doing the treatment. 

I made it to Swedish Medical Center within 45 minutes after my stroke. I was expected to make a full recovery. The challenge for me became finding the cause.

Over the next two days I floated on a slow-moving river of blood pressure checks and doctor visits punctuated by more tests. I no longer felt like a star. The urgency had passed, now that it was clear I would make a full recovery.

The doctors and physician assistants did their best to explain what was happening and to give me the impression I could control my fate. 

But like most patients, I didn't have a clue if my doctors were making the correct decisions. In fact, I take into consideration more factors when picking a restaurant than I did deciding which hospital would save my life.  I picked Swedish because it was close and I knew the way. I never even considered the level of care I would receive.

This feeling of helplessness isn't uncommon. Picking a hospital, especially during an emergency, can sometimes feel like a leap of faith. 

Finding the best care

There are lots of rating systems like LeapFrog, Healthgrades, Own Your Own Health, Blue Distinction Total Care or the Washington Health Alliance's Community Checkup that offer advice and data on choosing a doctor or a hospital. 

A majority of Premera's contracts with doctors and hospitals contain quality metrics that compensate doctors based not on the number of procedures or tests they administer but on whether the patient gets well.

Some hospitals in our network such as Virginia Mason have been named a Center of Excellence for a specific procedure. In this case, the hospital is considered one of the best in the country for knee and hip replacements.

Premera also offers customers a Find a Doctor Tool, a 24-hour nurse hotline and a virtual care line to locate a doctor in your neighborhood or to ask a health question.

These sites are good at painting healthcare with broad brush strokes, but filling in the details is still elusive. While these tools are all helpful, they still can't make finding the best back surgeon as easy as finding the best sushi chef in town. 

How do you measure quality?

Ironically, just before my stroke, I participated in meetings at Premera led by our Chief Medical Officer, Dr. Phil Colmenares, where we discussed developing quality and cost metrics for hospitals and doctors. The questions Colmenares and his team are trying to answer are complicated.

How do you measure the quality of a doctor visit? How do you compare hospitals that might excel at one procedure but only deliver so-so results in another procedure?

And how do you wrap this up in a package people will actually open? Even the best rating system isn't worth much if it isn't customer-friendly or directs you to doctors who are no longer seeing new patients. 

“Our customers no longer just want access and discounts, they want value.” Colmenares said.  “Part of improving customers' lives by making healthcare work better is addressing a core problem in the system: the variation in healthcare performance, and making that variation visible to our customers.”

As the largest health plan in the Pacific Northwest, Premera sits atop a mountain of healthcare data. We are working to combine this data along with data from reliable third-party sources to give our customers the information they need to find the doctor or hospital that is right for them.

The goal: Launch a simple, easy-to-use tool that allows our customers to compare doctors and hospitals.

A hole in my heart

After two days and multiple tests, the doctors confirmed my problem and diagnosed me with a PFO or patent foramen ovale. I had a hole in my heart that didn't close after birth. I learned later that about 20 percent of us have a PFO. The clot snuck through the hole and traveled to my brain, causing my stroke. Closing the hole can reduce the chances of future strokes, although there are no guarantees.

PFO closures have been considered controversial. The good news is recent studies support their effectiveness in certain circumstances. 

I had to consider if the risk-even if it was a relatively minor procedure-was worth the benefit, knowing I may never have another stroke even if I did nothing.  Many people live their whole lives with a PFO and never suffer a stroke.

In the end, I chose to have my PFO closed rather than the alternative, living the rest of my life taking blood thinners and hoping for the best. 

Six weeks after my stroke, I found myself back at Swedish for a PFO closure. The cardiologist delivered a small device made by Gore-Tex through the femoral artery and plopped it into the hole in my heart. Eventually, my heart will grow over the hole, closing it for good.

The procedure took 40 minutes. I lay awake, glancing at the monitors hung above me and asking helpful questions like how much longer? I went running a week after my procedure. As I write this, nearly two months later, I feel great. 

Steve-Kipp-ProfileWith plenty of time to research, how did I pick the doctor who I would entrust with fixing my broken heart? I consulted with a variety of people from the nurses at the hospital to the doctors I knew who worked at Premera to a family friend who is a retired cardiologist. 

Without hard data, the decision felt arbitrary. Relying on word of mouth and comments from strangers is one thing when deciding where to have dinner it is another thing when picking a doctor. 

Not to mention the fact that I consider myself an insider. I work in health care and knew the right people to ask for help.  What if I didn't work in health care? What if I didn't know doctors? What then? 

There has to be a better way, and I am glad Premera is working on it.

Steve Kipp is the Vice President of Corporate Communications at Premera. You can follow him on Twitter at @stevekipp

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