By John Espinola, M.D.
Executive Vice President, Health Care Services
It used to be that you had a relationship with your health provider. As a physician, I promise you that most doctors want to be that sort of partner in your health. But, sadly, much of healthcare is now transactional. Providers face time and economic pressures, just like the rest of us.
This leads to poor experiences, frustrations, miscommunication, and misunderstandings. It's something my wife, who is also a physician, and I actually experienced ourselves.
We have two children, both of whom are deaf and hard of hearing. A couple of years ago after a doctor's visit, the children ended up getting a CAT scan. It was completely unnecessary. And, because it was done on young brains, potentially dangerous.
It wasn't explained well to my wife. It turns out it was for a research study. We would have completely rejected it had it been explained properly.
What hope is there if two physicians cannot navigate a provider relationship effectively? Anyone without clinical expertise and experience must be completely befuddled on even what questions to ask.
Another experience that often frustrates patients is at the pharmacy counter. Prescriptions that need pre-approval sometimes have a 2- or 3-day delay before they're authorized. But often the patient doesn't know that. They go to the pharmacy, where they're told to go back home and wait.
That's frustrating, of course. And it can have health consequences if patients don't return to the pharmacy. As former Surgeon General C. Everett Koop said, “Drugs don't work in patients who don't take them.”
To make this better, we've initiated a process called auto-authorization for drugs that require review. We started it in 2016. In more than 40 percent of the cases so far, that prescription is already authorized by the time the patient shows up at the pharmacy.
What we want for patients
At Premera, part of our job is to make sure our customers don't need to be a clinical expert or a physician. They also don't need to understand the ins-and-outs of their policies. We want them to focus on getting and staying healthy.
And if we do our job right, we'll also make healthcare a much better and more effective experience for everyone. Far too many patients are confused by treatment recommendations and frustrated by the hoops they have to jump through to get what their doctor recommends. In future blogs, we'll talk about additional efforts we're taking up to make getting healthcare -- and staying healthy -- an easier and more seamless experience.
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John Espinola, MD, MPH is Premera's Executive Vice President of Healthcare Services. He is also board certified in geriatrics and internal medicine. Read more about Dr. Espinola on our executive bios page.