Non-compliant...sounds like something you don't want your insurance company labeling you as, right? I find this term so interesting because today's consumers of healthcare no longer go to see their doctor for absolute directives about what they should do to be healthy. There is no longer a desire, especially among millennials, to see a paternalistic doctor who authoritatively enters the room to give commands to the patient which the patient then obeys without question. Of course it makes sense that patients don't want that. After all, it is the patient's body, health, finances and lifestyle that these directives from the doctor affect, so why should they be blindly followed without a team-like approach to the patient's health. But yet, non-compliant is a term used with increasing frequency to describe patients who are not obliging with their doctors' directives. Among programs like the Patient Centered Medical Home, doctors, healthcare providers and the healthcare system recognize that patients are more engaged with their own health when we actually involve them with their own care decisions. This means practically within an office visit, having a conversation with the patient about what their diagnosis is, what this means for their lifestyle and treatment options for how this can be managed. It means that patients then are given guidance and education from an actual qualified medical professional about their options for treatment and then the patient decides what they want to do. I've had these conversations with many patients for example about their high cholesterol or diabetes. Some patients, when presented with the health risks they have because of their diagnosis, decide to radically change their lifestyle and diet, loose weight and get their disease states under control on their own. Some patients decide they are not going to do that and would rather take a medication. Either way, the patient has chosen and thus they are on board with the plan... and compliant.
All of that is well and good except that our current healthcare system (one in which patients pay a third party for insurance coverage [Blue Cross, Medicare, etc] and expect this third party payor to foot the bill for the entirety of their medical expenses), is not well suited to allow for extensive conversations with patients to enable their own decision making. Further, we are now shifting to the value-based-payment model which means that doctors will be paid based on "how well they are taking care of patients." It is fascinating that non health-care providers believe they can judge how well I am taking care of patients and then will use that judgement to decide how much to pay me for my services. Value-based-payment models of healthcare are intended to improve the quality of care that patients are given, reduce costs and improve patient satisfaction. But, in order for a third party (someone other than the doctor and the patient) to make a judgement call about how well I am taking care of my patient, it has to be some objective measurement. And if there is one thing I know about medicine, it is that there is nothing in medicine that is 100% black and white and purely objective.
Stay tuned for next week's blog...a real life example of how these changes are affecting individual patients.
Brooke Uptagrafft, MD
Dr. Brooke is a family medicine doctor.