I recently had surgery (my first ever) and experienced US Healthcare delivery first hand in a hospital setting. If I had to put a word cloud about my experience it will be filled with words like – Exceptional, Marvelous and world-class. Unfortunately if you pick up any recent media on the US healthcare system those are not exactly the words you would be left with. I stepped back and looked at my experience to see where the problem lies…
From the moment I checked in at registration to the time I got out of the hospital, my surgeon, physician assistant, the pre op team including the anesthesiologists, nurses and a host of characters that I haven’t met in the surgery room at the Inova Fairoaks hospital acted as a team with a clear mission – ‘my well being’. It was very evident in how they interacted with me every step of the way – the professionalism, the candor, and empathy were on display at their best. In short, they created an amazing experience for me at the most vulnerable time in my life. In short, the quality of care delivered is simply superb.
There is another key player in the eco system, the middleman between my provider and me – the payor. I am on a High Deductible Health Plan (HDHP) with United Healthcare and I continue to be a fan of HDHP’s. To add some context, the problem I was getting treated for was going on for over 2 months and I have gone through thrice a week Physical therapy sessions, a cortisone shot treatment, Electromyograph (EMG) test and multiple specialist consultations. The surgery was scheduled a week in advance and with all the claims activity this is not a surprise to the company that is processing claims nor it was the first resort.
The experience here was contrary to care delivery. When I was waiting to get into pre-op after my registration at the hospital, I was informed that a director at United healthcare is still reviewing my claim and the surgery is not approved. To proceed with the Surgery as planned, I need to sign for full accountability of costs not yet known. Not exactly the customer experience you want to provide when someone is about to get a 2-inch incision in front of his or her throat. The payor lost an opportunity to build a trusted relationship with me – with all the medical and pharmacy claims data available to the payor, wouldn’t I have felt like an angel watching over me if I they; Checked with me when the problem started? A follow up when I am attending thrice a week PT sessions? A nurse checking in when EMG test results came out or when the cortisone shot administered? An amazing consumer experience every step of the way could have been created. Instead, I am left with one interaction, which is extremely negative. Thankfully, there are solutions available to drive consumer engagement and inspire loyalty.
The problem is not with the exceptional care we receive it’s the way we pay for it. In the era of healthcare consumerism, I have hope. I am still waiting for the call – hope its just not about approval or denial of the claim.
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