HealthSparq provides pricing and shopping tools for healthcare. I spoke as an empowered consumer at their annual customer summit in Las Vegas. "HealthSparq’s disruptive technology solutions are rewiring the way people interact with the health care system. By turning passive patients into empowered shoppers, we can improve health care costs and quality—one decision at a time."

1. JAMIA, 1997
“e-Patient Dave” deBronkart
Twitter: @ePatientDave
facebook.com / ePatientDave
LinkedIn.com / in / ePatientDave
dave@epatientdave.com Skype: ePatientDave
How Educated Consumers
Can Change Healthcare

2. “Patient” is not a
third person word

3. How I came to be here
• High tech marketing
• Data geek; tech trends; automation
• 2007: Cancer discover & recovery
• 2008: E-Patient blogger
• 2009: Participatory
Medicine, Public Speaker
• 2010: full time
• 2011: international

5. “e-Patient Dave” deBronkart
Twitter: @ePatientDave
facebook.com/ePatientDave
LinkedIn.com/in/ePatientDave
dave@epatientdave.com
e-Patient Boot Camp
Athens 2013
Photo of the Acropolis here

6. “e-Patient Dave” deBronkart
Twitter: @ePatientDave
Cows behind a veil of
secrecy
Reinhardt didn’t
realize!
facebook.com / ePatientDave
LinkedIn.com / in / ePatientDave
dave@epatientdave.com

7. “I want to note especially
the importance of the resource
that is most often under-
utilized in our information systems – our
patients”
Charles Safran MD, Beth Israel Deaconess
quoting his colleague,Warner Slack MD
Testimony to the HouseWays & Means
subcommittee on health, 2004

8. e-Patients.net founder
Tom Ferguson MD
1944-2006
Equipped
Engaged
Empowered
Enabled”
Doc Tom said,
“e-Patients are

10. Pt of future

12. Me? An indicator
of the future??
• Who’s getting online:
– 1989: Me (CompuServe sysop)
– 2009: 83% of US adults (Pew)
• Who’s romancing online:
– 1999: I met my wife (Match.com)
– 2009: One in eight weddings
in the U.S. met online
– 2011: One in five couples
met online

13. The Engaged Patient
12 items in my pre-appointment “agenda” email

14. The Incidental Finding
Routine shoulder x-ray, Jan. 2, 2007
“Your
shoulder
will
be
fine
…
but
there’s
something
in
your
lung”

15. Multiple tumors in both lungs
Where’s This From??

16. E-Patient Activity 1:
Researching my condition

17. Classic
Stage IV,
Grade 4
Renal Cell
Carcinoma
Illustration on
the drug company’s
web site
Median Survival:
24 weeks

18. Facing the Reaper

19. My mother

20. My daughter

21. After the shock
you’re left with the question:
What are my options?
What can I do?

22. Get engaged.
Get it in gear.
Do everything you can.

23. E-Patient Activity 2:
“My doctor prescribed ACOR”
(Community of my patient peers)

24. ACOR members told me:
• This is an uncommon disease –
get to a hospital that does a lot of cases
• There’s no cure, but HDIL-2 sometimes works.
– When it does, about half the time it’s permanent
– The side effects are severe.
• Don’t let them give you anything else first
• Here are four doctors in your area who do it
– And one of them was at my hospital

25. E-Patient Activity 3:
Reading (and sharing)
my hospital data online

26. Surgery & Interleukin worked.
Target Lesion 1 – Left Upper Lobe
Baseline: 39x43 mm 50 weeks: 20x12 mm

28. Question:

29. How can it be
that the most useful
and relevant and
up-to-the-minute information
can exist outside of
traditional channels?

30. “If I read two journal articles every night,
at the end of a year I’d be 400 years behind.”
It’s not humanly possible to keep up.
Dr. Lindberg: 400 years

31. The lethal lag time:
2-5 years
During this time,
people who might have benefitted can die.
Patients have all the time in the world
to look for such things.
The time it takes after successful research is completed
before publication is completed and the article’s been read.

32. Because of the Web,
Patients Can Connect to Information
and Each Other (and other Providers)

33. “Data Liberación!”
Todd Park
Innovator
Entrepreneur
HHS Chief Technical Officer
US Chief Technical Officer

34. “Information liquidity”
transforms
what’s possible

35. Not liquid Liquid
• Moving it takes effort
• Slow and predictable
• Arrival on unexplained “tracks”
is suspicious
• Frictionless – controlling
the flow takes effort
• Fast and unpredictable
• “Tracks” are everywhere

37. Compare with
- “To Err is Human” (98,000 deaths/yr Nov 1999)
Death by Googling:
Not.
(Dr. Gunther Eysenbach, Europe: 0 deaths found in a three year search)

38. “It may be
more dangerous
not to google
your condition.”

39. “These conclusions
are no more anti-doctor
or anti-medicine
than Copernicus and Galileo
..were anti-astronomer.”
Patients can simply contribute more
today than in the past.

40. Obstacle to adoption:
“But patients
don’t understand
this stuff.”

41. If the data’s unclear
let’s MAKE it clear
Like other industries do.

42. Thomas Goetz, Wired

43. Thomas Goetz, Wired
“It’s time to redesign medical data”

44. Same data –
better software.
Information: clearer.
Consumer:
informed, enabled.

46. Things look different
when you get the center right
Source: Wikipedia, Copernican Revolution

48. Everyone’s saying
“Patient engagement is the
blockbuster drug of the
century”

50. Not so fast.
Let’s look deeper.

51. Drugs have two components:
the Active Ingredient
that produces the result,
and the Vehicle,
which carries the active ingredient
to the point where it can act
to produce value.

52. Patient engagement
per se
is just the vehicle.
It enables potential value
to reach the point of need.

53. But what’s the active
ingredient??

54. What are the concrete, specific, real, tangible
ways
that patient engagement
genuinely alters value
in clinical and business reality?

55. People perform better
when they’re
informed better.

56. It’s perverse
to keep people
in the dark
and call them ignorant
Corollary:

57. What happens
when a consumer
tries to be responsible
about costs?

58. N.H. insurance shopping, 2011
Premium
Deduc+ble
Co-­‐pay
a4er
deduc+ble
Max
OOP
(deduc+ble
+
co-­‐pay)
Stop-­‐loss
max
(in-­‐network
+
out)
Op#on
A
$894
Op#on
B
$705
Op#on
C
$581
Op#on
D
$495
Op#on
H
$624

59. The choices they offered
Premium
Deduc+ble
Co-­‐pay
a4er
deduc+ble
Max
OOP
(deduc+ble
+
co-­‐pay)
Stop-­‐loss
max
(in-­‐network
+
out)
Op#on
A
$894
$1,000
Op#on
B
$705
$2,500
Op#on
C
$581
$5,000
Op#on
D
$495
$10,000
Op#on
H
$624
$5,950

60. The choices they offered
Premium
Deduc+ble
Co-­‐pay
a4er
deduc+ble
Max
OOP
(deduc+ble
+
co-­‐pay)
Stop-­‐loss
max
(in-­‐network
+
out)
Op#on
A
$894
$1,000
20%
Op#on
B
$705
$2,500
20%
Op#on
C
$581
$5,000
20%
Op#on
D
$495
$10,000
0%
Op#on
H
$624
$5,950
0%

61. The choices they offered
Premium
Deduc+ble
Co-­‐pay
a4er
deduc+ble
Max
OOP
(deduc+ble
+
co-­‐pay)
Stop-­‐loss
max
(in-­‐network
+
out)
Op#on
A
$894
$1,000
20%
$3,500
$12,500
Op#on
B
$705
$2,500
20%
$5,000
$12,500
Op#on
C
$581
$5,000
20%
$7,500
$12,500
Op#on
D
$495
$10,000
0%
$10,000
n/a
Op#on
H
$624
$5,950
0%
$5,950
$12,500

62. I know – run some scenarios!

63. =IF(maxoop<J17+J18,maxoop,J17+J18)

64. I know – graph it!

65. My favorite
complaint:

66. “Patients are the only
ones who don’t have
any skin in the game”
- Practice manager, quoted in
Health Leaders, Fall 2011

67. 2011: EOB for a scan

68. Winter: Shingles vaccines

69. Speaking of
skin in the game…

71. Doing what empowered buyers do
dave.pt/skincancerRFP

73. Obstacle to adoption:
“My patients
aren’t asking
for this.”

76. And finally:
recognition
from the establishment

77. Patient-Clinician Partnerships
Engaged, empowered patients—
A learning health care system is
anchored on patient needs and perspectives
and promotes the inclusion of patients,
families, and other caregivers as vital
members of the continuously learning care
team.
Institute of Medicine – Sept 2012
Major New Report:“Best Care at Lower Cost”

78. October 2007
2.8 e-PatientYears in Pictures
December 2006 May 2009

81. Thank you,
medicine.

82. JAMIA, 1997
“e-Patient Dave” deBronkart
Twitter: @ePatientDave
facebook.com / ePatientDave
LinkedIn.com / in / ePatientDave
dave@epatientdave.com Skype: ePatientDave
How Educated Consumers
Can Change Healthcare