Trading Places

By Charlie Miraglia

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In the 1983 comedy Trading Places, starring Dan Akroyd and Eddie Murphy, comedy is used to poke fun at the fact that, as a society we sometimes (read: far too often) value money more than we do people. In the world of healthcare, more specifically, there are sadly too many examples of where this tendency is all too obvious and therefore difficult to deny. Interestingly, and perhaps ironically, in these stormy days of healthcare reform, there may be a silver lining in all these changes, especially from the perspective of the patient. It appears that we, the patients, may once again be number one in the healthcare hierarchy, with all providers focusing (finally) on how best to provide services to us as individuals.


To best understand where we’re heading, we need to take a quick look back at where we’ve been. First, let’s look at the healthcare provider side of the equation. For many years now the primary objective of any doctor, hospital, health system, etc. has been the quantity or volume (fill in any metric you’d like, from lab tests to MRIs here) per patient, per day, or per month – so on and so forth. To complicate the situation further, and in keeping with the movie theme we’ve discussed, the cost of services is rarely if ever discussed with or understood by the patient and can vary from provider to provider by orders of magnitude. How can a CAT scan cost $8000 at a hospital and $800 at a diagnostic center down the street? There is no rational answer to that question, but Randolph and Mortimer Duke would applaud the additional dollars collected by the hospital.

As patients and family members of patients, we’ve been in the dark about the cost of healthcare for years, never knowing what the cost is going to be until the bill comes in the mail. Even then, we may still not understand what the insurance company has paid or how much we still owe. While the out of pocket costs of healthcare are certainly going up for all of us, including our employers, there seems to be a real shift towards transparency of charges, which is novel but long overdue. Enter the age of consumerism in healthcare.

Let’s go back for a moment to those highly variable and unpredictable charges for tests, scans, and hospital stays (oh my). A new age is emerging there as well: a change from volume to value, from quantity to quality. This is obviously a welcomed change for those of us that are or will be patients (read: all of us). You might ask why it’s taken this long to get to this point, or you might just throw up your arms and exclaim that it’s about time. Either way, the next question is obvious – how will healthcare lower costs, increase value, and win the confidence (and dollars) of the patients? The key to all of this in my humble opinion can be described in one word: engagement.

I mentioned above that we are in the age of consumerism in healthcare. Well, we are also in the information age, a time when technology has given us the ability to create, store and move large amounts of data quickly and seamlessly. It’s the access to this data that will help hospitals continuously improve their quality while reducing their costs. In addition, it’s this same technology that will help them engage patients in ways that will individualize and personalize the healthcare experience, winning them as consumers in a highly competitive market.

Gone are the days when the patient has to wander aimlessly from doctor’s office to clinic to hospital, filling out the same information over and over again, and putting their lives in the hands of institutions that seemingly don’t even know who they are. As I said above, we’re in a patient-centric healthcare world now, where patient satisfaction is as important as any diagnostic result. As the costs go down, the quality goes up, and patients become happy and satisfied consumers only one question remains — what’s next for healthcare?

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