A Prescription for Fear, which appeared in the New York Times Magazine on February 6, 2011, and also online, points out the bias and pseudoinformation that result when consumer health-content websites such as WebMD allow health technology manufacturers to pay for content that may subtly promote their products. It’s not uncommon for bias and inaccuracies to infiltrate consumer health information and influence patients’ opinions about the healthcare they might receive, especially when companies create the perception of offering consumers “the latest and greatest” health technology. Unfortunately, consumers often can’t distinguish between hype and high-quality evidence. Consequently, they may wrongly seek out treatments or medications that have limited value or are unsafe—and demand that payers cover the costs.
With the array of new health technologies clamoring for attention from consumers and providers, the impact on healthcare payers can be significant as the costs associated with making wrong decisions continue to escalate. New and emerging technologies, even those approved for marketing, often have a limited evidence base with regard to their relative effectiveness and impact on clinical outcomes. Some are no more effective than competing technologies already in widespread clinical use; many are more expensive than existing options. Likewise, since serious and life-threatening safety issues often don’t emerge until after a new technology has been used by large numbers of patients over a long period of time, early adoption of such technologies could put patients at risk.
The Internet has made it easy for anyone with access to a computer to gather information about symptoms, diseases, and treatments. Social media networks such as Twitter and Facebook enable rapid dissemination of health technology information—accurate or otherwise—with little filtering or commentary from experts. When the evidence base for a certain health technology is inaccessible and/or uninterruptable to consumers, inaccuracies spread rapidly.
Certainly many reputable sites exist where consumers can find accurate health information National Institutes of Health; Centers for Disease Control and Prevention; and the Mayo Clinic, to name a few. Unfortunately, these sites compete online with others that provide less accurate and potentially biased information. Consumers need to be aware that certain health-related sites may provide health information that is incomplete, sometimes inaccurate, and may be subtly slanted toward a particular product or treatment. Some websites are developed specifically for individuals looking for evidence supporting a particular position; thus, the site doesn’t evaluate the entire body of evidence and doesn’t inform consumers about the quality of the evidence.
The evidence gaps that exist in some online consumer health information present an opportunity for healthcare payers. Evidence becomes the foundation from which payers can cut through the hype and direct their members toward cost-effective health technologies that improve net health outcomes. To become a resource for evidence-based information for your members, consider the ACE approach: Acknowledge, Compare, Educate.
Acknowledge. Acknowledge the emergence of new health technologies that have the potential to improve clinical outcomes, but also acknowledge the limited evidence that may be preventing the adoption of the technology at the present time. Let members know you are monitoring clinical trends and health technologies on the horizon to determine their clinical applications, benefits, and risks.
Compare. Whenever possible, gather evidence that compares new health technologies with competing health technologies (within a technology class or between technology classes) to determine which technologies are most effective, safe, and for which patient populations. Such comparative effectiveness reviews can prevent utilization of ineffective, inefficient, or unsafe technologies.
Educate. Although members are not always interested in the science behind new health technologies, it is important to educate them about the role of evidence as it applies to clinical decision making. Ideally, managed care organizations use high-quality evidence such as that from meta-analyses or multisite, blinded, randomized clinical trials to develop coverage policies. When that is not available, less robust data from small, single-site or retrospective studies, specialty society position statements, and published clinical practice guidelines can offer insight into efficacy and safety.
[A version of this post appeared in the April 1, 2011, online issue of Managed Healthcare Executive.]