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Idea Patient profiles and Primary Care Provider matching system

By Ryan Peterson | 03 Dec, 2014

Idea submitted by: Ryan Peterson

The choice of a primary care provider can have broad impact on a patient's interaction with the health system. Often, this choice comes down to picking the closest doctor or through word of mouth. The types of things that are important to different patients are often very different. Some may value scheduling availability, others may value shared decision making processes, others may value facility size or affiliation, others may value different types of referral patterns, etc.

One could imagine patients filling out a simple or more in depth profile in which they answer a series of multiple choice questions which would help inform what type of physician/clinic pairing that the patient would most value. This could be compared against standardized clinic, physician, or attributed patient surveys to determine which PCP is a good fit for an individual.

Building this repository of information across health systems in a standardized way will help improve a patients interaction with the health system and may reduce costs by eliminating the frequency of 'second opinions' when patients start with a doctor that may not suit their style.

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Thomas Tsai Advisor Replied at 12:24 PM, 4 Dec 2014

Hi Ryan,

Thank you for submitting your idea. I think you've focused on an interesting issue!

Some questions to think about:
1) Who do you think should run this patient-PCP matching system? This would seem to be an issue of interest to insurance companies. One could imagine that when an individual signs up for a new insurance plan, they can also fill out the profile which the insurance company can use to assign an appropriate PCP.
2) In order for the profile to work, it would also mean that the physicians themselves would need to have a profile in order to be matched to the patients. Do you think this will be burdensome for physicians?
3) How do you think quality fits into the profile as something that a patient could value?
4) There's a concern that insurance plans are using "narrow networks" to contain their costs, restricting choice of providers for patients. What if patients all value the same set of physicians--how do you allocate patients to the less desirable PCPs?

Interested in hearing more about your idea!

Ryan Peterson Replied at 3:23 PM, 4 Dec 2014

Thanks for the feedback! Some thoughts to the specific topics above:

There are three major components that would go into a program supporting this:
1. How the physician/clinic profile is created, and who maintains this information.
2. How the patient profile is created, and who maintains this information.
3. How the recommendations of patients to physician/clinics would be done.

One could imagine a program similar to HCAHPS for primary care physicians rather than Hospitals in which survey questions are responses are standardized. That data could be made publicly available. That profiled could be informed by administrative data, physician profiling (though not necessary) and by patients who have the physician as their primary care doctor or recently switched from that primary care doctor. The task of determining the 'right' questions that go into the physician profile would be challenging but worthwhile to patients. In the best of worlds these survey responses are collected via an interface that can inform the PCP metrics in near real-time (ie if patient wait time or schedule availability appears to be on the rise).

If only that data were put together and made available the rest could be administrated / open-sourced to the insurance companies, consumer groups, or any others with a vested interest in finding good primary care.

In an ideal world, the profile a patient fills out, along with the matching algorithm would also be standardized. However, there could be value in leaving these methodologies open to industry to 'get it right' for the areas that are most of interest to their patient population and regions served. As a data geek, I could see opportunities to open-source a project to predict patients happiness with their PCPs based on the patient survey data and PCP HCAHPS style results which could help inform the matching algorithms that insurance plans or a consumer website might use.

As to #4, should we be allocating patients to less desirable PCPs? If a PCP is still undesirable to a patient even if they have a very available schedule, that PCP may need to do something different. This could involve them filling out a more detailed profile that goes into the physician HCAHPS style scoring, offering a lower rate to insurance companies etc. In any other industry the less desirable provider just gets less business and has to change their practice in order to accommodate.

A/Prof. Terry HANNAN Advisor Replied at 8:38 PM, 5 Dec 2014

Ryan, I have formulated some responses to you posting in the hope that they offer some positive value to your submission.
In response to your first sentence: This is the ideal scenario but which health systems –private/public/public-private] permit this to occur?
In response to your statement " One could imagine patients filling .......": So do current or future systems permit these choices? With my limited understanding of health delivery in North America do health insurance organizations permit ‘free’ choice of doctor and for the uninsured how are their needs met?
In Australia we have a “free universal health care system” however the question needs to be asked does this system deliver free choice of access to the patient’s clinician of choice. Probably not, for a multitude of reasons.
In Primary Care (PC) the patient can chose their clinician however access may not be timely because many PC clinics have long waiting times. Some PC clinics require a payment (often a gap) for their services and this affects some patient’s choice of clinician. So it is cost that determines who sees the patient and not who is the best person for this patient. Limited or poor access to PC often encourages the use of secondary (hospital-based) health care facilities.
For private Specialist care it is considered the patient has a ‘choice’ of doctor and this is theoretically so. However a not insignificant number of privately insured patients enter hospital and are classified as private and their ‘choice of clinician’ is an add on mainly for reimbursement purposes for the institution and the clinician.
Regarding the “profiling” for matching patients and clinicians there are some issues that need to be addressed.
As Dr Mark Smith formerly of the Californian Health Care Foundation stated “I may know the most popular doctor for ‘x’ disease but is that person the best?” he then stated “We must therefore That we must remove ourselves from the ‘unscientific, non-data driven personal recommendations’ for care. That we need to move the care delivery system away from the costly and inefficient ‘widgets’ model of care based on pre-determined ‘appointment system’ involving health care encounters.
In response to your statement "Building this repository of information across health systems......." One can but agree with this statement. As Dr Mark Smith also stated, “That care needs to be directed at patient self-management. Give them the HIT tools to manage their health.”
On moving away from the doctors style there is the knowledge that patients are aware of how much modern health care is not meeting their needs. In fact there is emerging evidence that in certain situations using modern web-based technologies those patients are performing better in their health care assessments and management than the doctor!
Topol E "The Creative Destruction of Medicine: ISBN-13: 978-0465061839 ISBN-10: 0465061834
Surowiecki j. The Wisdom of Crowds. Anchor, editor. New York: Random House; 2005.

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of Technology for Patient Engagement and GHDonline staff