My wife and I have been helping an extended family member through some health issues and we have been learning a lot about our healthcare system.  I know I am a complete process-nerd, but three things became abundantly clear over the past weeks:

• You don’t know what you don’t know until you need to know it;
• This is primarily a transaction-oriented system rather than an outcome-based system; and
• You must have an advocate.

You would think with Google and all the information on the planet readily available, we can all be experts on anything.  But even if the information is there, most people don’t start searching until there is a need.  In a system based on a patchwork of layers of insurance carriers, state laws, individual provider rules, and lawyers, any broad-based education about the “health care system” is essentially, well, useless.  There is no universal truth to how things work and the experience one person has in one area of the country with their particular insurance carrier will differ significantly from another person with the exact same issue somewhere else.  As a process-minded person, this drives me nuts!  Every new situation requires a new education on the particular rules that apply.  Argh!

Fortunately for us, this is the first time we have had to interact with the health care system for an extended problem.  All our previous experiences have been normal wellness checks, an occasional ER/urgent care visit – all “normal” interactions.  Most importantly, the one thing all our experiences have had in common, they were single visits with a single purpose.  Maybe a follow-up visit, but nothing long-term or systemic in nature.  In other words, transactions.  As our family member went through one thing after another, it became clear that each step, each specialist simply wanted to complete their transaction with us and move us on to the next.  There was nobody that wanted or took the time to guide us through the process to ensure a positive outcome for the wholistic problem. 

This is so jarring to me because as a goals-based financial advisor, my entire job and process is built around that end-to-end guidance for my clients.  So, when I met up with this transaction-oriented system, it has felt like I am beating my head up across the twin brick walls called “silos” and “insurance”.  Every care provider works within their particular silo and is at the mercy of the insurance company’s remote decision on how to proceed.

It also strikes me that our system fundamentally misaligns the interests of the patient and the interest of the insurance carrier.  As a financial advisor that earns my compensation based on the assets I manage, when those assets grow, I make more money.  My interests are aligned with my clients.  If a patient gets covered (wins), the insurance company pays (loses).  This makes it really easy to distrust the motive of the insurance company when something is declined, even if what they are saying is “we think there might be a better alternative”.

Which brings me to the final lesson we have learned – you absolutely MUST have an advocate that both understands the underlying system and is focused more out the outcome rather than each transaction.  Our current system, right or wrong, places this responsibility on the “primary care provider” and we have discovered just how valuable a long-term relationship with a quality PCP is.  Placing this level of responsibility on a single person rather than building it into the system elevates the importance of finding the right person for you. 

That person who knows you, knows your history and can help you navigate an environment that seems foreign to you is simply invaluable.  That person who can coordinate specialists within the context of an overall plan.  That person who places trust, education and outcomes above everything else.   Sounds a lot like a trusting, long-term relationship with a really good financial advisor.  #InvestWithAPlan

Graphic: Monitoring Transactions by Vectors Market from the Noun Project