Photo by Emily Davis

The hidden power of the patient

New book seeks to empower patients to take charge of their health care

In her 30-year career, Archelle Georgiou, M.D., has been a practicing physician, a health insurance executive and even a reporter for KSTP-TV. Now she is the author of Healthcare Choices: The Five Steps to Getting the Care You Want and Need.

MNBIZ: Tell me about how your book empowers patients as health care decision-makers.
We have this system out there that desperately needs consumers to make better choices. Yet no one has taught consumers how to assess those choices that they have. The CARES model (Conditions, Alternatives, Respect, Evaluate, Start) is a framework for how to make a choice about anything, between two complex medical choices that you could make, about how to pick a doctor, how to find the insurance benefit plan that’s the best one for you, how to make an end-of-life decision.

MNBIZ: What inspired this book?
When people are faced with making a health care decision, they become passive participants. The more serious their illness is, the more passive they become. That’s because health care decisions are hard to make. They’re scary to make. Nevertheless, you have to make them because your health is the biggest asset that you have. I thought I had to write this book because I think that’s what’s missing in our health care today.

MNBIZ: But self-care by the patient flies against the idea that doctors know best.
Doctors know best when it comes to diagnosis, treatment and treatment planning. But that is only as good as the history and the facts that the patient gives to that physician. The doctor is an expert in the science of medical care, but you are an expert in you. It’s together that you get the best health outcomes.

MNBIZ: Another angle is that the insurance company knows best, but you discovered some limitations in that approach.
Yes. In the mid-1990s I gave a patient a Pap smear and she started profusely bleeding. That shouldn’t happen. I got the Pap smear back and the lab result said it was normal. Well, obviously that’s wrong.

I told the OBGYN my patient needed a further test — a colposcopy. But he said, “I’m sorry. I can’t do it. The health insurance, HMO won’t approve the payment for the colposcopy because she has a normal pap smear.” That’s when I knew something had to change.  

As it turned out, she had invasive uterine cancer. It was at that moment that I wondered how many more people are being negatively impacted by the rules of managed care. That’s what got me out of practicing medicine and put me on a path of being an executive in the managed care industry.

MNBIZ: What did you accomplish as a health care executive?
Ultimately, I used my authority to change the system. That’s what I’m really proud of. That happened in 1999 when, as the chief medical officer of United Healthcare, I architected the elimination of the medical necessity review process, which has gotten in the way of patients getting the care they need.

MNBIZ: The doctor can judge what the patient needs better than the insurance company?
You can’t know what a patient needs when you are across the country. Ultimately, it’s the doctor and patient who know what they need. I thought we needed a system that would support that, rather than get in the way of patient care. We eliminated medical necessity review and replaced it with care coordination. Now, that term is widely used. In 1999 when we launched this, it was a brand new term.

MNBIZ:  If you could improve the insurance system, what would you do?
I would change how providers are reimbursed. Doctors and hospitals should not be paid for doing more, but for doing better. This payment system is the root cause of the high cost of insurance.

MNBIZ: Do patients have the potential to help change the system?
There are about two million nurses, 4,500 hospitals and about just short of a million doctors. I think it is much more important to try to change the behavior of more than 300 million Americans than trying to change insurers, hospitals and providers. If you think about it, each person’s biggest asset is their health. I think that each person really cares about their health. Unless the consumer is involved, I don’t think progress will be made.