My Designer Prescription for Medicare's Ills

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By Leslie Smolan
Sunday, January 22, 2006

When I read the headlines last week about seniors lost in the maze of the new Medicare prescription drug plan, I didn't just see them as further evidence that the confusion-ridden, fraud-laden, money-squandering Medicare system is headed for disaster. The news also bolstered my conviction that most of Medicare's failings can be tied to a single "disease": disastrously poor information design.

Designing information is a large part of what I do for a living. Designers like me try to simplify complex information for a time-starved, information-hungry society, whether that means helping you sort through the investment options in your 401(k) plan or figuring out how to make the most of your visit to the Louvre (regardless of what language you speak or your familiarity with a complicated piece of 16th-century architecture).

Despite all my experience, I recently fared no better than the average Medicare patient when it came to understanding a system that seems almost deliberately obscure. Last year, my elderly father became chronically ill, and I was forced to navigate Medicare's labyrinths to manage his care. Every step of the way in my long and frustrating dealings with the system, from finding a nursing home to tracking down my father's medical records to reconciling the endless stream of bills, I found that the information I needed was either unavailable, unedited or unintelligible. Clearly, our healthcare system is sick, and unless we focus on curing it before the first baby boomers become eligible for Medicare in 2011, it is likely to be so overwhelmed that it will either cease to provide any reasonable standard of care -- or cease to exist.

What follows is my modest proposal for saving Medicare. As is the case with any ailing patient, the cure depends on making the right diagnosis.

Diagnosis: Information Discontinuity

Symptoms: My father's predicament began with a bad fall that resulted in a cerebral hemorrhage. As he was air-lifted to the hospital, my mother, overwhelmed by the swiftness of events, had to immediately produce a health directive, living will, power of attorney, Medicare number, secondary health insurance policy and prescription drug card. These separate documents all come in different formats and are produced and distributed at different times. Even if you have them all, finding the latest version of each can be a challenge. Imagine if you had to provide a bank balance, credit history, utility bill and birth certificate every time you made a credit card purchase. The wasteful, labor-intensive process of repeatedly generating and collating the same information became a recurring theme throughout the year ahead.

As my father was moved from hospital to nursing home and back to the hospital again, I was shocked to discover that basic information about his condition and treatment did not always make the journey with him. Every healthcare provider in the Medicare system maintains separate records; there is no universal data bank that they all can access. This absence of continuity in the flow of information often resulted in an absence of continuity in care, as when my father's recurring urinary tract infection was misdiagnosed . . . as a stroke!

In addition, Medicare, the insurance companies and the doctors all have different computer programs, making cross-referencing bills and payments nearly impossible. The secondary insurance company pays its portion once Medicare has paid. Despite Medicare's approval, we began to get "scare letters" from the secondary insurer saying they would deny claims unless they got certain information. It turns out that the insurance company's computer system accommodates fewer characters per line than Medicare's, so half the information dropped off when Medicare passed on the claim.

Treatment: From the moment someone enters the Medicare system, all information about his illnesses and treatment should be entered in a confidential, centralized database to which the patient himself (or a designated representative) grants access. Any number of entities could be in charge of the database, from the government itself to an independent third-party provider. With a central database, the necessary information will always be at hand when the patient, doctor or even a pharmacist needs it. When you consider how easy it is for anyone to obtain your detailed credit report, it's clear that the technology exists to remedy this information-sharing crisis (and also, sadly, that our priorities are out of whack).

Diagnosis: Information Overdose

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