HLM: Can you describe pseudo-patient centeredness?
Millenson: Most of what is done as patient-centered care is customer service.
Customer service is great, but genuine sharing of power, being out in the community, that's what hospitals need to do.
Also, much of what the healthcare system talks about as engagement and patient centeredness is really compliance in nicer language. 'I want to engage you so you understand why you should do what I told you to do.'
Sometimes there is nothing wrong with that. Your doctor told you take the meds and you ought to take your meds, and now your providers are going to engage you in a different way so you take your meds.
But often, for the provider, it is simply 'I came to a decision. This is what I think you should do and I'm going to engage you until you realize that I'm right and do what I told you.'
HLM: How does the recognition that meeting social needs such as housing and transportation fit into the concept of collaborative health?
Millenson: Theoretically in the best of all possible worlds, our society would be taking care of public health and homelessness…Even if you are middle class and you are going home all alone, because you are elderly there would be help from a social service agency or a church or a synagogue.
None of this would be the responsibility of the healthcare system, but that is not the real world. What's happened is we are making social needs the responsibility of the healthcare system and breaking down the boundaries.
Now all of the sudden if you [the providers] are talking to me about my need for a wheelchair ramp and my home life, you are engaging me in a different way.
If now my health plan is providing foods and someone from the plan calls and asks how I am doing, that changes my relationship with my doctor.
Tinker Ready is a contributing writer at HealthLeaders Media.