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Amazon and the Future of Accountable Care

You wouldn’t think Amazon and Accountable Care initiatives have much in common, but think again.

Back in December, when my cell phone stopped charging correctly, I found myself searching for a replacement battery on It didn’t take long to find several sources, check the reviews of their products and performance and to order one that seemed a good deal—about $5.

It arrived in the mail a few days later. With it inside the envelope was a small note.

“No problem can’t be resolved,” it read. “We stand behind our products 100%. If you are unhappy with the item or anything about the transaction for any reason, please let us know before leaving feedback.”

I paid the note no attention and immediately installed and charged the battery. But within days I realized something was wrong. It wasn’t holding its charge for more than a few hours and after several discharge cycles I determined I’d just find another source. The cost hadn’t been high enough to make returning it worthwhile.

Before I got around to that, an email from Amazon arrived asking me to rate my transaction. I made a brief comment to the effect that the battery hadn’t performed as it should and that I was looking for a different replacement.

It was only an hour later when the phone rang. The caller turned out to be online retailer from whom I’d bought the battery.

“We sell only OEM (original equipment manufacturer) batteries,” he said. “You must have received a defective one. We want your complete satisfaction and will be glad to send a replacement—you don’t even have to return the old one. ”

“Great,” I replied. In my mind I was still very surprised that someone—anyone—had responded so quickly.

“There’s just one thing you have to do,” he said. “If you go to your computer, I’d like you to retract your comment. I’ll walk you through it.”

“All right,” I said. “But the replacement better perform, or I’ll be a lot more direct in my comments the second time around.”

I returned to my office and computer, followed his directions to log back in to the Amazon site and withdrew the comment.

“Thanks for your business,” the guy on the line said. “We sell hundreds of these every day and want to make sure our feedback shows 100% satisfaction.”

The new battery arrived a few days later, performed fine and that was that. But I couldn’t get the experience out of my mind, and perhaps many readers will now see where I’m going with this editorial.

As the Accountable Care Act (ACA) is implemented, one part of it will make available  unprecedented public access to large databases of metrics. These will show outcome results, patient satisfaction scores and other data that internet savvy consumers will use to make their decisions about which procedures, hospitals, nursing homes and physicians they will choose.

This approach is also going to eventually remove the veil of obfuscation that surrounds the price hospitals and physicians charge for procedures. Up to now, medical facilities have largely managed to maintain a near complete lack of transparency in this regard, stymying the best efforts of even sophisticated patients to find out in advance what will be charged for procedures before they are undertaken. (You can read a recent, interesting New York Times article about this problem here.)

Other web sites, like Angie’s list, are beginning to rate physicians, much as they already rate plumbers, electricians and other service providers. Organizations like are creating tools based on billions of data records to help consumers obtain the best care at the best cost.

Like it or not, this is the wave of the future. If Accountable Care—and the high-deductible insurance plans most of us will eventually have—are to help rein in healthcare costs, such transparency is essential.

And in the same future, it’s not so hard to imagine that as patient feedback and ratings become a key part of making healthcare choices, you might find a provider calling you on the phone some night, looking to make things right.

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