It’s no secret that the U.S. healthcare system is seriously challenged in terms of cost, quality and patient experience. For years, the momentum driving us toward an expanded role for patients (aka healthcare consumers) in improving their own health has been building. After all, health status is determined mostly by factors outside of the traditional healthcare system, including consumers’ everyday actions and choices, like what to eat or whom to spend time with.
To improve health, we have to better enlist and empower individuals, giving them greater agency in successfully shaping their own health journeys. Fortunately, technological advances are making it easier to achieve that goal every day. As we begin 2019, we have a solid health IT infrastructure in place, supercomputers (in the form of smartphones) in most people’s purses or pockets, and a move toward value-based healthcare payment models solidly underway.
So let’s be bold. Let’s move beyond engaging patients as mere recipients of healthcare services to a new model of health that truly empowers and supports each consumer as the leading actor in his or her own unique health story.
Priority #1: Define Value from a Healthcare Consumer Perspective
Misaligned payment incentives are, in my opinion, the single greatest problem with healthcare in the U.S. today, and fortunately the tide is slowly turning toward payment for value, not volume of care. But there’s an important nuance that is often overlooked. Value for whom?
Since healthcare is so complex, too often value is defined only from the perspective of the payor – the government, the insurance company, or the employer – or the care provider. Ideally, it should start with and also reflect the needs and priorities of the healthcare consumer or patient, taking into account both direct financial costs and invisible costs in time or convenience.
For example, as reported by an article in NEJM Catalyst, “Electrocardiograms, x-rays, and ultrasounds can all be performed in the patient’s home with use of portable technologies. In a pilot study, the total costs of care were reduced by 19%, and only 2.5% of 323 patients had to be transferred into the hospital from home. Similarly, in the University of Colorado system, patients who otherwise would have to drive hundreds of miles for a routine postoperative evaluation are able to skip the long drive and visit with their surgeon virtually from the comfort of their own home, avoiding countless hours in a car and the resulting costs.”
Finally, value from a healthcare consumer perspective should also include his or her perspective regarding successful outcomes. The most perfectly-performed procedure may appear to be a success in the short term, but if it doesn’t take into account the priorities of the patient, who ultimately has to live with the ramifications, it won’t achieve the desired effect.
- A lack of measurement of or accounting for the non-monetary costs and benefits of healthcare that are accrued by consumers
- A lack of transparency regarding healthcare costs and the portion borne by the individual healthcare consumer
- Short healthcare visits that often don’t allow time for healthcare consumers to understand their options and choices, and for healthcare providers to understand consumers’ priorities and motivations
- A shift in cultural expectations toward consumers as partners and decision-makers in healthcare – informed by internet information and norms in other industries
- Growing healthcare consumer cost-sharing, which includes increases in deductibles
Priority #2: Take a Holistic View of Health
There is a growing appreciation of the impact of social determinants of health, defined by the World Health Organization as “the conditions in which people are born, grow, work, live, and age.” For example, some companies and healthcare providers are branching out in untraditional ways, such as providing rideshare services to get patients to their health appointments more easily.
At the same time, with the mainstream availability of fitness devices and other wearables, some healthcare providers are incorporating patient-generated health data about movement, diet, mood, glucose levels, and other metrics into their practices. A recent survey of healthcare providers found that “79% of respondents agreed they would like to have more data about patients between encounters such as office visits, and 72% said they need patient-generated data to make good decisions on chronic disease management. Of those respondents already incorporating data from wearable devices in their workflow, 90% see it as strategy that can positively affect management of chronic conditions such as type 2 diabetes, obesity, hypertension and smoking addiction.”
The incorporation of both social determinants of health and patient-generated health data represents a positive move toward a more holistic view of health and healthcare that we should continue to expand in 2019.
- A distrust of nontraditional types of data by some healthcare practitioners
- A lack of standardized methodologies to apply new types of data to heath
- Fee-for-service payment models
- The growing popularity and availability of smartphones and wearables such as smartwatches and fitness trackers, in addition to services such as app-enabled ridesharing
Priority #3: Support Behavior Change
As a recent article in NEJM Catalyst points out, today’s greatest health ailments, such as chronic diseases (obesity, diabetes and heart disease) and the disproportionate killers of some segments of society (suicide, alcohol and drugs) are different from those that plagued previous generations in that they relate, to a high degree, to behaviors and mental health.
According to the authors, Stacey Chang, MS, and Thomas H. Lee, MD, MSc, “Even when patients present with apparently physical ailments, solutions often lie in addressing behavioral and social factors – a task for which traditional doctor-patient interactions are inadequate. Such factors are better addressed through a series of meaningful interactions focused on motivation, engagement, empowerment, conviction, and resilience.”
In sum, we need to consider healthcare consumers not just from a biological or hard-sciences standpoint, but to recognize them (that includes all of us!) as emotional, sometimes-irrational, and complex beings, taking into account what motivates them to change their own behaviors in ways that help them to achieve their health goals.
- Traditional models of medicine, which tend to separate mental from physical health
- Stigma often associated with mental health issues
- The recent growth of behavioral science in a variety of fields including economics and health
- New research about how the brain functions
As we roll into 2019, I’m excited to continue to engage with the health IT community about how to empower and support healthcare consumers in new ways. To keep the conversation going, I suggest joining the following sessions at HIMSS19.
The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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