Historically, healthcare has generally looked at the people they serve as patients. This definition is important because the word patient has a very distinct meaning, “a person receiving or registered to receive medical treatment.” This definition may have been appropriate when the business of medicine was disease- and condition-centric and primarily attended to fee-for-service economic models. However, these models are quickly evolving as we move to value-based reimbursement with a focus on preventive medicine.
A majority of healthcare providers will soon be incentivized not for the number of procedures performed, per se, but the health outcomes of the people under their care. In this paradigm, the true goal is to keep people well, rather than treatment frequency. The continuum of care becomes incentivized using a preventive medicine model where a reduction in the need for care is how success is measured.
Now that we are beginning to frame the success of health services using outcomes as a performance indicator—rather than volume of services performed—the distinction of the word outcome becomes important as well. Outcome is defined as “a final product or end result.” Unfortunately, in medicine, many old habits die hard. Even though our language has changed a bit, current views in healthcare still generally frame success as the ultimate result of treating a specific condition.
We have known for a long time that exercise is some of the best, most easily accessible, preventive medicine available. Yet, even today, we do not find meaningful handoffs between traditional providers of care and upstream wellness providers like health clubs. This reality persists even though substantial health systems monitor exercise as a vital sign, and advocacy groups like Exercise is Medicine (part of the non-profit professional association American College of Sports Medicine) have existed for years.
So why has it been so difficult for exercise prescription and other physician referral exercise programs to take off?
First, in my experience, is that providers are reluctant to refer their patients to an environment for which they are unfamiliar. For instance, many providers have legitimate concerns about the handoff—not knowing what type of exercise program and training their patients will ultimately receive, as well as the level of certification of the professional delivering the service. In contrast to physical therapy where there is often a professional relationship between the referring physician and therapist, a professional association is much more unlikely between a physician and the allied health professionals that provide fitness- and wellness-related services.
Second, there is a lack of functional technological integration between medical practices and wellness service providers. Even at fitness facilities associated with medical providers, it is often difficult to access reliable information on intervention design or data on a specific intervention’s efficacy.
Fortunately, there are some signals—fueled by digital health innovation—that we might be taking steps in the right direction. In addition to EHR technology, there are now electronic wellness record (EWR) options. EWRs are better suited for administering and monitoring lifestyle interventions, as well as longitudinal condition-specific protocols that are not delivered within a hospital setting. Where EHRs are designed to document the episodic relationship one has with a provider, an EWR tracks the rest of what we do every day to support our health—whether that is merely tracking a weekly weigh-in or the progress one makes mitigating Parkinson’s tremors over time.
Patient engagement platforms are also stepping up to the plate and expanding the continuum of touchpoints their health technology covers, from upstream providers like health clubs to downstream providers like hospitals. In the early days, these tools were simply expansive communication channels that helped providers scale their ability to reach patients through increased message frequency. For newer, forward-thinking platforms it is no longer only about patient engagement, but ways to help influence total patient well-being. With improved integration capacities, we can now cater to the entire patient journey map, providing better-informed nudges that increase the efficacy of lifestyle and condition-specific interventions. For instance, these platforms can better the engagement in behavioral health initiatives such as diabetes prevention programs and participation in exercise protocols like boxing for Parkinson’s remediation. The best technology in this space creates a closed-loop system, meaning the software provides both user engagement as well as tracks progress and results.
Many of us in healthcare speak of the continuum of care, but in our current reality, a true continuum only exists as a conceptual idea. How can a true continuum exist when our relationship does not start until we are considered patients? It is clear that the way we define our relationship with healthcare needs to expand, and digital health can help scale the continuum in a realistic way that doesn’t further burden providers. Great health technology does this by reducing administrative burdens and easing friction in the various handoffs.
There is still a significant need for us to get ahead of avoidable diseases with preventive medicine. Medicare reimburses for annual wellness visits is a good start, but there is so much more to do. This has never been truer when you consider mortality from emerging health threats often has a high correlation with comorbid conditions. In the case of COVID-19, nearly 90% of those hospitalized had at least one underlying condition, many of which are preventable lifestyle diseases. As such, increasing our focus on prevention is not just about saving money; it is about saving lives.
I lost my younger brother to a complication associated with obesity. My brother had a trusting relationship with his providers and would have certainly adhered to any regimen that was easy to follow. Unfortunately, this did not happen because, in his case, his providers were not empowered or incentivized to easily administer and monitor preventive medicine through exercise prescription or other such measures. Instead, things were treated as needed until it was too late.
I hope that our collective efforts through health technology innovation, as well as genuinely catering to the entire continuum of care, will help build a world where we can shift our focus toward success measures we base on true health and wellness. In this new reality, we circumvent the need to treat preventable conditions in the first place and can transition to a paradigm of betterment.
The views and opinions expressed in this content 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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