Disrupt “healthcare” to be about community “health” first, and “care” second
Collaboration is needed to address wasted resources and social determinant drivers
Why not have a health insurance plan or physician value based contract with incentives to shop at farmers’ markets? Or script Virtual Reality for anxiety?
We all know healthcare is changing, not only in terms of how it is delivered and how much it should cost, but also in terms of who is included in the definition of “healthcare.” It is a good time to reset the expectations for the system as a whole.
I did an analysis for another article recently that illustrated a very strong link between escalating healthcare costs and preventable hospital stays, lack of physical activity, and insufficient sleep. These three factors were broken down further; for example preventable hospital stays were able to be explained by obvious factors, like prevalence of obesity, but also as much by an index on the quality of life, compiled from survey data assessing physical and mental well-being, prevalence of low-birth weight births, crime and prevalence of “disconnected youth.” The conclusion is consistent with other articles that illustrate impact of social determinants on health, and cost of healthcare, such as the expose in The Atlantic, July 25 2016, discussing the prevalence in housing of gas leaks, mold, and rats.
There is awareness of the issues, of course, and public policy and healthcare administrators have been managing the ramifications. Judging by the trends in conference presentations and published articles, there is a growing awareness to the linkage between certain social determinants and the impact on the cost and over-use of healthcare.
Why are these elements important? In my experience, roughly two-thirds of a given population in any given year will not see a physician. There have been numerous studies that illustrate the lower 50% of people who are patients routinely use less than 5% of the total healthcare spend (e.g. mostly preventative / exploratory services). Taken together then approximately 80% of a given community consumes 5% or less of the total healthcare based resources, as traditionally measured. Perhaps this expands to 8-10% if ancillary or nontraditional services are added in the mix. This presents two challenges. The first is to help those who are already healthy remain so, and the second is to use our collaborative capabilities to proactively identify and intervene on behalf of those who are becoming at-risk, before they become poly-chronic patients. This will shift the use of resources away from care maintenance and diagnostic reaction, more toward preventive and patient engagement (versus admissions), with the potential to reduce the cost burden of the healthcare system.
The emerging definition of healthcare from this increased awareness must reflect coordinated efforts between physician care management plans, public policy programs, and health plan insurance product designs/incentives. There is more work to be done; design of these efforts has to be with comprehensive understanding and empathy for the community and the people in it. We will thereby collectively address social determinants of health and not just onsets of disease states. This implies a collaborative effort around encouraging healthy eating and physical activity / exercise, as well as addressing health factors in the public policy realm, such as income based disparities in housing conditions, crime, access to clean water and access to healthy food. It also implies recognizing non-traditional but valuable modes of care, such as music and art, that reduce stress, build a sense of community, raise self-esteem, and encourage well-being.
Profitability and solvency are major concerns for all the enterprises involved, whether for-profit or non-profit in their mission. The alignment of cash flows can be created to sustain all parties, if they work together, and to also do so in consideration of these broader community based considerations. Is it a flight of fancy to imagine a health plan that offers “coverage” for farmers’ market expenses and discounts off museum memberships, in addition to gyms? That value-based care includes incentives for coordinated care plans that include nutritionists, carpenters, and therapists? Achieving this vision will require equal parts evolution in how we do things and disruption from both emerging technology and new competitors. I believe the emerging technology and data give us this opportunity to change the vision for healthcare.
Contact: Mark Jamilkowski