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Out and About

by John Moore | May 20, 2013

Some of you may have noticed a precipitous drop in new content, ala posts, as of late. A few things have contributed to this. First, it is often tough to find time to write when one is traveling from one activity to another (in fact this is being written as I fly back to Boston from the west coast). Second, Chilmark has several reports that will be released in the next few weeks, all of which have consumed a significant amount of collective analysts’ bandwidth, including my own. And lastly, on a personal note, I’ll be getting married in late June to an amazing woman who has fallen from the stars and into my life.

During my travels I’ve had conversations with countless people from a CMIO in New York, to the head of HR for a major semiconductor manufacturer, to CEOs of numerous HIT companies to the CEO of national commercial payer. Reflecting upon these conversations, common themes arise.

There is a clear recognition that the delivery of care must change but there is little agreement as to what that change should be. All have said it will require a major restructuring of the healthcare industrial complex and that the patient/member/consumer/employee must be engaged to take personal responsibility for the management of their health. Fine. But when one asks more probing questions as to how that will actually be accomplished  – what will it take – the opinions diverge.

  • For the CMIO, it is about the “Cloud” where patients and clinicians will meet with their mobile apps and Bluetooth-enabled sensors to manage care.
  • For the head of HR, it is about creating a corporate culture of wellness within the work environment and then taking steps to extend that culture into the home.
  • For HIT executives, it is developing a solution suite that extends beyond the confines of their current offerings to enable community health. Within that context many expressed a need to redefine the vocabulary we use as the current vocabulary limits a more expansive, strategic discussion of what it means to engage the patient, the populace, in self management.
  • And for the CEO of the payer organization, it is about the need for internal transformation to create a trusted relationship between them and their members.

While one cannot quibble with any of these views, each being reflective of the vantage and leverage point these executives have at their disposal, the problem remains: Getting the average citizen to engage in their health will remain a significant challenge, and frankly, “the system” is not helping much to overcome this challenge.

The top five hurdles are:

  1. The pedagogy of medical school education does not encourage proactive, collaborative engagement between patient and clinician.
  2. The lack of trust that payers carry around the neck like an albatross is due to business practices that are not in the best interests of a member, or potential member with a health condition, but the financial interests of a payer. Yes, there is a delicate balance, but denying someone due to a pre-existing condition (a practice now outlawed) does not instill a warm and fuzzy feeling among the general populace.
  3. Employers’ inability to instill healthy behaviors among their employee base, including top ranking executives. If they can’t get that senior executive to stop smoking, you think an underling will?
  4. Bridging the disconnect between the rich tools that a consumer can use to manage numerous aspects of their life including the proliferation of health and wellness apps and devices with the rather paltry patient engagement tools that most healthcare providers currently offer.
  5. Overcoming a culture of entitlement to healthcare regardless of cost. Consumers do not truly know what they are buying with their healthcare dollars and didn’t have to as employer benefit plans covered costs. We now have an adult population that has grown accustomed to simply not worry about the consequences of their behaviors till it is typically too late.

My attendance at these numerous events gave me good perspective on these challenges and how they may be addressed. But I walked away slowly from each conversation thinking:

Yes, these are all good ideas but systemic change will take time. It took us awhile to get into this current mess and likely will take a similar amount of time to dig out.

Question is: Do we even have the luxury of such time?

One response to “Out and About”

  1. james oneill says:

    “Consumers do not truly know what they are buying with their healthcare dollars and didn’t have to as employer benefit plans covered costs. ”

    consumers are a faceless mass of automatons…

    healthy people and patients (sick people) are passive participants in the healthcare industrial complex much like the citizen and the GI is a passive participant in the defense industrial complex

    insurance companies, employers, pharmaceutical and device companies interact with government run the healthcare industrial complex for their benefit….they have created a highly regulated market where profit margins are high….think about it wall street invests in for profit health insurance companies?…wall street invests in pharmaceutical companies who make their money with patent monopolies…..people don’t manage their health…people need to learn more healthy ways of living and most people need access to better health support….remember the tradition is the doctor only sees you and talks to you if you can pay him for “that visit” and that visit is now 10-15 minutes

    information technology will be immensely helpful but not transformative unless it is used to support the work of doctors and the support health needs of patients…..i don’t see the investor and cost containment entities that rule being interested in this…government wants to keep costs low and corporate interests want to make their profits….

    i may be idealistic but i think financial interests dominate the healthcare industrial complex…have you read paul starr?

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