Jane Sarasohn-Kahn, THINK-Health and the Health Populi blog
The U.S. spends $2.2 trillion on health care each year. About $3 of every $4 spent on health care in America goes to caring for chronic conditions such as hypertension, heart disease, and diabetes. Though the U.S. spends more per capita on health, the return we get on that health investment is relatively low based on the high levels of chronic illness in the nation.
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Regardless of what may or may not emerge from Congress this year in the guise of health reform, there’s one critical success factor to bending the American health care cost curve: engaging patients in their own care towards Participatory Health.
How do health stakeholders effectively engage health citizens, and how do health citizens engage in turn? If the challenge of chronic care were easy to solve, we’d have done so by now.
Managing chronic care involves some complicated and heavy lifting. The response to the health engagement question is multifactorial, including:
Building trust between health suppliers (such as health plans, life science companies, and pharmacies), providers, patients, and families. Trust is a prerequisite for a patient to be willing to engage with health stakeholders.
Aligning incentives among suppliers, providers and patients. The current system of discounted fee-for-service rewards utilization, not outcomes. And while patients might have more ‘skin in the game’ of higher co-payments and coinsurance, these out-of-pocket costs often lead people to make rational short-term fiscal decisions (i.e., postponing a visit to a doctor when feeling quite ill to save a co-payment fee) which can lead to longer-term poor physical outcomes.
Clarifying regulations regarding health communications, personal health information, medical devices and information technologies involved in storing and delivering health information between providers and patients.
Enlisting and engaging clinicians in wanting to be a partner in patients’ participation. Physicians aren’t generally engaged with patients more than a few minutes a year. Providing opportunities for provider-patient e-mail, personal health records that link into a doctor’s EHR, and paying physicians for condition management versus encounters would go a long way to bolstering participatory health that links patients with a medical home, ongoing.
Motivating and keeping patients engaged in their own care, a challenge for all stakeholders whether pharmaceutical manufacturer (think: compliance and adherence), provider (think: weight management and blood glucose testing), plan sponsor/employer (think: wellness program), or health plan (think: early diagnosis, intervention and care management). One aspect of keeping people engaged is through the emerging tack of “libertarian paternalism,” as discussed in the important book Nudge by Sunstein and Thaler. A carrot can work better than a stick when it comes to health care, and health consumers need a whole lot of nudging.
Like I said: “heavy lifting.”
Participatory health is driven by many factors in developed countries, but has roots in developing nations. RAND Europe has explored these roots in an excellent report on the subject, which found that,
“Initially stimulated by long-term processes of historical and social change in developed countries, participatory research has been driven lately by the emergence of powerful new actors in civil society—some of them social movements (including the feminist movement), others formal organizations, and, in a small number of cases, individual activists. It has been associated with parallel changes in the status of patients, who are increasingly regarded as active participants in defining the care they receive, rather than passive recipients.”
What’s helping patients in getting to be participatory in health is a growing array of tools that leverage investments people have already made in communications technologies for managing other aspects of their lives, like travel, financial management, and entertainment: namely the Internet, broadband connections, and mobile phones (both “smart” and “POCs” – plain old cellphones).
Participatory health is enabled through these base technologies – which allow people to research health conditions, connect with fellow patients and caregivers, continuously monitor and communicate Observations of Daily Living (ODLs) and medical data (e.g., blood pressure, blood glucose), participate in clinical trials, and a myriad of other tasks which can active health citizens and ultimately improve health outcomes. But it’s not only knowing one’s numbers that helps a patient heal and be well; it’s continuous (or near-continuous) monitoring that gets communicated to a coach or clinician in a closed-loop that can inform the patient, on an ongoing basis, how to continue to tweak his/her self-care.
The partnership and continuing communication between a patient and the stakeholders around her – especially the health provider and clinical expert – is the collaborative effort that will contend with the chronic care challenge, reduce costs in the health system, and improve quality of life for patients and their families.
I’ve written about participatory health and emerging tools for managing chronic conditions in my latest issue brief for the California HealthCare Foundation – Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care. Please take a look into the report and let us know your views on participatory health here on the Path of the Blue Eye blog.
There’s nothing more collaborative than Participatory Health, and collaboration is the way of the Path of the Blue Eye …
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