The United States healthcare system may be the most complex industry in the world. It will soon become exponentially more complex. The current “healthcare” framework of reimbursement, research and technology is designed to treat conditions and provide services. While this healthcare system has brought major medical advances and breakthrough treatments, it lacks the necessary focus for successfully “managing individual health”. The result of this is the United States spending the more per person than any other country, 50% higher than number two, while finishing last in performance in a study of 11 countries. To address this, many new value-based reimbursement initiatives are being developed to realign the healthcare system to add “managing individual health”, improving health outcomes and reducing cost.
While the current “healthcare” framework still has opportunity for improvement, new “managing health” framework layers will need to be developed to overlay upon it. With just 2.7% of the United States population living a healthy lifestyle, these new framework layers must address human behavior as well as aligning the healthcare system to delivering overall individual health outcomes.
This will require collecting new “managing health” information that has not typically been part of the current “healthcare” framework. This is a major new challenge that will take many years to develop. It will we require advances in passive data collection sensors, interoperability (sharing existing data), user experience (it’s fun or no big deal) and individuals rewards (better health, lower cost, improved quality of life and/or gamification). The current healthcare system captures a snapshot of information to treat conditions and provide services while the patient is in a physician office or healthcare facility. It may offer little insight into what happens to the patients the other 99%+ of the time. If only 10%-20% of health outcomes can be attributed to medical care, effectively “Managing Health” will require understanding the other 80%-90% of determinants.
The “managing health” framework information layers must be developed over the next decade to improve and understand how to achieve the triple aim of improving the patient experience, health of populations and reducing the per capita cost of health care. The following are some of the framework layers that need to be developed:
I. Interventions & Determinants – Understanding the individual patient’s determinants of their health and behavior. Understanding the individual patient interventions and their associated health conditions and/or barrier (determinant) it is addressing. The current healthcare system typically collects only information required to treat a condition or to provide a service, which is a small subset of what is required for “Managing Health”. This is the foundation for the entire “Managing Health” framework and will be the first layer built. This layer is the primary focus of the Patient Well-Being Foundation.
II. Goals & Alignment – “Managing Health” goals need to be establish for success to be measured. These goals are based on individual patient’s definition of well-being that can be determined with motivational interviewing. The best care plan will not work if the patient isn’t motivated. The Care Plan must align with the patient’s goals, their determinants and members of their care team (caregivers, physicians, other providers).
III. Status & Actions – This is a dynamic layer that measures the patient’s status (health, well-being), actions taken (interventions) and changes (goals, determinants). This could be done each week, each day or each hour depending on the individual. If a patient has a hip replacement, we want to know when their quality of life improved, care goals were achieved, their actions (interventions) were skipped or a new barriers (determinants) occurred like a job loss. This set of information will be massive, yet the insight it will provide from looking back could be outstanding.
IV. Individual Health Performance – “Managing Health” is an iterative process of trial and error as to what works for certain conditions while aligning with other interventions (for other conditions), patient determinants, their behavior and the care team. With each of the three underlying “Managing Health” framework layers in place, individual “managing health” performance can be monitored and measured based on patients’ goals.
V. Managing Health Performance – When patients are willing to share their de-identified information to a “Managing Health” registry, we will begin to get meaningful insight and establish machine learning as to what works based on determinants, interventions and goals. We may be able to learn which providers are the best at “Managing Health”. For this to happen, each of the four underlying framework layers needs to be in place.