The Future of Health Care Called—We Didn’t Answer
Not so long ago, other than actual face-to-face conversation, the telephone was our primary verbal communication resource. It still is, of course, but it’s evolution as a communication device is both staggering and unprecedented—texting, instant messaging, and countless social media platforms are now inherent to phones.
The devices themselves have long since been pried off the wall and computerized to fit into our pockets. Personal conversation—true, orally based exchanges—have almost gone the way of the house call—almost. In desperate attempts for privacy, we snaked the phone cord through rooms, around doorways, across coffee tables, and even into the bathroom while still anchored to the device’s wall-mounted base. After the cord could take no more punishment, we delighted in holding it by the end that connected to the base to let it spin with abandon until it freed itself from a tangled mass of knots. Minutes later—voila—the cord righted itself, and the phone once again became flexible enough to let us stray a few precious feet, all the while keeping us tethered to the foundation.
While still a mainstay for most healthcare providers, consumer use of landlines has become all but obsolete. Sure, a few die-hards still use them, but phones have evolved to the point where they’ve become an intrinsic part of everyday life. We don’t have to search for a phone to make a call—it’s in our pocket. We can order a pizza on the way home from work, but can we get our physician on the line for a quick consultation? Phones travel with us and have adapted to our lifestyles. Can we say the same for the delivery of health care?
Apple long ago realized that to be practical—to be useful—phones had to conform to the evolving needs and expectations of forward-looking human behavior. Hence, Apple became a consumer-driven enterprise. In essence, although Apple makes the phone, we the consumers tell Apple how the phone should function. We don’t tell Apple how to make the phone, but do we tell them the qualities that the phone should extol. The power to control Apple, therefore, lies with the people. Consumers either buy the phone or they don’t. In fact, a phone isn’t just a phone. It schedules, reminds, organizes, talks, texts, and broadcasts. The masses quickly reject devices that don’t function optimally.
How’s that Palm Pilot working?
Health care can take a lesson from the telecommunications arena. If the cell phone industry were to look back, they’d soon realize that they got ahead of the game by looking ahead. Much like the crank phone gave way to the rotary, gave way to the push-button and innovative “Princess” models, gave way to the cell, gave way to the smartphone—many facets of the healthcare industry are lagging in the rotary zone.
Transformers
The time is nigh for transformational redesign. Like the rest of the world’s economy, health care is a consumer-driven service. Some would rightfully argue that health care is a commodity. The frame of mind that got us here—if you build it, they will come—is no longer valid. We built it, but patients no longer need to come. Now, they call or Facetime or Skype, and the care delivery community needs to answer. Employers and patients—the insurers and the insured—have grown weary of bearing the cost burden and seeing little in return, save high premiums and insurmountable deductibles. We’ve played the short game, and it bit us. Technology is on the side of the consumer. Cost-shifting is not a healthcare reform strategy—period.
The care model must transform, and the answer, quite literally, is in our hands. Think of the mobile device as your “office on the go.” That is your platform. Quite simply, we’re behind the times. We must transform just to catch up—never mind gazing into the future (yet gaze, we must).
Where does the transformation begin?
Close to home, of course. Remember—the core healthcare delivery objective is to provide health care—to deliver value to the patient (note the word “patient”—not the “insured;” not the “consumer”—the person). Care-in-place means just that—care for the patient where it makes sense to care for the patient. The office visit still makes the list, but not at the top. Why do we insist on forcing patients into an antiquated model of care when technological advances tell us otherwise? Even if we don’t consider the patient’s convenience, let’s think of ourselves. Do we really need an office visit to diagnose common maladies that are likely as effectively, and undeniably more efficiently, treated via telehealth and home-based services? (See “The Transformer Mindset.”)
After all, waiting rooms are petri dishes in the making. Arrogance maintains the expectation of access and the office visit. As described by Duffy and Lee, the office visit should be “Plan B.” It’s easy to look back—who doesn’t play Monday morning quarterback? But as we reflect, it’s vital that we use history to model the future.¹
Healthcare systems that employ physicians lose money on office visits as segregated services, yet that same system compensates physicians based on the direct visit construct. Today’s reimbursement methodology simply doesn’t support consumerism.
Many of us don’t want to acknowledge it, but the road to transformation is a customer journey—yes, customer—and is rife with opportunity to create value along the way. Think about taking a drive—we don’t consistently hit the gas or ride the brakes, or even stay in the same lane. We adjust as the journey and the road dictate. Health care is no different—we accelerate or decelerate care as the prognosis and patient needs demand.
Rotary Phone Era Designs
The advent of Medicare 53 years ago, followed by Blue Cross’ launch of expanded outpatient services coverage and subsequent denial of inpatient claims based on its view of medical necessity, put reimbursement in the driver’s seat on the provider expedition. Despite the perceived certainty that health maintenance organizations (HMOs) and capitation would rule the 1990s and value-based incentives would replace fee-for-service, providers have enjoyed incrementalism’s dominance over radicalism. The current clinical operational model was designed in the era of rotary phones and postage stamps to meet the challenges of answering machines and faxes. Think about it—the typewriter was once the hallmark of the word-processing industry. When was the last time you used one (if you ever did)?
The current combination of cost-shifting from payers to individuals—high-deductible plans to preserve commercial payers’ profits along with inevitable associated cascades—and augmented mobile and virtual technology adoption creates the probability that the consumer will drive evolution across the healthcare continuum, not limited to the physician’s office.
In the era of consumer-driven expectations and demands, high-performing organizations accept that it’s not enough to adapt existing workflows, processes, and systems. It’s imperative that we engender a discipline of collective idea generation, rapid prototyping, and continuous testing to match patient needs and schedules with what is technologically feasible, provides inherent value, and is a viable organizational strategy. We’re still playing catch-up when we should be anticipatory.
Power to the People
Your charge, then, is to stand on the following pillars:
- Respond in kind to the forward-looking patient’s evolving needs. Compete, and ride along on the customer journey, creating value at every step.
- Transition from a legacy point-of-care model to a population health platform that addresses identified health improvement opportunities. The population health model was over before it started. Do you treat people or populations?
- Today’s patient/consumer has advanced expectations of the healthcare system; therefore, our measure of access is no longer the third available appointment. Our greatest competition isn’t competing healthcare systems, niche providers, retail clinics, Aetna-CVS, or the payer forces. It’s us.
- The real and virtual worlds are one and the same to the consumer—likewise for your organization.
The concentration on population health showed tremendous promise—investment in wellness, prevention, and the management of episodes of care in a highly resourceful manner. Unfortunately, the initiative became a euphemism for moving risk from payer to provider and from provider to patient. The lesson? Cost shift is not reform. Though a sound strategic endeavor, population health management lacked effective execution, as communication didn’t flow freely. It became a bastardized shell of its noble intent, and therefore no longer a visionary strategy.
Oh, the Humanity!
The vision is to integrate digital science (i.e., technology) and biological science (i.e., best-practice medicine) to augment humanity. Human assistance enhances even the best computer simulation program. Enhanced judgment by way of real-time tools enable the human elements of empathy, ethics, choice, and exceptions to the rules to bring a personalized approach across the continuum of care.
Imagine a world where personalization—think “emotional connection”—works in collaboration with algorithms to support evidence-based care decisions. As Swiss designer, educator, and entrepreneur Yves Behar concluded, “The next frontier is integrating technology as just an everyday tool” that serves human needs, rather than viewing technology as an end in itself.
“Technologies that are changing us these days don’t come from big engineering labs, they come from technologists. The cool stuff is coming from humanists. Technology is just a tool.” ²
Leadership’s Role
That’s where we, as leaders, figure into the equation. We need to drive change and progression, and that starts with leading effective teams. It’s our responsibility to know our staff and to genuinely recognize their talents and interests so that we can help them construct career paths that foster learning and growth. If we demonstrate sincere attention to staff development and the realization of their professional objectives, we become more than in-house problem solvers. We develop purpose-driven positive energizers. We become partners in our own success and the well-being of our patients. Here’s a notion: Let’s leverage humanity.
“Health isn’t digital. Not at all. But digital health care makes perfect sense. Health care is a human construction made up of a series of decisions, interventions, and outcomes based on insights, values, and options. The options are finite, the choices are discrete, and the outcomes are often binary.” ³
I believe that Dr. Smith is evoking the human traits of skill, intuition, experience, compassion, and empathy as a world view. Technology as a device exists to make our lives easy, but it only serves as a foundation. Communication is the healthcare tool that pushes change.
However, it would be foolhardy to solely rely on technology for communication. After all, technology is a tool to help relay thoughts, lessons learned, education, common sense, and compassion—the leverage of humanity. In a complex way, technology is the digitization of leveraged humanity. The data that we enter into any device is only as good as what we as humans have collected and coalesced within our own individual humanity and personal experiences.
Technology only puts the bow on the gift that we already own—our humanity. Technology consists of algorithms that are devoid of the human experience, and rightfully so. They drive us to fact-based decisions that make sense, but algorithms are nearsighted. They focus on data that gets us from A to B. Humanity focuses on the journey.
“The hospitalized patient feels, for a time, like a working part of an immense, automated apparatus. He is admitted and discharged by batteries of computers, sometimes without even learning the doctors’ names. If I were a medical student or an intern, just getting ready to begin, I would be more worried about this aspect of my profession. I would be apprehensive that my real job, taking care of sick people, might soon be taken away, leaving me with the quite different occupation of looking after machines.”4
Model Behavior
It bears repeating: As physicians, it’s our responsibility to employ the tools, but to primarily leverage humanity. We’re as much partners as we are providers. As such, it’s up to us to break the boundaries and biases of the physician-patient relationship.
Our goal is simple—assure access and clinical reliability to optimize individual health. The tactical approach is to:
- Transition from office visits to “care touches”
- Move from point of care to “platforms of care”
- Ensure that intelligent order sets augment care team decision support
- Employ telehealth to support small/underserved markets
- Assess cost avoidance opportunity
- Balance system resources with local needs
- When pondering technological applications, consider a three-year window of available apps (actionable items will impact outcomes)
To summarize, we need to make the leap from traditional care models to population health platforms that address individual health improvement opportunities.