Dear Future Health,
We haven’t met yet. But, I’m a really big fan and when I heard you may be open to some alternative music, I couldn’t resist introducing myself. I think there are some really interesting things we could compose together . . . and, I would love the shot at rocking your world and just maybe, introducing an entirely new genre of music together.
Let me explain.
I know you have been frustrated with the current healthcare scene. High prices, poor access, low quality, and just a plain bad rap. Not to mention that nearly everyone I talk with is frustrated by the current playlist – patients, physicians, payers, and other partners. Even when your biggest fans wanted to play your tunes and provide more coverage for more people, that just didn’t seem to solve the cost, quality, and experience problems at all (we both knew that more coverage would never equal more care). Heck, many are even saying that the bands in the UK, the Netherlands, and even Canada are better than you. I know a lot of people have tried to make your style of music more popular – health consultants, payment reform, demonstration projects, and a variety of academics – – but nothing has really seemed to help you get out of your funk so you can begin to climb the charts again.
So it got me thinking . . . and, I wondered if you were open to a few ideas?
I don’t know everything, but I’ve tried some riffs that really seem to working, and I was wondering if you would be open to considering playing a few with me? It’s not much, really. It just requires you be willing to pay for a few things differently, focus on a primary care as a foundation, add digital tools to extend the reach and impact of your current providers, and ultimately, ensure access to data and insights that allow your users to take action while managing their most important asset – their health. If you want to get fancy, you could even work on developing specialized networks, centers of excellence, bundled payments, and incentivize people to be accountable for their own health (wow – novel idea!). I believe if you can engage individuals in their own health you can make a dent in the chronic disease plague that is ultimately the root cause of why your tunes haven’t caught on.
Again, all basic things – most of which have been successfully played previously – but only in parts. I would love to put all of these chords together and crank out a beautiful new soundtrack. Here is how I would recommend we compose the change:
- Chord 1 – Digital First, Technology Enabled. When thinking about building something special with you, I realize that we may not have a building at all. I anticipate that up to 70% of care in the next decade will be delivered online and occasionally in person. I believe that most care connections will begin digital first, but will have real value because they’re powered by real humans. I further believe that a new type of health record needs to emerge that will be mainly for communication and relationships, primarily asynchronous, use structured questions, prescribe standardized care plans, organize referrals inside an approved network, enable direct payment, and help your patients project manage their health conditions alongside their trusted care team.
- Chord 2 – Defined Populations cared for by Designated Care Teams. Our new health composition still has to continue to offer team based, comprehensive primary care regardless of the channel the member-patient chooses to engage in. This model is proving to be best at managing members’ health conditions over time and will be the foundation from which we build care services. Those services should include comprehensive primary care, physical therapy, chiropractic, acupuncture, mental health, and health coaching to ensure we address as many primary health needs as possible. The care model includes daily huddles on key care issues, collaborative partnerships on individual members, warm handoffs between services, and the entire workflow organized around the needs of the member. There is nothing better for a member than knowing your entire care team has your back (and the rest of you too!).
- Chord 3 – Evidenced Based Care with Proven Outcomes. “I love it when a plan comes together” is never more true than when your trusted care team puts together a health strategy that an individual can follow with support. The improved health outcomes do all the talking. Using recognized standards of care, following recommended care guidelines, and measuring ourselves against the best providers in the country allows us to demonstrate real value. The data show the integrated, comprehensive primary care model consistently reduces cost – primarily through decreased utilization of “secondary care” services as well as improvements in underlying physical and mental health. These improvements can be measured, are repeatable, and become an objective standard by which our unique care model could be proven effective.
- Chord 4 – Health Management and Care Navigation. 85% of health care spending happens outside of primary care. As a result, it is actually critical how and where referrals are made into the “secondary care” system when it needs to be accessed. Because the financial model I propose incents me to manage health care costs, I actually care about the network of specialist, diagnostic centers, and hospitals that I refer to. As a result, I built a Care Navigation service that manages >90% of all of my care team referrals and ensures that >95% of the referrals scheduled actually happen. I am able to do this by curating the existing network, surveying our members, and validating the value of episodes of care in the claims data. This is “real” network effects.
- Chord 5 – Digital Health and Care Programs. For the last 10 years, point solutions have dominated the digital health airwaves. My employer clients don’t know what to do with most of these, but I have figured out that some of these tools, apps, and devices can be used to extend the reach and impact of my providers. In fact, I created a service to evaluate, validate, and integrate these directly into our primary care workflows while ensuring I can measure their impact and outcomes. I could see us working together to adopt the best of digital health and care programs to engage members outside of traditional office visits, for specific chronic conditions, and to augment and extend the reach of my providers.
- Chord 6 – Financial Accountability and Healthcare Value. As with everything, we will have to prove wrong the “show me the money” naysayers. This can be demonstrated conclusively by reallocating money into a primary care platform, proactively managing health conditions as recommended, referring to the right network partners and then watching the costs decrease, the quality increase, and most importantly the engagement in health soar. Despite these successes, we will have to demonstrate that the outcomes achieved divided by the cost required to achieve them is both the definition and yardstick by which we measure the value we have created. We will share our successes and struggles with the world by continuing to publish results in peer reviewed literature.
We have to shake up the healthcare world, and we’re not going to do it by playing the same old tunes or even the same old instruments. I hope you can hear how the chords above come together to make some beautiful new music. While I might walk to the beat of a different drummer, I think you can see the rhythm, the movement, and the magic in how we could play, together. I understand that it might require quite a Magnum Opus from both of us to get others to see, hear, and feel what we already know – but remember – if you partner with me, all your wildest dreams will come true.
Your biggest fan,
PS – If nothing else, would love to meet you in SoCal for a surf session!