I’ve been thinking about wellness lately. No surprise, really, as we’re in the middle of a three month webinar series all about wellness. I’ve been thinking about the ways the healthcare industry needs to shift and the role wellness promotion, prevention and early detection will play in that transition.
One way of looking at this change is to stop viewing the system as one physician focusing on the needs of one patient, and instead focus on how to best manage the overall health of a population of patients.
It seems like a small change. Physicians certainly tell their patients to make better lifestyle choices. And when a physician treats patient after patient, don’t they end up treating a population? The answer, unfortunately, is no. Those physicians aren’t reaching all of the people who need services or approaching the early causative factors that lead to disease in a systematic, consistent way. Most of the physician’s energies flow into diagnosing and treating issues that have already presented themselves. This is a physician’s training and it’s how they get paid.
Instead, we need to look at the problem from a public health perspective. An annual check-up isn’t sufficient to facilitate lifestyle changes. Physicians often point their patients to classes and fitness facilities as a longer-term reinforcement tool, but there’s rarely any follow-up to see if they ever signed up or attended.
This paradigm shift can be felt from the patient’s side of things, too. For example, this patient blogger, with rheumatoid arthritis, is staring down the reality that making healthy choices in life doesn’t keep people from getting sick.
It’s the difference between shifting the percentages – the chance that you’ll become ill – and the personal reality when you’re the one who loses the roll of the dice. It seems unfair that when you do the right things –stay active, eat right, and lose weight – you sometimes end up with a debilitating illness anyway.
This is part of the challenge faced by health consumers as they evaluate care options. Sure the risk of some bad thing happening is 50% higher in one place than another, but in the end if that works out to 3% rather than 2%, it’s simply not meaningful.
When we start looking at the problem on this larger public health scale, the percentages become meaningful. The one percent differences work out to dozens of patients and the problem becomes important enough to get someone’s attention – the payback is worth the time and effort required to improve.
These programs are most effective with the participation of the primary care team. Insurers have tried for years to institute programs for active disease management with little in the way of success. This is more an issue of the source of the offered assistance rather than the quality of the programs themselves.
There’s a need to add a new set of programs into the toolkit at the physician office which are proactive, targeted and persistent. It begins with the basics, such as identifying which patients are overdue for a regular physical. But it continues with actively reaching out to at-risk patients, then motivating, educating and supporting preventive activities, chronic condition management and recovery from procedures and diseases.
Certainly technology plays a role, but technology islands have failed to make a difference so far. What matters is when technology is placed into care experience. When the physician prescribes online tools. When care team members monitor and engage through those tools. When the care model shifts to be about the patient rather than about the encounter. These are the ways that large-scale change becomes a reality.
The tools exist or can be built. The challenge now is getting the healthcare system moving to embrace a new future.