Transforming US healthcare into a whole person care system
Of the US healthcare system’s innumerable problems, three in particular stand out as the biggest priorities to address. The system is built to optimise billing, rather than to actually care for individuals. It focuses on assets, rather than on people. And it provides episodic care, rather than a true continuum of care.
From the recent New York Times article warning about the “moral crisis” a lot of emergency physicians are experiencing, to the Radical Health Festival noting that health systems are being “squeezed” by a variety of factors, it is clear that change is needed.
From built-to-bill to built-to-care
There is a way. I call it flipping the system to embrace whole person care. That’s not just an abstract concept or slogan. It’s an actual approach to providing care, and the examples I have seen of whole person care orchestration give me great optimism about the future of healthcare.
If we flip the current built-to-bill system to a built-to-care system, healthcare consumers and providers alike would be healthier as a result. Whole person care checks all the boxes of the Quadruple Aim: it enhances the patient experience, improves population health, reduces costs, and improves the work life of healthcare providers.
A better system is attainable. We know that because there are solid examples of healthcare organisations embracing whole person care and successfully achieving Quadruple Aim metrics. Whole person care is consistent with value-based care and some of the other enabling tactics that we've seen begin to take hold in the market.
Whole person care orchestration
Our challenge with the legacy healthcare system is that it’s full of messy hurdles. We have to take those apart and put them behind us in order for whole person care orchestration to succeed. I believe we can do that. In fact, I believe we can see whole person care become the dominant model for the majority of healthcare consumers in the US by the end of this decade.
Organisations that have embraced whole person care have every incentive in the world to keep you well. They stand in contrast to the giant integrated delivery networks (IDNs) that aggregate ambulatory care services around a hospital bed.
When I am in the hospital, it's because there's something acutely, horribly wrong and I desperately need medical expertise. We need hospitals, but we should reserve them for catastrophic circumstances.
Unfortunately, we’ve allowed IDNs to make the hospital the centre of gravity in the healthcare system because of how we have paid historically and the systems that are ‘built-to-bill’. Allowing all the ambulatory care services we consume in our lives to remain aggregated around a hospital bed is a mistake in alignment.
So, there is some taking apart of the IDNs that has to happen. There will be a couple of big brands that will get bigger and survive, but there will be more and more separation between acute and non-acute. And that's a good thing, because non-acute care shouldn’t be held captive to the legacy built-to-bill hospital systems.
How technology can help
Going forward, we can see refreshing new ambulatory care models that are personal and focused on the consumer’s satisfaction and wellbeing. Two of the biggest are UnitedHealth Group and Kaiser Permanente, with smaller ones that are able to pivot and operate with more agility.
This transformation towards whole person care orchestration wasn’t really possible a decade or two ago because the technology didn’t exist to amplify our human capital. We had to do everything with people.
The pandemic dramatically accelerated the proliferation of technology into all sorts of new nooks and crannies in the healthcare system. Technology has become smart enough to enable this move toward whole person care.
For example, Generative AI models are allowing us to amplify our human capital more than ever before. This means we don't need more doctors to provide more care, which is good news for both providers and consumers.
Technology can reduce or eliminate certain tasks. Let a machine deal with the drudgery, while humans handle high value tasks and more personable care. Technology today allows clinicians to operate at the top of their license.
Our technology is making it possible for one care team member to affect the wellbeing of, in some cases, thousands of individuals, instead of the old one-to-one person ratio. So, we don’t need to let the headlines and surveys showing we’ll be facing a nursing shortage to become our reality.
Technology will also accelerate our ability, in a whole person care paradigm, to create hyper-personalised care plans for each individual healthcare consumer. And we’re talking about care plans that are holistic, not episodic.
They’re based on a huge amount of data that allows us to think outside the traditional confines of healthcare. Say you’re an elderly resident living by yourself in south Florida, and you’re managing a chronic condition - or more than one, like many Americans. Let’s say your air-conditioning system is on the blink: the heat in your home affects your health, all the more so because of those chronic conditions.
You may be far better off having somebody come to fix your air conditioner than going to the emergency room when your health hits a tipping point. On top of getting your air conditioner fixed, your personalised care plan could also call for tele-visits and even a home care visit to make sure your conditions are monitored, your mental and emotional health are factored in, and you can stay in your home where you want to be, while avoiding unnecessary hospital acquired conditions.
Technology-enabled, but data-fuelled healthcare
All of that not only takes the right technology, but also lots of data. We're never going to know every single thing about a person, but if we pay attention and are intentional about the care that we are aiming to orchestrate, then the more we learn about a person and the more personalised we can make their care.
Every care interaction is an opportunity to learn even more, which means we need to capture that information and make the best use of it on behalf of that healthcare consumer. The process becomes a virtuous circle of data-driven personalised care.
So, technology-enabled, data-fuelled whole person care replaces the IDNs’ hospital-centric approach with a consumer-oriented approach that is organised not around a billing system, not around hospital assets, not around making someone come to a facility for ambulatory sub-acute services - but around achieving and maintaining a person’s wellbeing.