Converging to Consumer-Centric Care

Previously in our series about the U.S. Healthcare System, the discussion has been about issues, alignment, and trends.

Now, it is time to talk solutions.

Healthscient believes healthcare must become consumer-centric…not insurance, health system, or physician centric. The focus must move to health, not healthcare…to consumers, not patients…to proactive and preventive, not reactive and medicated. The new path is to reconnect the consumer and the primary care physician, to focus on achieving long term health as naturally as possible, and to become very consumer-centric.

Here are our four tenets of a healthier, low cost path forward:

     A. Seek consumer-centric care – control your health decisions and data

     B. Partner actively

     C. Embrace monitoring, testing, and improving your biology

     D. Restructure health insurance and major medical risk

 A. Seek Consumer-Centric Care – Control Your Health Decisions and Data
This path forward is taking shape, and the benefits are becoming obvious. Focusing on health – not healthcare – is a prerequisite. The goal of proactive, preventive, consumer-centric care is improving the overall health of engaged consumers. Overall healthcare costs go down as health improves because a greater percentage of major medical costs are avoided.

Consumers will have to pay more for primary care to reduce their healthcare costs overall. This view may be counterintuitive for some. But paying more for performing preventive maintenance to avoid larger costs and consequences later is solid advice in most areas of life.

As healthcare becomes more proactive and preventive, you can and must take control of your health decisions and health data. As a healthcare consumer and patient, you should not be a passive participant. Instead, you should be an engaged partner with your healthcare providers. Demand that your primary care physician, specialist, and health system provide you visibility and permanent copies or access to your healthcare data. You paid for this information and should have immediate access to it for the rest of your life.

B. Partner Actively
Seek out and partner with physicians and clinicians that are aligned financially and clinically with you to optimize your health, not to providing you healthcare. The goal is to avoid health issues and healthcare. You need clinical expertise to a) address medical issues which arise and to b) guide your journey to optimizing your health for your age and physiology.

Your health is your greatest asset, especially in retirement. Better health improves life and conserves money. Poor health decreases joy and energy along with draining financial resources. For better health and lower total healthcare costs, pay more for primary care and wellness. You need an expert guide for optimal health. Find a physician who has the time and expertise for discussing wellness, nutrition and physical performance and who is financially aligned to your clinical success.

AJMC Dec 2012

In the December 2012 edition of The American Journal of Managed Care, the article,“Personalized Preventive Care Leads to Significant Reductions in Hospital Utilization”, reported that increased physician interaction and proactive, preventive care lowered hospitalization utilization and overall healthcare costs. The model and physicians network analyzed was MDVIP, which is a personalized healthcare or concierge medicine network. It was not a minor reduction. As shown in Figure 1, hospitalizations for individuals with commercial insurance ranged from 49% to 72% per year.

AJMC Dec 2012

In the Medicare population, the reduction was more significant with reductions from 71% to 79% per year. Amazingly, the Medicare readmission rate (readmission to the hospital after being discharged) was reduced by 91% for pneumonia, 95% for congestive heart failure, and 97% for Acute myocardial infarction, as shown in Figure 3.

Virtuous Cycle of Accelerating the Advancement of Medicine
As technology lowers our costs to diagnosis illness, monitor biometrics and physiology, and track real world health outcomes, our insight into the accuracy and effectiveness of both diagnosis and treatments will increase.  Healthcare will begin a virtuous cycle of continually refining and improving both diagnosis and treatment from this much richer set of real world data from ongoing patient treatments. As diagnostic tests improve in accuracy and treatments become more targeted, medicine moves closer to being a pure science rather than a combination of art and science. It is the complexity and unknown aspects of our physiology and medical treatments that have kept healing a blend of art and science. The unknowns regarding our physiology will be uncovered at an ever-increasing rate as our imaging tools gain magnification and clarity and the ability to embed small and eventually microscopic sensors provide additional insight into our biology. This new knowledge will further accelerate the virtuous cycle of improving diagnosis, defining more effective treatments, and improving health outcomes.

C. Embrace monitoring, testing and improving your biology
With your healthcare information from healthcare providers and diagnostic information from new sensors and tests, you can become a well-informed consumer. Wearables, sensors, and low costs diagnostics will highlight issues early for those willing to act and pay attention. Leverage these low-cost diagnostics for genetics, biochemistry, infectious agents, and biomarkers as they become affordable for you.

More insight will be gained regarding the underlying causes of chronic issues and how to leverage natural methods of diet and exercise to cure, improve, or avoid these issues. More now than ever, behavior management and healthy lifestyles will be vital to improved health and lower risk of serious health issues and associated costs. The amount of health and medical knowledge on the internet is immense, and new solutions are evolving to connect patients with similar chronic issues and better curate complex medical knowledge.

D. Restructure health insurance and major medical risk
Combine the improvement in accuracy and effectiveness in treatment with proactive and preventive care and the healthcare cost curve doesn’t just bend. It breaks and heads downward. To remove the administrative burden and the unnecessary complexity at the primary care level and to gain the benefit of proactive, preventive care, the current employer and health insurance paradigms may have to adjust. Direct alignment for clinical and financial success must be in place for the consumer and the primary care physician.

Health insurance will need to extract itself from primary care, which is more about health and health maintenance, and return to focusing on the insurance aspects of hospitalization and catastrophic coverage. New alternatives to health insurance are popping up to support individuals and families that are focusing on healthy living, more engagement with their primary care physician, and the need to manage the risk of major medical issues. Medi-share and Liberty Medi-share create a community of consumers funding and sharing major medical costs of the community. With the sharing of medical expenses, they manage the risk without insurance and fill the void of lower cost hospitalization and catastrophic coverage undermined by the ACA aka Obamacare.

Combining strong primary care, like Direct Primary Care or Concierge Medicine, with hospitalization or catastrophic insurance or medical cost sharing programs can create a comprehensive healthcare solution that results in enormous savings over Obamacare Health Insurance Exchange plans or individual plans. If employers embrace these plans for their staff, they can also achieve these savings while providing a “concierge” level of health care to their employees. Self-insured employers may have additional options to leverage HRAs to fund employees primary care monthly membership costs, negotiate lower specialists’ costs, and engage a reinsurance company to manage their risk from employees’ major medical issues.

These models will work best for the engaged consumer, who gains the benefits of being proactive and making good health decisions. There will be portions of the population that will not embrace the additional effort to improve health and will rely on reacting to health issues once they cannot be ignored. There will always be accidents and serious illnesses that are not easily found or prevented. But Ben Franklin’s statement, “an ounce of prevention is worth a pound of cure”, is more applicable now than ever.

Recapping the Healthier, Lower Cost Path Forward

So, in review, how do you leverage these trends and changes to lower your healthcare costs while improving your health and having a better relationship with your physician?

D. Restructure Health Insurance and Major Medical Risk
Returning to a direct relationship with a primary care physician, who has a focus on health and fitness and not just medicine and services, will reduce overall healthcare costs and services. Combining strong primary care with hospitalization and catastrophic health insurance or a medical cost sharing solution can cut annual costs by half.

C. Embrace monitoring, testing, and improving your biology
Embrace monitoring and tracking technology for your biometrics, fitness, nutrition and treatments. The better you know your body and what is normal for you, the better you can work with healthcare providers to determines issues and address them early. Embrace nutrition and fitness as both are key drivers of long term health and a significant cause of illnesses, if neglected. Both food and medication have side effects. Do not underestimate the impact of either.

B. Partner Actively
For better health and lower total healthcare costs, pay more for primary care and wellness. You need a physician who excels at treating illness and becomes your guide for achieving optimal health. Find a physician who has the time and expertise to partner with you regarding wellness, nutrition and physical performance and who is financially aligned to your clinical success.

A. Seek Consumer-Centric Care – Control Healthcare Decisions and Data
As the consumer/patient you have the ability to be more of an expert in your individual health than health care providers. Leverage the healthcare industry and your primary care physician as medical experts but retain control of your healthcare decisions and ensure access to your health data. Only you can weigh the value and benefits of medicine and treatments to your goals for your life. The best healthcare is the result of partnering with your healthcare providers.

Remember that your health is your greatest asset. Good health increases mobility, broadens opportunities, and conserves money. Poor health decreases joy, energy, and your bank account.

About Healthscient
Healthscient is committed to supporting patients in understanding their physiology, improving their health, connecting with expert clinicians, and leveraging technology to improve the effectiveness, efficiency, and accuracy of healthcare. Through our website, we highlight beneficial trends and solutions relating to health, technology, and consumerism in healthcare. In 2018, Healthscient will launch products to assist physicians and their patient customers in establishing productive, dynamic partnerships that support patients’ journey to optimal health and fitness for their age and physiology whether they are at home, in the physician’s office, or traveling the world.

Join Our Newsletter
If you would like to get updates on our published articles and get our quarterly newsletter, please sign up at Join Our Newsletter.

 

Matt Larsen, Principal, Healthscient

 

 

by Matt Larsen, Principal, Healthscient

Email: matt.larsen@healthscient.com
LinkedIn: Matt Larsen
Twitter:  matthewrlarsen

Published on Healthscient.com: Nov 16, 2017