One of the problems that we have in healthcare is that we love labels (probably not restricted to healthcare). Labels are easy because it allows us to classify groups of things without individual nuances. That works for things like blocks (square blocks vs. rectangle blocks) or for technology (smartphone vs. tablet vs. desktop) but it’s really hard in healthcare to apply that to people. But that’s what we have done.
We have created these very ambiguous silos in healthcare to help people better manage their health when they are not in a clinical setting (which most of us aren’t that often). We call it wellness or disease management. Unfortunately wellness gets assigned to people that are generally in a state of good health (let’s keep it that way) and disease management is about people that are in a state of bad health (let’s fix you). Hmmm. It’s just simply not that black and white. The problem is even worse in that wellness tends to be an “employer” program and disease management tends to be offered by health insurance companies. Hmmm. It’s just not that disconnected.
With outcome based reimbursement, physicians are motivated to keep track of patients that aren’t adhering to a course of prescribed care. How are physicians going about doing that? Well, they aren’t doing it that well. Once the patient leaves a clinical setting, the data feedback loop that helps a physician intervene when there is an exception is far and few between. Yes there is population health software that helps identify patients but the programs that actually activate and engage? Not happening.
Many patients don’t have a costly disease yet (a few risk factors maybe) but it might be incumbent upon the provider to recommend continued engagement around movement and nutrition. Maybe one person also needs a bit of coaching support because they respond well to that. Maybe one individual has a significant financial burden and would benefit from connecting to an advisor that could work with them. We know that stresses in other areas of life can have a dramatic impact on health. So what label would you place on these people? Wellness or Disease Management? Neither….it’s called PERSONALIZATION.
Health plans are also really motivated by personalization. They have mandates through Medicare (STARS) to deliver individual programs that if not delivered effectively could threaten their status as a Medicare Advantage provider. They also have ratings they are driving like HEDIS (Health Effectiveness Data and Information Set) which have a big impact on their marketability to employers. Putting the right program in place for the right person at the right time (so that they actually use it) is essential.
Technology is also driving the benefits of personalization. Millions of us are carrying around smartphones or wearable devices tracking certain health statistics (steps, heart rate, miles, etc.). This technology is by no means limited to the wellness or disease management label. The data is about each individual person, where they are in their life, what success looks like for them, and what value they receive from their progress.
Posted on July 31, 2015 03:00 PMComments: