The Future of Healthcare? It’s In The Past
By Tim Perry, MPA, MS, CPHIMS, PCMH CCE, CISSP
Look Back to See Where We Are Going
To celebrate its 200th anniversary, the New England Journal of Medicine published an article in June 2012 titled, “The Burden of Disease and the Changing Task of Medicine“. The authors did a wonderful job of looking not only at clinical data on disease but also shed light on changes in society that affected the prevalence of diseases. A particularly interesting part of the article is a chart depicting the Top 10 Causes of Death in 1900 vs 2010. Notice the changes.
The wonders of modern healthcare practically eradicated the three leading causes of death from 1900: Pneumonia or Influenza, Tuberculosis, and Gastrointestinal Infections. The #4 killer in 1900, Heart Disease, became the #1 killer in 2010 while Cancer moved from #8 to #2. Unfortunately, not only did Heart Disease and Cancer cause nearly 2/3 of deaths in the US in 2010 but they had each increased in the number of deaths per 100,000 since 1900. The number of deaths caused by Cancer per 100,000 nearly tripled.
Chronic Disease — A New Enemy
Both Cancer and Heart Disease, as well as a number of others listed in the chart for 2010 causes of death, are chronic diseases and are not easily addressed with conventional medical practices. This is where the Future of Healthcare is actually in its Past. Unlike infectious diseases and trauma in 1900, chronic diseases cannot be as easily cured or prevented through a medical intervention such as a pill or a procedure. The US spent $3 TRILLION on healthcare in 2014 and 86% of those dollars went to chronic diseases. Still the US is fighting, at best, a stalemate with the epidemic of chronic diseases.
So what can we do to “win” against chronic disease and thus save millions of lives and billions of dollars? The overarching answer is “Population Health”. In a Wall Street Journal article, “How Technology Can Deliver Broad Improvements in Health Care“, Dr. Kenneth Kizer of the Institute for Population Health Improvement at UC Davis said:
The term population health was introduced about a decade ago to recognize the important role that factors other than health care have in determining health outcomes. Prominent among these factors are education, employment, housing, transportation, public safety, lifestyle and the environment. [emphasis added] Many people are surprised to learn that these social determinants of health have more to do with reducing preventable deaths and improving population health than health care itself.
More of the Old, Less of the New
The real Future of Healthcare is continuing to improve on what humans have had for generations: “education, employment, housing, transportation, public safety, lifestyle and the environment.” Those companies that want to be the Future of Healthcare in the US will be those that help consumers eat better, live cleaner, make informed choices, play more often, appreciate the spiritual side of Life, and enjoy relationships with those around them in the Community. In the 2,000 year old philosophy of Traditional Chinese Medicine… we must achieve balance or harmony among the many aspects that make up our overall health.
Unfortunately, too much of our efforts has gone into new systems, new drugs, new procedures and so little has been invested in the social determinants of health like diet, lifestyle, education. The US healthcare system has spent billions of dollars on Electronic Health Record (EHR) systems that cannot easily, reliable, securely (and more adverbs) exchange even clinical data within the same health system. We will spend trillions in 2016, 2017, 2018, 2019, 2020… on pharmaceuticals and procedures and specialists and diagnostics and other clinical orders that will not stop the epidemic of chronic diseases. Healthcare costs will continue to outstrip inflation and those who have health insurance will most likely see higher premiums and/or reduced benefits as the US fends off chronic illnesses coupled with an aging Baby Boomer population.
Consumers Don’t Want to be Patients
To get some sort of relief, consumers have already started to take matters into their own hands by using their disposable dollars and time to address health issues.
The Nielsen Company and the Natural Marketing Institute (NMI) produced several insightful pieces on consumer preferences in health. Here is a nugget from the August 2014 Health & Wellness in America publication:
Baby Boomers, born in the 1946-1964 period, now control more than 70 percent of U.S. disposable income and drive much of the demand for healthy products. Fiber, at 62 percent, is the ingredient this age cohort “wants more of”, followed by antioxidants, heart-healthy ingredients and vitamins/minerals at 57 percent each, with Omega-3s and Vitamin D at 56 percent each, calcium at 54 percent and whole grains at 53 percent.
The CDC used the June 22, 2016 edition of its National Health Statistics Reports to address Expenditures on Complementary Health Approaches, relying on data from a 2012 study in the US. The analysis found “[a]n estimated 59 million persons aged 4 years and over had at least one expenditure for some type of complementary health approach, resulting in total out-of-pocket expenditures of $30.2 billion.” While many might picture those billions coming from the affluent for massages by poolside, the data showed that wealthier families did spend more on average ($590 for family incomes over $100,000) but even those families with incomes below $25,000 still spent $435 out-of-pocket for complementary health items and services in 2012.
Wired published a June 30, 2016 article by Meaghen Brown titled “Fitness Isn’t A Lifestyle Anymore. Sometimes It’s A Cult” that let outsiders in on a new health movement… the November Project where fitness has become social again, no longer strangers running silently on treadmills at a local gym but members of a “tribe” who push each other to show up at free workouts and (literally as well as figuratively) embrace each other for their efforts.
Harvard Medical School posted an article in December 2015 extolling “The health benefits of tai chi” that led with the sentence: Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” The article highlights the health benefits to those who are not in great shape but want to combat chronic disease through a low-impact, mindful exercise. While Americans continue to explore and enjoy the health benefits of Taichi (and its cousin, Qi Gong) there has also been an explosion in the use of Yoga for health and wellness among US consumers.
The opportunities to improve health through non-medical social determinants like “education, employment, housing, transportation, public safety, lifestyle and the environment” exceed my abilities to catalog them, with new products and services coming to light continuously. There is a hunger among consumers for “something better” where health is an enjoyable balance in one’s life and not an avoidable trip to the doctor.
Conclusion
We want to keep those marvelous cures that have saved so many from trauma and infectious diseases like Tuberculosis but we must also address non-infectious chronic illnesses at the root… social determinants as well as molecular pathways. Borrowing from the World Health Organization, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The Future of Healthcare in the US will certainly build on the contributions of medicine that have helped reduce so many infectious diseases and trauma from causes of death; however, health is more than the absence of disease and consumers want that balance of physical, mental and social well-being in their lives. This is the Future of Healthcare.
About the Author
Tim Perry is a partner and Chief Technology Officer at NEW Ventures LLC and has demonstrated experience and leadership thru his 25+ years of experience, which includes Chief Information Officer (CIO) of entrepreneurial startup HealthCare Too and top roles in several global organizations. Tim holds a Master of Science in Technology Management, a Master of Public Administration from The Ohio State University, and multiple industry certifications.
Editor’s Perspective
I’m happy to publish Tim’s article here, because I too believe that Benjamin Franklin was right when he said, “An ounce of prevention is worth a pound of cure.” That’s why I’ve published over 100 articles on wellness and prevention, including some on the pillars of health (nutrition, exercise & sleep) and of wellness (body, mind & spirit). I’ve also come to learn that the biggest benefit potential will come from breaking outdated business models and embracing disruptive change, so I also publish article on public policy and the future of healthcare. One of my favorite articles on this topic is Moore’s Law and the Future of Healthcare.