The Pursuit of Health Optimization
By Jeff Margolis
For over 30 years I have been burdened with Crohn’s disease, a serious and currently incurable illness. It may seem ironic that I am on a crusade to enable all the “mostly healthy” people to achieve their highest possible health status at the lowest possible cost. After all, a number of excellent physicians, nurses, hospital staff, and technicians of all varieties performed skillfully in the US “sickcare” system with surgical and medical interventions that kept me alive.
These expensive interventions, which were largely paid for by my health insurance plan, would have otherwise financially disrupted me and my family. Let me be clear in saying that I am not ungrateful for the currently inefficient sickcare system nor do I have anything less than admiration for the efforts and capabilities of the medical professionals who comprise it. And yes, I am in a small minority that fully understands the critical role of our health insurance plans in weaving together the incredibly complex fabric of access and economics for our population.
I would be unequivocally grateful for a highly efficient and holistic “healthcare” system, whereby a cultural norm of admiration and rewards for each of us being skilled healthcare consumers would co-exist in a complementary way alongside our skilled medical professionals. After all, most of us in the population are healthy most of the time. In other words, except for the sickest of us who cannot care for ourselves at all at points in time, we have the opportunity to make choices and take actions every day that affect our health status and costs.
Our society has developed the cultural norm of seeking professional medical assistance when we become sick. How do you argue that such behavior is not rational? We start that behavior when we are young, throughout adulthood, and into our last days.
Let’s play this out in contrast a bit. When we are young and hungry, we typically rely on an adult to cook for us and feed us. Likewise, when we are children most of us (unfortunately not all) receive unconditional love whether or not our actions are deserving. Somehow, as we get older, we take responsibility for feeding ourselves when we’re hungry and we learn that loving relationships require effort to maintain. We generally learn to navigate abundant consumer options in order to get nourishment – ranging from five-star restaurants to growing our own food. We also pursue multiple pathways to personal relationships.
So, who decided that we should not be responsible, either individually or as a population, for the status of our health? And when was it decided that the way in which our actions impact our controllable health factors and costs was not our responsibility?
We have a challenge to solve in the affordability of healthcare and a huge opportunity to have a healthier population. Let’s begin by embracing the incredible array of consumer-facing resources that each of us healthcare consumers can wield — whether on our own or in coordination with our doctors and health plans. These resources, propelled by the digital age, include education and content about health benefits and care; methods of connecting to other consumers with common issues; wearable and carry-able devices that give us anytime access to capture and share health-related data; programs that increase our levels of fitness, nutritional, and physical well-being; programs that help us manage our known health challenges; methods that understand our motivations and lower our likelihood of developing depression or malaise; and capabilities to incentivize and reward us to do the right things.
The challenge is (and has been) that these types of consumer-facing resources are 1) fragmented into thousands of partial solutions; 2) constantly being innovated and updated in the marketplace; 3) disconnected from the way the current sickcare system operates; and 4) not contextually attached to any meaningful intrinsic or economic benefits for the healthcare consumer.
Stated another way, the well-intended ecosystem of things that a consumer can do to achieve their highest health status at the lowest possible cost exist in a state of confusion and chaos for the healthcare consumer. Further, the consumer is not incented or rewarded (i.e., paid for performance) to be skillful in matters of our health, as contrasted to the medical professionals to whom we turn.
The promise of health optimization platforms are both practical and staggering in its enormity. Think of it this way: If we place such a platform and its capabilities alongside the existing sickcare system (which remains essential for the aspect of our health that we cannot control as consumers), then we get a new kind mathematical equation in the US healthcare system. One where the sum of the parts becomes less than the whole – with that whole being the current three trillion dollar cost of US healthcare spend.
This orginal post appeared on HISTalk in March 2015.