For those who have not read the business book “Who Moved My Cheese”, my take on the premise of the book as it relates to healthcare is that it could come down to one of two things.  Either nobody moved it, and you have not found it because you have not bothered looking for it.  Or two, you have been looking for it in the wrong place, in the maze.

Whether you have made zero attempts, or numerous attempts to find the cheese, I moved it.  And I am putting it right out in the open.  The cheese–the prize–in healthcare is consumerism through contextual, cognitive health.

Call me healthcare’s fromager.

What if instead of looking for the cheese you made the decision to make the cheese?

According to LinkedIn, I am connected to 1,117 healthcare CEOs. If this is not the year one of them decides to recast healthcare into a consumerism and cognitive model, which year is?

Let us begin 2016 by looking at the end of 2016. Let us begin by asking of those 1,117 executives, “What did you do to find the cheese in healthcare in 2016?”

I think those of us reading the answers to that question 361 days from now will be really disappointed with the answers. I suspect many of the 1,117, upon proper reflection, would be equally disappointed with their own answers. “I cut costs by 9%. We implemented valet parking. Customer surveys showed a 15% improvement in the food we served in the cafeteria. We added a Starbucks cart to our lobby. Our HCAHPS number improved by 3.14159…percent. (π. An irrational number—so is the value of improving your HCAHPS score; irrational, that is. (Sorry, I digressed.))

Mark Zuckerberg, Facebook’s CEO, stated he is going to make cheese.  He is creating an artificial intelligence concierge in 2016. Now, that is a goal. It is a big goal. It is a measurable, binary goal—he will do it, or he will not.

Dear 1,117; What is/are your goals?

Could the answer to that question come down to one degree of separation? There is something incredibly different between the numbers 211 and 212. One unit. One of the numbers represents nothing. It represents being close. It represents doing nothing. It represents the ability to do nothing. The number 211 is one degree away from being able to change the world; one degree of having changed the world.

Water, at 211 degrees, is hot. Pretty hot. Really hot. But that is it; it is not hot enough. There is nothing else you can say about 211-degree water.

However. Heat water to 212 degrees and you recast the entire world. Water boils at 212 degrees. Boiling water creates steam. Everyone knows about steam. Steam redefined the world. Not a big deal except for the person who realized that a one-degree change in temperature can cause a twenty-ton locomotive to move. Twenty tons of steel sitting motionless. Twenty tons of steel, not only set in motion, but also set in motion at your direction.

It would be so much easier to be able to report that all of the healthcare CEOs were sitting there at 211 degrees. Clearly, that is not the case. Like pin-the-tail-on-the-donkey, many of them are cold. Some are dealing with issues that are lukewarm. How many are at the cusp of changing the world, of deciding to make cheese?

CEO. Chief Executive Officer? Chief Execution Officer? Cheese Maker.  The word ‘executive’ is a noun. It does not imply action or accomplishment. On the other hand, Chief Execution Officer implies someone with a charter to do something. But, to do what? Cut costs? Grow the endowment? What, why, and what was the benefit are the questions that matter.

All of these people have their hearts and minds dedicated to improving healthcare. And that is good. What I am looking for, what seems to be missing are the handful of individuals who are tasked with rethinking, with reinventing, the business of healthcare; cheese makers; fromagers.

Not the business of how do we make more money. The business of how do we improve everyone’s and anyone’s health. Who is in your organization, be it provider, payer, or pharmacy is in charge of that? Who is the person in charge not of fixing what is broken, but of making sure that everyone under your care, patient and consumer is better served by the end of the year?

Better served means better access to your organization. It means access when and how people want it. That leads to consumerism. People do not want to have to work hard to interact with your organization; they do not want to be limited to doing it between 8 A.M. and 5 P.M. Monday through Friday. They do not want to have to pick up the phone to interact with it. Today, access is poor. And because access is poor, healthcare consumerism—unless someone is on their way to CVS—does not exist.

Once your organization, be it a provider or payer, improves access and opens the door to consumerism, the next step of the continuum to recast healthcare is context. What is the context for the interaction? And context requires a great tool set. If you know the context but do not have the tools to fully meet the context, you will have failed your consumers and patients.

Access. Consumerism. Context. Drum role…..Cognitive Health.

Population health. Population health management. I may be naive, but seems that it is impossible to manage the health of the population without knowing the health, the real-time health—how is Sally today—of any of the people who comprise the population whose health you are to be managing…and improving And who knows the health of anyone?

To those of you charged with coming up with the answer to that question, might I offer a suggestion? Just suppose all of the people within your radius of service had the ability to communicate their health information to you on a daily basis. People means those whose health data resides in your EMR, and those whose data does not—let’s call those people consumers.

What if, instead of people who have no understanding of the health data they record on their smart apps, those who have no ability to draw inference on the data they record on those same apps, could provide data to those who could provide that inference?

That would be a good thing. But when measured against the qualifier of being both necessary and sufficient that is only a necessary thing. So is a two-hundred million dollar EMR. If the most recent bit of health data we know about all of the Sallies is that they had their gallbladder removed three years, we know nothing about how healthy they are today.

What is missing? What is missing is having someone state that their goal for 2106 is to create a Zuckerberg-like solution regarding an artificial intelligence (AI) for healthcare. Alexa-like (Amazon) capability for healthcare. AI for healthcare.

The moonshot for healthcare is an AI capability for someone, for anyone, to interact with an AI healthcare ‘concierge’ and manage their health, and manage their wellness. That does not exist today.

There are a gazillion ways to record and track someone’s health data via smart apps and wearable devices. There is no way to answer the question ‘so what’, regarding any of that data.

The elephant in the room is that the only person who knows anything about the data stored on those apps or on those wearable devices is the least qualified person to know what to do about that data. The consumer.

The problem is that smart apps are nothing more than dumb apps. They are not able to tell you what you should be doing; they simply record what you did.

So, back to my 1,117 CEOs. Wouldn’t it be helpful to be able to tell people, patients and consumers, on a habitual, knowledge-based and interactive basis what they should be doing to take care of themselves, to manage their health?

None of the smart apps, none of the wearables can walk and chew gum at the same time. They cannot answer the question  ‘so what,’ and they cannot relate the data collected from one app with that of another app.

Let’s make cheese.