I received an email asking if I would consider presenting at TED Talks this fall. I read the email twice just to make sure it was not meant for someone else.
I am the guy who brought the elephant into your room. It doesn’t do to taunt the elephant—it makes you look foolish, and it irritates the elephant.
Today we are going to irritate the elephant. A lot. And then we are going to look at how to calm it down, and hopefully get it out of your room.
Healthcare has a lot of balls in the air—population health, accountable care, value-based purchasing, and the Affordable Care Act. While managing all of those, it is supposed to provide care, manage care, and drive wellness.
Healthcare’s ability to provide care is generally exceptional across the board. However, its ability to manage care is far from exceptional, and its ability to drive wellness is basically nonexistent. Gartner estimates that 275 million wearable devices will be sold this year. I estimate that 275 million people will still not know any more about their health than they did before they bought them.
Speaking of wearables, a parole officer knows more about where his parolee is than the average clinician knows about the current state of someone’s health.
Now before you get blinded with rage, permit me to explain my reasoning with an example involving all of the healthcare sectors.
Suppose I am your patient, and your health system treated me ten days ago for one thing or another. Payers, suppose you are reimbursing me for some fraction of the cost of that treatment. Retail pharma, you sent me my medication, and life sciences, you do not even know that I exist.
Given that, how am I?
None of the players can answer that simple question. They cannot answer the question because they do not have any new information about how I am doing from the day my treatment ended. Nobody is actively managing my care for the condition for which I was treated.
My provider does not know if the treatment or procedure worked. My payer doesn’t know a single thing about me except for my claim, but I am giving them a temporary hall pass because they are way too busy sprinting away from Obama Care. My pharmacy knows nothing about beyond whether I picked up my medication. And the firm that made the medication does not even know that I exist.
In short, nobody is managing anything about the care I received ten days ago. The Care Gap—the point in time from when someone knew how you were until today.
Under the existing model of healthcare, the only way anything is going to be managed regarding my care is if I initiate contact. One hundred percent of the responsibility for managing my care post-treatment falls on me. The problem with that model is that I am the least qualified person on my care team to manage my care.
Manage is a verb: I manage, you manage, and he, she, or it manages.
To manage my care somebody has to have relevant information about my current state of health regarding the treatment I received. Without that, they are managing air.
Still focusing on the patient in Issue 1, other than the condition for which he was being treated, what else may be going on with his health? Suppose that over the last four months the patient’s weight increased by twenty pounds and, unknown to his PCP, his blood pressure had increased from 80/130 to 95/145.
The patient had all of that data; he’d been collecting it for two years. He’s also been collecting beer cans. But, he knew more about his collection of empty beer cans than he knew about his health data. His data uploaded automatically to his laptop every day. And there it sat in dozens of disparate folders in a digital version of Al Gore’s lock box on his C drive.
The disparateness, if left unchecked, might kill him. And that would be a shame since he had all of the data necessary for someone to know that he had a serious health problem.
Unfortunately, there is no app that serves as a data aggregator. There is no tool that marries the data from someone’s smart watch and the apps collecting all of their health data.
So to summarize where healthcare’s care and wellness gaps are concerning the first two issues:
- We have no knowledge of the health of someone who was treated after they leave the building
- We have no knowledge of whether that person has other health related issues
- We have the ability to solve both of those problems
- We do not have the leadership to solve them
Healthy people—people not under care. This is the largest group of people. For many of them, they fall into the healthy category only because nobody told them they were not healthy.
And that gets us to the crux of the problem. On any given day, most people do not really know whether they are healthy. The best information they may have is that they do not feel ill and that nobody has told them otherwise.
I have a lot of data about the factors, that when combined could tell me a lot about my current state of health. But until someone with the knowledge to assess my data actually assesses it I am left to rely on how I feel.
We do not have to settle for that. This problem could be solved within a year. What is needed is a tool capable of aggregating, monitoring, and assessing someone’s health data on a regular basis, and a firm with the desire to built it.
Until then, population health and accountable care are just pipe dreams. You cannot manage the health of the population when you know little or nothing about the current health of the individuals in that population. How can healthcare profess to provide accountable care when it knows nothing about my health from the time I walked out the door.
There is a lot of talk about Big Data. There should be a lot more talk about No Relevant Data.
The good news is that I feel pretty well today; thanks for asking.
1 We have no knowledge of the health of someone who was treated after they leave the building.
2 We have no knowledge of whether that person has other health related issues.
3 We have the ability to solve both of those problems.
4 We do not have the leadership to solve them
Yes, for (3) – we did it, others may have or could have done it,
See Coast Healthcare Management e-hub press release at
except they got bought out before things got going.
As for (4), the state of affairs right now is we have “leadership” in the form of government regulations that pretty much blocks initiatives to put any significant focus on wellness.
You perfectly describe the healthcare paradox that keeps anyone from suggesting that we should re-build the health system in the US from the ground-up. i.e. Burn this mother down and start over.
Because we have a “Heroic Healthcare System” many of us marvel at the dramatic and impressive ability of our system to save lives. But we need a “Persistent Healthcare System” which intervenes when inexpensive and sensible solutions could steer patients towards a healthier future.
The increasing role of government and especially the federal government with its massive spending profile has turned the system participants into lemmings who have learned to follow reimbursement. We need to train ourselves to listen to better pricing signals, because they are there and chirping loudly.
I think or at least hope that we are on the cusp of a massive attitude shift driven by consumerism in healthcare. After several years of high deductible insurance policies we are starting to see the Patient/Consumer awake and ask new questions. General Practitioners are beginning to see that the money is in their patient’s wallets not their back-office operation churning out insurance claims.
My path into the healthcare industry was via the telecom industry where we know the health of a fan in an equipment cabinet and monitor for signs that it will fail so we can replace it before is causes an outage. The reality that we don’t track key metrics of a frail 70 year old with several chronic diseases is stupid because it is so easy to fix and incredibly cheap.
James, thank you so much for making the time to share your ideas and feedback