If You’re Not Seated At The Table, You’re On The Menu

If you, as a patient, are not seated at the table, you’re on the menu.

I received an email asking if I would consider presenting at TED Talks this winter. 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 non-existent. Gartner estimates that 275 million wearable devices will be sold this year.  I estimate millions of people will still not know any more about their health than they did before they bought their wearables.

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 the healthcare sectors.

Issue 1.

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 additional 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 my health except for my claim, but I am giving them a temporary hall pass because they are way too busy raising Obama Care premiums. My pharmacy knows nothing beyond whether I picked up my medication. And the firm that made the medication does not know 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 must have relevant information about current state of my health regarding the treatment I received. Without that information, they are managing air.

Issue 2.

Still focusing on the patient in Issue 1, other than the condition for which he or she was being treated, what else may be going on with that person’s 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 that data; he has been collecting it for two years on his wearable or health app. 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 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 of all apps. There is no tool that marries the data from someone’s smart watch and the apps collecting all their health data and sends it to someone who could assess it.

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, like Elvis, leaves the building
  • We have no knowledge of whether that person has other health issues
  • We can solve both of those problems
  • We do not have the leadership to solve them

Issue 3.

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 if they are healthy. The best information they have is that they do not feel ill and nobody told them otherwise.

I have a lot of data about my factors, that when aggregated, could tell me a lot about my health. But until someone who knows how assess my data assesses it I am left to judge my health.

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 build a solution.

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.

Patients are the ones not seated at the healthcare table. They are on the menu.

The good news is that I feel well today; thanks for asking.

4 thoughts on “If You’re Not Seated At The Table, You’re On The Menu

  1. close to impossible for “a firm” to undertake such a necessary project; what is needed is an independently regulated quasi-governmental (ie at 2/3 arms length) health care data agency with a single goal: to use current and esp future data and ai capabilities to find the greatest efficiencies possible for the provision and delivery of all health care services.


  2. Nailed it! So true and with so many technological and medical advancents it is unacceptable that we have dropped the ball. Sign me up. We need to get started right away.


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