The Central Myth of American Medicine

In recent years, there has been significant progress in trying to predict future disease both by statistical and biological methods.  The combination of genomics and artificial intelligence has proved to be quite powerful in moving us along a path that can drive better disease prediction.  I spend most of my working hours with this effort driven by my assumption that early warning will lead to better interventions to fight disease and ultimately to better health.  But I can’t be 100% sure. What if all those predictions only cause anxiety and confusion? I thought about this as I read an article in the WSJ about too much messaging, coming too early dulling our reactions.  This was in the context of storm prediction but similar principles apply in health and disease.  Ultimately, with both storms and impending illnesses, the questions are all about what can be done to either prevent or at least mitigate the potential catastrophe.   Do you want to be able to plan, to take medication to lower the risk, to change your lifestyle? Or will all that information just create anxiety, depression and contribute to a nihilistic type of fatalism?

In the case of storm prediction, the article pointed out that “More accurate data gives more time for emergency planners and residents in a storm’s potential track to prepare. But the long lead-up also can result in saturation storm coverage and social media hype that leads some people to tune out.”

It goes on to note that “continual storm coverage was a source of annoyance for many and led to fatigue for some, adding to concerns that information overload would lead them to miss key communications.”  The earlier the information is obtained and given, the more likely it is for the information to inform, but also the more likely the information will ultimately be wrong. Time is an important variable, and it has a habit of changing things in the weather as in life.  

Health plans, health systems, private companies, and government are all using huge data bases of claims, medical records, genetic data, and anything else they can find to create algorithms or formulas which can predict our future health.  These efforts are having some success, and as someone who works in this area, I expect our abilities to increase. But will we actually be helping by predicting? Will we be contributing to an unhealthy focus on disease prevention instead of healthy living or to a numbing of a message that change is needed?

The questions we are attempting to answer almost appear to have a biblical quality….Who shall live, and who shall die?  Who shall be infirm and who shall be healthy? I am Jewish and will be stating words very similar to these in the Rosh Hashana and Yom Kippur services which are around the corner.  We say this as we pray for forgiveness and hope that in the coming year we will be blessed with health and happiness. It does seem almost God-like to be able to predict in this way.  But it’s important to remember that our predictions are never 100% accurate, and that even if they are, we don’t really know if the predictions will help or not.

The optimists among us believe that these predictions will allow us to intervene and help prevent the diseases before they appear.  The pharmaceutical companies believe that they can develop medications to forestall and prevent diseases before the illnesses express themselves to the detriment of the patient.  Those in the wellness fields believe that changing lifestyles will forestall the “ultimate decree,” as is said in the prayer book for the High Holiday services.  

But we don’t really know, and we also don’t know if we will just be creating undue anxiety and depression.  We don’t know if we will contribute to information overload that does not really help those we hope to impact most.  We don’t know if our new medications and our new approaches to intervention will ultimately lead to unintended consequences that may be harmful.  

We don’t even know how much people want to know.  We do have experience of a sort from the testing for genetic diseases that offer people some predictability.  Huntington’s Disease is a genetic illness and was one of the first genetic diseases for which there was a definitive test to see if someone was a carrier, or likely to have the disease.  It is a disease in which brain cells are killed and which leads to death. Since we can identify people who will likely develop the disease, it is informative to see how often people want to know.  A review from the BMJ showed that only 10 to 20% of those people at risk for Huntington’s Disease end up being tested after being approached and offered genetic testing.  The other 80-90% prefer not to know.  

Perhaps they are right.  After all, life is not about avoiding illness.  Rather it is about enjoying your time on earth and making a difference to those around you.  While health is a central element, it is not the only element. Living your life with a focus on avoiding disease may be the right decision for some, but for others that focus on disease may prevent them from focusing on family and friends. 

All that is not to say our prediction efforts and our attempts to decrease health risk should stop.  It certainly is a big part of what I do every day and I am proud of my own work and believe it can improve people’s lives.  All this brings me back to the title of this blog post. The central myth of American medicine is that Death is Optional. It is not.  Life is a fatal disease. I for one believe that the efforts to predict disease must be tempered by the knowledge that we must use predictions to help people live the lives that they want to live until the moment they die and allow the focus to be on living rather than disease prevention at any price.  I question whether the desire to tell everyone everything about the future may end up making us sicker than we started.  

Tracking Hurricanes and Predicting Illness

As I watched the slow moving disaster known as Hurricane Dorian this past Labor Day weekend, it struck me that the prediction models for both the direction and strength of the hurricane kept changing.  The striking fact that was clear as I sat in the safety of my Chicago condo, was how hard it is to predict exactly where a hurricane will go and how strong it will be.  Different models had it originally heading across Florida into the gulf and later models were constantly being adjusted and changed.  Eventually, it hit the Bahamas, made a hard right turn, and it did not hit the American mainland until it meandered up the eastern seaboard to North Carolina.   An article in the Wall Street Journal about difficult in creating the predictions quoted Matt Lanza, managing editor of Space City Weather, as stating, “I’m constantly amazed at what just one tiny change can do to the whole picture.”

I understand.  I have spent a good deal of time and effort leading a group of very smart data scientists, clinical informaticists, health economists and statisticians in developing algorithms to predict the “path” of illness in order to better intercept and intervene before disaster hits.  We have the advantage of using the largest commercial claims data base in the US and possibly in the world, with over 40 million people per year.  It is also possibly the most up to date health care claims database, as it is refreshed monthly, and the database with the greatest claims history, as it reflects 10 years of claims.

Yet even then, it is very difficult because “one tiny change” can have a dramatic impact.  Medicine and health care are filled with low probability and high consequence events.  Life is as well.  Recently, we have been working on a model to predict people who are likely to be sick enough to generate $250,000 in claims in the coming 12 months.  It means predicting any illness, all of which have different profiles, and different patterns that lead up to catastrophe.  Thus, there are many numerous variables to predict numerous disease and combinations of diseases.  This creates a data science problem that belies an easy solution.  It means identifying someone who will be one of the 1 in 7,000 people to be sick enough to generate $250,000 in costs.  The nature of the prediction  challenge is also to identify those who are likely to have an illness that we can impact with proper treatment and/or proper support to improve the outcome.  A missed prediction could mean a person has a much worse outcome, even death or disability.  A personal “hurricane” that one may not be able to withstand.

The data that one uses must also include all factors that are present when a person becomes ill.  That means including data on emotions, social factors, finance and culture, among others.  If someone you love is in an accident and you are speeding while distracted while going to the hospital, you are more likely to have an accident.  That is a data point that medical records or health care claims will not reflect.  If you have just been fired from your job, that is another datapoint.  If you are poor and/or lonely, these are extremely important factors in trying to predict illness.  It is not just biology.

But biology is the central pathway, and claims databases, while reflecting medical care and medical interventions and encounters, are basically financial databases.  Electronic medical records, genomic information, and social information must be integrated into co-mingled databases to make analysis and, more specifically, prediction more powerful.

With healthcare, as opposed to hurricanes, there are issues of privacy and confidentiality that bring legal and ethical issues into play when combining data.  Dorian does not care if we know the details of its hurricane force winds but Jane Smith might care a lot that we are using her genetic information, combining it with her financial profile, any police record, her family dynamics, her friends and her spirituality to try and predict any illnesses and healthcare needs.

All these data feeds help us to become more accurate, but even if the privacy concerns are overcome, there will always be uncertainty. Progress will increase with each new insight, but someone can always trip in their own home and break an arm.

With each new insight we gain more predictability. Recently, in trying to predict patients who are likely to have very high costs due to critical illness, we found that the “velocity” of their medical activities was a useful variable in building our models.  To calculate this requires a different algorithm to feed the algorithm.

In other work I am doing, we have found that knowledge of the genetic makeup of the bacteria that are in a normal human intestinal tract, part of the microbiome, can help predict things like sensitivity to medications, propensity to diabetes depending on diet, and disease activity in someone with Inflammatory Bowel Disease.  Thus, the microbiome data has become an important variable in predicting disease.

And yet, our society demands perfection and immediacy.  In another article about forecasting the path of a hurricane, it was pointed out that forecasts tend to define a forecast cone.  The forecast cones have gotten significantly more narrow in the last ten years due to better measures and techniques, but there is still a 1 in 3 chance that the hurricane will be outside the cone completely.  That is far from perfection.

I believe that in healthcare, it will be no different.  We will make progress and get better with our predictions, but we must always remember that there will always be uncertainty in medicine.  We will need to better differentiate between the need for huge databases, such as the one used by my team, and the deep data that will come from more knowledge of the individual, and how the the two will interact.  In a future post, I will talk more about big data and deep data and how they both must be used.  Ultimately, there will always be some uncertainty, but we can decrease it incrementally in our quest to improve care.

Restarting - It Appears I Have More to Say

I have taken a hiatus of a few years from writing these thoughts, opinions, and occasional facts about health care, health economics and health benefits.  The hiatus came from a lack of time, a shift in my focus, and a need to rethink my reasons for writing.

During this writing lull, I have continued to fight for approaches to health care that are data driven and humanistic.  I have continued to fight entrenched ways of doing things, the use of health care for political means,  and the decisions made based on poor judgement, faulty data, and over reliance on blunt instruments.  I have continued to fight organizations that make decisions based on protecting their own positions and organizations rather than understanding and addressing the needs of people who are suffering.

I have seen health care attorneys look at all health care through the lens of the contract, health care data scientists look at all health care as new data algorithms to be developed, and internet entrepreneurs look at health care as their latest app.  With all this, I have also seen physicians move from being independent patient advocates to being shift workers paid by large systems whose goals sometimes seem to be more focused on margins and growth than on caring for those in need.  I have seen ego and wealth generation driving decisions instead of healing those in pain.  I have also seen brave, caring professionals who get up every day to fight for the patient.  I see those people getting tired and beaten down by the system in ways that are sad to watch.

So I will start again to put down my thoughts and observations in writing for anyone who cares to read them.  My first blog post will be posted shortly, and I thank those who do take the time to read it.

Healthcare, Humanism and the Humanities

I am returning from a prolonged trip in France visiting my son, daughter-in-law and nine month old granddaughter followed by a few days in Amsterdam. In many ways, the trip has been an emotional journey more than anything else as my wife and I were able to hug, and play with Hannah, our French-American grandchild.  

That trip was all about emotions, history, art, and family.  It was about different cultures and traversing lands with different languages.  In the glow of that trip, I can't help making some observations on health care.  I ask myself whether, in a humanistic endeavor such as health care, do we leave out, or under emphasize those aspects of life I focused on during my trip.   

In France, I lived with my son and found myself in the rhythm of French life. It is a life that reflects French culture and values which appears at first glance to be focused more on the everyday than the goal oriented life that I see in the United States.  There is a saying that people in the US live to work and people in Europe work to live and I wonder if there is a kernel of truth to that. Just to clarify, I am speaking of small town France and not the frenzied Paris life that is similar in major cities worldwide. One can find a closer parallel in small town America than one can probably find in Paris to my French trip.  There appears to be, in the tradition of Rousseau, great value given to the logic of a balanced life. As Rousseau said, "Happiness: a good bank account, a good cook and a good digestion."

Our life there took on a certain rhythm that did revolve around our meals.  This is especially meaningful to me as a gastroenterologist and expert in nutrition. Meals were savored over time with real focus on the food; stores closed midday so storekeepers could enjoy their own long lunches; walks were taken slowly after lunch. It took a while for me and my wife to get comfortable walking slowly.  In many ways, what we now call mindfulness seemed to be part of my son’s family, and my daughter-in-law’s extended French family daily living. Of course people work and are productive and have all the worries that people all over the world have.  The attitudes towards those needs appear to be different.  We would stop in the afternoon at a cafe to give our granddaughter a snack as we sipped wine and watched nature, people and the world around us. History was all around us as these buildings we sat in could have been built in the 1600s.or 1700s.  I returned feeling like I had done nothing but eat and found that I had lost weight.  (I discussed this after a previous trip to France in a blog entitled “How I Spent My Summer Vacation and the French Paradox”). 

On our stop in Amsterdam on our way back home, we went to the Van Gogh museum and I was struck by all the medical aspects of his work and his history.  The painting “Two Hands” that show working hands that are thick from manual labor but also seem to have some contractures that may be indicative of arthritis show the intermingling of life and work.  His “Head of a Skeleton with a Burning Cigarette” should be used in programs to stop smoking. 

What I am describing, in an academic sense may be seen to be part of cultural anthropology, art history, sociology, philosophy, and history. Throw in a dose of academic French, enology for all the wine we had and a bit of high level culinary art and it became apparent that our experience in France and Amsterdam can be intellectually understood from study of the humanities rather than just, for example, from geography. Just as one cannot interpret a trip such as ours as being only about geography, one cannot interpret a trip to the doctor to be only about biology. 

Life is all about balance and good medical care is all about life.  It is not only science.  Our health professionals should be well versed in disciplines that help them understand that balance.  That may mean more use of literature and more instruction in psychology, sociology and anthropology.  I don’t have an answer of a specific curriculum to recommend.  I only know that we must do all that we can to prevent our medical and nursing education from driving the humanity out of the talented people who choose those paths.

There is a concept that is reflected in a number of sources, most notably the Zohar, the Jewish book of mysticism, which states that evil occurs when there is an imbalance between love, wisdom, justice and glory.   In some ways, the science of medicine often reflects the justice and the glory.  The evidence based algorithms and those in medicine who believe that they have all the answers to the dilemmas of health care produce a certain regimentation which creates a framework for justice and the entrepreneurial and the academic aspects of health are often driven by those in search of the glory.  While individuals have tremendous love and wisdom, it may not be built into the system to the degree needed to prevent a system designed for good from having evil elements.  I remain optimistic that movements such as the Narrative in Medicine movement which stresses the importance of storytelling as part of medicine will take hold and be important in the education of health professionals.  In order to have that happen, we need to bring more humanities into the teaching of medicine and nursing.  After all, we want the health professionals who will be at one point or another caring for all of us to be holistic caring people who understand the impact the illness has on our life as well as an understanding of the illness itself.  

The Balancing Act of Health Care

Closing one chapter and opening another is an opportunity for reflection.  I have used the two months since I last wrote a post to determine how I can continue to have an impact on health care, while having the most fun as my work and life journey continues.  That has created more questions than answers and more shades of grey rather than sharp lines of clarity.  However that is good.  I have always believed that questions are more important than answers and that those with perfect clarity about a situation just do not understand the situation well enough. 

So it is with health care.  Health care is filled with questions, with difficult choices and with confusion for patients, for health professionals and for health policy experts who want a neat and clean answer to our system challenges.  In other words, health care is a terrific reflection of the human condition and must be seen as a part of the complexity of life.  While the understanding of human physiology and pathology may one day be totally answered by science and amenable to computer generated algorithms (although I doubt even that), health care has always been about more than biology.  Emotions, social interactions, finance, culture, communication, spirituality all are part of health care and they don’t all follow simple biological rules.  Even the biological sciences obey the old saw that the greater the knowledge of a topic the more unknowns that surface.  Good scientific answers tend to elicit new and more questions rather than simply settle old questions.  An economics joke is told by doctoral students (mentioned in a Bloomberg Business Week article) that the questions on the doctoral exams haven’t changed in 50 years but the answers have.  The same can be said of medicine.  In health policy debates we often hear the term “scientific fact” however the true scientist, including the true medical scientist, knows that “facts” are never written in stone and that the teachings of today tend to be proven false tomorrow. 

Since health policy is involved with politics, and politics thrives on simple answers and sound bites, it is no surprise that in health care policy, there are always those who claim to have the magic bullet – the answer – usually based on scientific fact.  That solution is often manifested as new laws and rules to address high costs, inequalities, lack of access to care, and potentially poor quality care.  However they may not address the constant trade offs we must make as we deal with the need for access to good care for all and the need for individual autonomy, individual respect, and customized solutions based on the person and their unique situation.  As Isaiah Berlin has said, “Liberty for wolves is death to lambs.”  We may produce liberty and equity and not pay attention to the lambs that are being eaten by the system.  New regulations and laws may also have the effect of pushing professionals to focus more on proving one is following the rules than encouraging those professionals to actually care for those who are in need. 

In this spirit, I have my own “top ten list” of unanswerable questions related to my life’s work of improving access to quality care.  They include:

1. How do we fit the black and white of contracts, legislation and regulations into the shades of gray that good medical care requires?
2. How do we balance the needs of a population and a community with the needs of unique individuals within that community?  As an example, how do we make the choice between the cost of care for a healthy 95 year old that may benefit from complex surgery and the thousands of children who could be immunized using those funds? (I believe we can and must support both). 
3. How do we address the fact that human physiology is the same around the world however the non-biological factors that make medical care more than biology vary immensely from country to country, state to state, community to community and even person to person? 
4. How do we create efficient systems and smart systems that can assist health professionals while encouraging them to keep their focus on the individual patient and not the computer screen?
5. When we speak of outcomes and quality, from whose point of view are we looking?  Is it the patient, the family, the doctor, the system or the population?  Often outcomes and quality are in the eye of the beholder. 
6. How do we monitor care to ensure it is high quality while also allowing for the modifications of care depending on the life context and the unique situations of the person in need? 
7. How do we build systems that allow for innovation, even with individual patients, but still protect patients from being subject to experimentation and poor care?
8. How do we encourage good health habits while not creating a system that punishes those who do not follow those habits? 
9. How do we prevent care equity becoming poor quality, least common denominator care for all?
10. How do we acknowledge health care as a spiritual and social need and not only a biological one?  

These questions and others like them offer opportunities to continuously fine tune and change our approach to the problems based on the specific community, the specific patient, the specifics of the health care resources that are available, and the times we live in.  We must have systems and laws however our systems must be flexible enough and smart enough, supported by smart caring professionals, to address all of these dilemmas.  We are in a constant balancing act trying to make hard choices and doomed to never reach perfection.  However our attempts to try to be perfect will lead to better care for all.  We must recognize that arrogance is the enemy, humility is needed and questions may not have a “right” answer.

The processes we build and the regulations we put in place impact populations and individuals who may not be in the center of the bell curve but off to one side.  All systems and rules produce unintended and potentially negative consequences for those people who do not fit neatly into the norm and the processes must allow for a mass customization to address those atypical people, who may in aggregate be the majority of patients.  In dealing with life and death health care decisions, care and sensitivity to the patients, their families, and the health professionals manning the front lines of health care must be emphasized and our systems must not only allow for that care and sensitivity but encourage it.  I, for one, am excited to be on this journey even as I know that my solution today may need to be changed tomorrow.  Such is the nature of health care and of life.  

Moving On

For the past nine years, I have been involved in building a company, Accolade, dedicated to experiencing the health care journey through the eyes of each unique individual and family who are in need.  Starting with a one room office, and a small team led by Tom Spann, our CEO, we spent years finding solutions to the problems inherent in experiencing illness in an attempt to make that journey as simple, and as stress free as humanly possible – all that with the knowledge that there is no more stressful time than when you or a family member is ill.  In addition to medical and insurance knowledge, we brought into the equation information on decision science, the psychology of persuasion and behavioral economics and created a coherent set of processes that we could manage while making it seem to the people we helped as if it were effortless.  We created simplicity during extremely complex and emotional times for people.   This took immense work and creativity as there is no more difficult task than creating simplicity out of the chaos that is often experienced when ill.  It meant rethinking how to engage people and how to create the type of trust that allows the right type of help to be offered and to be accepted.  It meant understanding a person’s need for autonomy and to be seen as unique rather than as a disease or a demographic.  It meant understanding that the experience of being sick is more than biology and insurance benefits but is also emotional, social, financial and even spiritual.  It is intensely personal for each person affected and our methods and procedures had to find commonalities while recognizing the segment of one that each person is. 

Ultimately we created a new profession – the profession of Health Assistant and the internal mechanisms to support that profession.  The Health Assistant has to be an expert problem solver, a relationship builder and to be conversant in the language of medicine, finance, social work and insurance benefits.  He or she has to be team oriented in order to pull in their expert colleagues, whether nurses, doctors, psychologists, pharmacists, social workers, insurance experts or even attorneys when needed for a particular issue.  The communication links and the information have to be at each Health Assistant’s fingertips in real time in order to keep it simple, real and humanistic.  It can’t be scripted or too rote but it must be performed with a certain rigor that is behavioral and scientifically based and consistent across health assistants.  It must follow process but not be a slave to process. 

We started out with the belief that this service would not only help and delight people, but it would save money in aggregate.  Taking the fear out of so many decisions that drive people to ask for unnecessary tests and services and helping influence people towards the right care seemed to us to have the potential to save money while doing the right thing for those in need.  We proved that to be true as well.  Time and again, when we studied populations with pilot populations versus control populations, keeping everything else the same, savings were documented that exceeded even our initial hopes.  There were even indications of improved quality of care from decreased readmissions, increased medication compliance and increased use of preventive care.  At one point, one of our esteemed Board of Directors said, “You guys have discovered penicillin!” 

Those types of results do bring growth.  Accolade is now a company of over 700 people with three offices around the country and continues to grow.  A new CEO has been named and a new team is being put in place to bring Accolade to the next level of growth.  As such, I am taking my leave but remaining as a shareholder, an advisor and a supporter. 

So I move on to my next chapter.  I remain a strong believer in the ability of health plans, physicians, nurses, health systems and all components of health care to better organize in order to create more support and simplicity for both the patient, the family and the dedicated physicians, nurses and other health professionals who serve them.  I will continue to focus my career on finding solutions that achieve lower costs and better access while removing administrative and other barriers for both patient and health professional.  I have always done so with the strong belief that each person is unique and must be treated as such and have found that with respect for all involved the best results can be realized.  I will now leave the growth of Accolade to others, knowing that the foundation is strong and the principles, processes and systems we implemented and tested have been proven to be effective and look for my next opportunity to change health care for the better.  

What Does the Patient/Consumer/Beneficiary/Person (pick your word) Care about when Accessing Care?

A new survey commissioned by Accolade (I am Chief Medical Officer and a founder of Accolade) performed by Harris Interactive (the Harris Poll people) attempts to answer that question.  From a medical vantage point, it may seem like a simple, obvious question. The person accessing care wants to get better!  However, the answer is much more complex.  People, when ill, tend to worry about more than those aches, pains and other symptoms. 

The title asks one question but implies a second question.  What does the person care about is the first.  The second is whether the person accessing care is a “patient” a “consumer,” a “beneficiary,” or some combination of all of those?  While physicians and nurses clearly prefer to see those in need as patients, the most used and perhaps overused term in the health industry these days is consumer.  This often appears to be aspirational as programs and companies are formed to try and find the magic formula with which to induce patients to purchase health case as if it were any other consumer item.  I question whether the emotional nature of illness, and the impact created by the potential for catastrophe inherent in medical issues will ever allow the patient to truly be a consumer.  “Consumers” traditionally are focused on cost and feature comparisons such as deciding whether to get leather seats in a new car.  I don’t believe that when you or someone you love is ill, you ever are a true consumer as implied by that example.  However, at the same time patients are rarely if ever only worried about the cure which use of the term patient may imply.  They are worried about their family, their finances and how their illness will affect all aspects of their life.   People, therefore must be helped to understand the value potential in each health service and see clearly how those services relate to their life issues.  That may fit into the term “consumer” even more than it does into the term “patient.”

I date myself a bit by using the term “beneficiary” as this is the traditional way insurance companies have described those who enroll in their health plans.  I rarely hear that term used in today’s world.  “Consumer” has replaced “beneficiary” except in legal documents.  People “benefit” from the access to care and the financial security that health insurance and health plans offer hence the term beneficiary.  Fundamentally beneficiary communicates the ability to gain access to care and to guard against financial catastrophe rather than reflect the care itself or guard against medical catastrophe. 

I admit to struggling with the right word to use as I jump between the different but co-dependent worlds of health care delivery, health benefits, and the business of health.  For the person in need, the distinction between these worlds means very little and actually just reflects some of the challenges of obtaining needed care in today’s world.  This is reflected in this survey.  It asks questions that approach the issues with the knowledge that each respondent is a complex person with multiple concerns that overlap into all these areas. 

The Accolade Consumer Healthcare Experience Index Poll surveyed 2.046 adults over the age of 18 of whom 1,536 have health insurance through their employer, private insurance or Medicare.  What was clear from the poll is that the experience of accessing care is seen as a daunting task for those in need.  While they trust their physician for health information with 74% saying that they prefer to get information from their physician, they are frustrated by a lack of coordination and challenged by the benefits rules and the costs.  Overall, 53% stated that the hassle of “understanding what care will cost me” and “coordinating all aspects of care” was the major problem that they faced when ill.  It is interesting how strong the fear of these issues is, even perhaps surpassing the simple question of getting accurate diagnosis and treatment. 

67% of those surveyed said that they wanted their health care providers to understand their life circumstances more in order to address their illnesses in a better way.  People understand, perhaps even more than many health professionals that coping with an illness while coping with all the challenges of everyday life are intertwined.  The idea of a physician treating a disease without good knowledge of their other needs and responsibilities whether they are related to work, family or finance is a source of frustration.  80% told the surveyors that they would want a single person to trust to be with them and help them navigate the systems and navigate the challenges of their lives when they require care and they appear to recognize that person is not likely to be their physician.  These numbers reflect a widespread concern with the impact the disease has on a person’s life and family and not only a concern with the biology of the illness.

 

Much of this comports with ideas a group of us had some nine years ago when we, led by Tom Spann as founding CEO started dreaming of a better way to help people through the health care system and the health benefits system.  We had to rethink the consumer and the patient and the beneficiary and think about how to create not just a company, but a new profession, that of Health Assistant, supported by the right information technology and the right management systems.  The Health Assistant has to be part insurance expert, part social worker, part financial advisor, part coordinator, part health educator and most importantly a trusted friend.  While training and experience is needed, equally important are the management processes, the right content that is always kept up to date on the technology platform, the right pay structures and metrics for the Health Assistants, and a sense of purpose and responsibility towards those being helped.   The technology has to support and drive all of those functions while avoiding the trend to become a checklist that harms the human interaction that is core to the function.  We have done that.  We have proved that we can help people in a very positive way and help the health care system as well with our approach. Data from this poll only confirms our initial dream and makes us want to work even harder to continuously improve our systems, training and approach in order to bring this type of support to everyone.