It is not the Internet, or the Internet of Things, or Big Data, or analytics, or a host of other technologies that are foundational to population health that will eventually transform healthcare. These technologies may be necessary, but they are certainly not sufficient. No, what will drive transformation is the way in which the medium will improve conversations that take place between human beings (i.e. between providers and patients). The improved human dialog is the change agent.
We need to insert the patient into the equation. Although this may seem obvious, it is one that the FFS model has ignored for well over 100 years. Everything else was a distant secondary consideration. Why has the patient been left out of the equation? Because unlike almost every other market you can imagine, in healthcare the patient historically was not the entity that paid for the services. Hence, from an economic perspective, the healthcare industry was free to ignore the very people they purportedly served.
Atul Gawande spoke about the need for communication and systems thinking in healthcare. In a TED Talk, he summed it up by saying “We’re all specialists now, even the primary care physicians. Everyone just has a piece of the care. But holding onto that structure, we built around the daring, independence, self-sufficiency of each of those people has become a disaster. We have trained, hired and rewarded physicians to be cowboys. But it’s pit crews that we need, pit crews for patients.”[i]
The very reason that population health is in a state of crisis is that the focus formerly has been on a million and one potential distractions with very little attention paid to how we were going to engage with the patient, and moreover exactly where was this engagement going to take place. A premise of the population health “movement” is that healthcare has to transform its view of the patient from a “clinical thing” to be examined and studied, to a natural person with whom we want to engage in a mutually beneficial dialog.
A few thousand years ago there was a marketplace. Never mind where. Traders returned from far seas with spices, silks, and precious, magical stones. Caravans arrived across burning deserts bringing dates and figs, snakes, parrots, monkeys, strange music, stranger tales. The marketplace was the heart of the city, the kernel, the hub, the omphalos. Like past and future, it stood at the crossroads. People woke early and went there for coffee and vegetables, eggs and wine, for pots and carpets, rings and necklaces, for toys and sweets, for love, for rope, for soap, for wagons and carts, for bleating goats and evil-tempered camels. They went there to look and listen and to marvel, to buy and be amused. But mostly they went to meet each other. And to talk.
Yes, markets contain prominent conversations. The Cluetrain Manifesto[ii] propelled this meme on the world’s stage over fifteen years ago. However, very few people intuitively understand the implications, and fewer still are leveraging the idea, as a way of doing business in healthcare. Enormous opportunities await any organization that finds its voice, and through it learns to have an ongoing conversation with its patients.
Further, patients are eager to have this conversation, as long as it is no more demanding of them then their use of Facebook, or WhatsApp, or Snapchat or whatever social media platform they choose to engage with. Moreover, it is clear that the conversation needs to take place in one virtual space, not hundreds. The idea of patient portals is DOA. Why? Because a patient is not going to visit twenty different portals to engage with all the clinicians (i.e. specialists) that our currently fragmented delivery system mandates.
[i] Gawande, Atul, MD. "Transcript of "How Do We Heal Medicine?"" Atul Gawande: How Do We Heal Medicine? TED Talks, Apr. 2012. Web. 28 Aug. 2016.
[ii] Rick Levine et al., The Cluetrain Manifesto: the end of business as usual (Cambridge: Perseus Publishing, 2000).