I Want You to Incite a Revolution

August 26, 2016 Wayne Oxenham, president, NA

As a retail pharmacist, my brother sees lots of high-needs patients who regularly find themselves back in the store to pick up more prescriptions or back in the hospital to get more treatments. 

One day, he wondered if there was anything he could do to help some of them reduce their need to visit him so often.

My brother’s theory was that if he could add just a little extra social element to his dispensing work, perhaps his high-needs patients wouldn’t need him as much.

So he decided to conduct a little experiment. He randomly chose just one patient—let’s call him Ronnie, 82 years young—and committed to calling him regularly for a number of months. Just two to five minutes, five times a week.

He’d ask Ronnie questions like:

  • “How was your weekend?”
  • “Have you been taking your meds?”
  • “Has that new drug reduced your arthritis symptoms so you can open that jar lid you’ve been struggling with?”

He showed a real interest in Ronnie, and Ronnie could sense my brother’s sincerity. Ronnie was clearly grateful, honest about what he was doing well and where he was falling short, and often intent on keeping the conversation going as long as possible. 

Over the ensuing months, Ronnie did, in fact, visit the pharmacy a whole lot less.

And he didn’t visit the hospital at all.

Perhaps we can think of this proactive care as personalized wellness. While personalized medicine is about analyzing all available information about an individual, identifying their risk factors, and treating them when they’re ill, perhaps we can think of personalized wellness as a form of proactive care that aims to maintain a specific patient’s well-being so that their chances of getting sick in the first place are minimized.

Proactive care activities like this don’t always align with the quid-pro-quo values of big business, which so frequently aims to deliver more—but not necessarily better—services to more customers.

Instead, proactive care aligns with the belief in a sustainable healthcare system that uses the right technology to actually incentivize and support behaviors like my brother’s. I believe it’s a mindset that must be widely adopted so that the practice of accepting Ronnie’s endless visits to the pharmacy instead of calling him five times a week is, at the very least, questionable.

Don’t set yourself up to recognize your own practices as being questionable someday.

Instead, join a growing number of healthcare professionals by committing to proactive care today and taking these four powerful actions that will help us incite a revolution and change healthcare forever.

  1. Insist upon all the information available. Demand clarity around what the options are, based on all the information about the patient receiving care. Don’t settle for just clinical information either—demand social, environmental, and genomic information to determine precisely which treatment will work for that individual. And when I say “social,” I’m not just talking about income and education levels. I’m talking about attributing greater importance to personal goals and religious beliefs, factors that research has shown to have actual statistical bearing on a person’s well-being. The more we, as a society, adopt the notion of customizing healthcare, the more we’ll drive targeted treatments, enjoy better outcomes, and reduce costs, because we’ll essentially be ambushing sickness from all sides.
  1. Embrace real-time analysis. Still, comprehensive information isn’t enough. To treat a patient when they’re well, a provider must monitor the patient’s key vital statistics live, in real time, so that they can act upon the earliest glimmer of sickness. Capturing this data at scale is now possible thanks to connected wearables, but be sure your IT infrastructure can acquire and aggregate the enormous volumes that these wearables generate, and that it can scale elastically and automatically optimize itself to accommodate a healthcare record that will end up in the cloud sooner or later. Otherwise, you won’t be able to efficiently leverage all that data and effectively execute a proactive care delivery plan. 
  1. Get comfortable with artificial intelligence (AI), or “tools for cognitive offload,” as Casey Bennett, a senior fellow at the Centerstone Research Institute in Nashville, puts it. “Probabilistic thinking is not something humans are really designed to do,” he says. “A computer can consider so many more possibilities than we can. So, if we can offload some of what's going on in our heads that we're not good at—use AI as an assistant to people—then we can focus on things we are good at.” No one expects you to be able to digest such unimaginable volumes of information without cognitive support, and this truth is being realized in other industries, too (e.g., transportation, where services like Uber and Waze provide cognitive support for ride sharing and traffic routing, respectively). So, as AI makes its way into healthcare, be open to allowing it to do things for you that you have always been physically incapable of doing yourself, like reviewing hundreds of thousands of patient-cohort records in an instant and recognizing that the expensive test you were about to order usually produces limited results for that cohort’s members.
  1. Adopt a proactive mindset. If you’re a provider, payer, or patient advocate, take a cue from my brother and show a real, ongoing interest in all of your patients, whether they’re relatively healthy or gravely ill. You don’t have to sit at a telephone and make calls all day to do it, either. Instead, you can set up alerts that will, for example, notify you when one of your patients has been admitted to a hospital far away, or when a new drug becomes available that promises to be effective for a specific patient’s particular genomic variation.

At first glance, proactive care doesn’t appear to align with the quid-pro-quo values of big business, but when you consider these four actions and the business opportunities they will create, the case for proactive care, even from a sheer business perspective, becomes clear.

Except it isn’t up to the government to make this case. Or for society to demand more healthcare reform to effect change.

No, it’s up to us—the direct participants in the business of healthcare—to fix this ourselves.

And the tools and the spirit we need to incite this revolution I’m describing are available now. If we just use them well—if we show the interest my brother showed and amplify it with the right technology—we will embrace proactive care like never before.

***

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