HealthCare and Wellness – Converging Concepts

Traditional healthcare relationships are changing, as is the nature of the health IT that supports them. The “doctor-patient relationship” has been about sick-care, and trying to intervene early in a disease process (or even do something pre-emptively for those at risk of developing a disease) is increasingly the focus of attention. Health care costs are at stake, as there is a considerably body of evidence that shows what is intuitively obvious – make early primary-care interventions and very-expensive catastrophic rescues can be avoided.

At the same time, wellness care is moving more into the mainstream. Traditionally, practitioners of “wellness” have been outside the boundaries of the health care establishment, often dismissed as being un-scientific. One domain of such care has been in Employee Wellness programs offered by (usually large) employers. Such programs, centered in the workplace and intended to reduce absenteeism by keeping employees healthy, are often focused on lifestyle – smoking cessation, fitness, healthy eating, etc. These programs, generally outside traditional health care, represent a separate budget item for corporations: the employee wellness program budget, and the healthcare insurance budget. Sometimes, employers will incentivize their wellness program by offering discounts on health care (e.g. lower co-pays) for those who participate, or achieve certain milestones.

Much of the change we are at the threshold of witnessing in health care revolve around a coordinated approach to managing the health status of a defined population. HMO care, when delegated to a medical group or risk-taking Independent Physician Association (IPA) – this has been a dominant theme in California, but rare elsewhere – has been an attempt at achieving this (mixed success).

Emerging new forms of clinical organization, such as Patient Centered Medical Homes (PCMH) are a more integrated way of taking care of the health of a population. Rather than being focused on the reactive nature of transaction-based healthcare encounters – doing the right thing at the time of an in-office medical exam – PCMHs need tools to look at their populations, identify who has “fallen through the cracks” and needs outreach, and use more non-traditional ways of helping people stay health (e.g. robust home care services) in order to reduce the total cost of care.

Convergence from the consumer market
Perhaps a way of summing-up the shift in traditional healthcare delivery is that it is moving into a more coordinated, holistic approach focused on keeping people healthy. Healthcare payment reforms are moving towards incentivizing such change – shifting away from simple fee-for-service pay (which benefits a transaction-based approach to health care), and towards a performance-based approach (which benefits efficient population management).

At the same time, consumer-based health is emerging as well. This has been entirely outside the realm of traditional health care – innumerable web-based services exist that help people with health information searching, social connection with communities of others with similar interests or experiences, or self-tracking services (like measuring walking, running, healthy eating, or the whole “ quantified self” movement). Not unlike Employee Wellness efforts, which are supervised by employers, these efforts are about staying healthy, though driven by motivated individuals using modern technology.

What we are starting to see, then, is a blurring of the line between what we consider “health care” (in the sickness-care and sickness-avoidance traditional sense of the term) and what we consider “wellness.” It involves a change in perception from the standpoint of traditional healthcare practitioners, and such a change in perspective may end up being generational (=slow). It involves changing the way the healthcare delivery institutions are structured, and it involves changing how health care is paid for. Yet it may be the only way to bend the curve of runaway health care costs, one of our most significant national dilemmas.

The technology platform needs to support this
Anticipating the convergence between health care and wellness care, and the convergence between traditional professional-based service and consumer-based service, the features of health IT needs to evolve as well. Electronic Health Records (EHR) systems emerged from a past based in a fee-for-service world, and were focused on capturing and maximizing the payments for services delivered.

Knitting together the fragmented nature of health information – interoperability has been a very big challenge for technology as well as national policy – helps gather information more effectively, so that efficiency can be improved. This is important both for healthcare practitioners as well as for consumers who want to track their own information.

But modern health IT also needs to anticipate the changes that are emerging in the realm of health care, and not only respond to it, but actually lead it. Robust tools that help health care professionals identify individuals at risk of disease, and help facilitate a coordinated approach to such care, are the next “big thing.” That means Business Intelligence tools to analyze data, and do predictive modeling. It means robust clinical decision support based not only on prompting around Clinical Quality Measures, but also on crowd-sourcing treatment approaches (“for patients with condition x, most physicians have done a, then b, then c”).

Further, modern health IT needs to be a seamless bridge to consumer experience – shifting away from “patient experience” and toward “consumer experience.” The social sharing of health experiences that people will do on-line needs to have methods of connecting with healthcare professionals in order to provide seamless care focused on maximizing wellness.

Needless to say, we have a long ways to go. Data safety, permission structures, trusted networks, protection from discrimination – all these allied questions need to be adequately addressed both in policy and technology. Fundamental payment reforms need to become mainstream in order to encourage such change and reduce the total cost of care. But these are “how to get there” questions – the fundamental direction of “which way is there?” is becoming clearer.