People Not Patients - Transformation Not Tools

Health care in the United States has been a slow motion car wreck for many years: costs keep going up while the quality experienced by patients is going down. In the midst of this macro trend, I have spent decades working on a dramatically different approach that improves care while lowering costs. I, together with other extremely talented like-minded people,  have proven that it can work with industry leaders and startups alike. I remain obsessed with developing programs, incentives, and even new companies to continue scaling this approach.

The Current Environment

In spite of, and sometimes because of, advances in genetics, pharmaceuticals, telemedicine, and medical technologies, costs are going up by 10% or more per year.  Despite that, patients are less and less satisfied with the care that they receive.  A 2023 Harris Poll found that 70% of U.S. adults feel the healthcare system is failing to meet their needs in at least one way.  From the patient’s point of view, the system is not affordable, it’s difficult to understand and access, and when accessed it’s disjointed and depersonalized, according to the Harris Poll.  

People are complicated and messy.  Each person has a unique genetic makeup, a unique microbiome , a unique lifestyle, a unique set of beliefs, and a unique social milieu.  Each person is also a unique decision maker.  Whether or not we agree with the decisions that person makes, those decisions must be respected.  Their decisions are based on their own life priorities and not only what is necessary medically.  

People don’t trust their doctors and nurses in the ways that they once did.  It is a paradox that at a time when our medical diagnostics and therapeutics are stellar, people’s trust that they will be better off because of it is at a low point.  According to data from 2021, trust in healthcare is significantly lower in the US than in other countries, including the United Kingdom, Australia, Germany, Canada, and many others. 

Health professionals are also miserable.  A 2023 study found that fewer than 10% of physicians found joy in their practices. Clinician burnout, job dissatisfaction, intent to leave and turnover are at crisis levels (JAMA Health Forum 2023 July 4(7): Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice).

Older physicians and health executives (including me), who are now more often patients than doctors or health care executives, see and feel this every time we need medical care despite our expertise and knowledge.  

So alongside technology that is more powerful than ever, we have unhappy patients, unhappy doctors and nurses, and costs that keep going up.

My Point of View

I believe our healthcare systems must care more about people and invest in understanding who they are as people.  Investments must be made to build relationships and trust.  This will result in lower costs and improved outcomes, both medical outcomes as measured by health care professionals, and social and emotional outcomes from the person’s point of view.  I know this to be true because I have been involved in designing and building the data systems to support this approach and the operational systems to bring these approaches into scalable reality.  

Lack of trust in healthcare drives increased costs. Misery felt by both doctors and patients drives far more decision making than what is actually needed and best for the person who is suffering. Unless we rebuild trust and personalization in a scalable way, we will struggle to lower costs and improve quality of care and quality of service. I believe that if our healthcare systems care more about people, not only as patients but in their full selves, and we invest in building relationships and trust, then costs will come down as outcomes improve.  I know this to be the case because with the proper use of technology and data science, especially using AI properly, I have led teams and been part of teams that have accomplished it and produced measurable proof. We must transform systems of care and systems of payment to foster caring, and not only medical science.  

That involves understanding and influencing the elements that go into the decision making of patients, doctors, and other health professionals.  While we may talk about benefit design, contracting, and care management as the tools of our trade on the health plan side, the fact is they are all meant to influence the decision making process in determining health care delivery.  Within the delivery system, we must focus on building trust between patients and health professionals.  This means focusing on empathy and compassion and not only on evidence based medicine.

Below are five basic principles for accomplishing transformational change.  I have used these principles successfully over 30 years, when designing new companies, such as Accolade, Carallel and Laguna Health, as a hands on consultant within large employers such as Bank of America and UPS , in large health plans such as Anthem (now Elevance), and in data organizations, such as Blue Health intelligence, Decode and Vital Data Corporation.  The newer tools of Natural Language Processing, Predictive Analytics, and Machine Learning Techniques have supercharged our abilities to accomplish that formula by creating the opportunity for the right organizations to produce transformational change. 

1. “It is much more important to know what sort of a patient has a disease than what sort of disease a patient has.”  
2.  Incentives are now in place to make systems of care bigger and less personal when more personal care is needed.
3. Data is critical, however if it is not the right data, it can point you in the wrong direction.
4. The trust bond between health professionals and patients is being sacrificed in the name of efficiency when actually, we are making health professionals less efficient by forcing them to focus on the computer and data entry instead of the patient.  
5. The health care experience is limited to the hospital, clinic, and office and is not in the home in the way it should be.  

Summary

Humanistic Care is scalable and costs less when technology is properly applied.  Creating systems of care and data systems that are dedicated to understanding people and supporting them as people, not just diagnosing and treating patients, is core and can be done.  I know this to be true because I have been fortunate to have both led, and been part of teams that have accomplished this.