My mother-in-law is awesome (I’ve had a few, so I feel qualified to judge). One of the things we share is a love of cooking. Sandy makes incredible, elaborate meals that delight our entire extended family, from babies to seniors.
My approach, by contrast, is a bit different. I have enjoyed cooking all my life, adopting a style forced upon me by circumstance. First as a weary medical student and continuing through my hectic career, I learned to put complete, healthy meals on the table, start to finish, in 30 minutes or less. No dish in my repertoire has more than five ingredients or uses more than one pot or pan (this minimizes cleanup). Holidays are no exception. My three sons and I make our entire “Manly Thanksgiving” feast in under two hours (feel free to email me for the recipes and timing spreadsheet).
When my wife and I were first married, Sandy would share her recipes with me. I instantly knew I would never make them. Invariably, they involved multiple preliminary steps (toasting, marinating). I disqualified them if they had statements like “in a separate bowl,” or “allow to cool.” No matter how delicious or healthy, her recipes for me just did not work.
We often forget this in health care. The US system is entering an era of connected health in which new devices, tools, therapeutics, and processes will transform the industry. But, we have to be mindful that unless the approach is tailored to the individual, benefits may go unrealized.
The Deloitte Center for Health Solution’s new paper, “Accelerating the adoption of connected health,” looks at the adoption of connected health (cHealth) and how it can support value-based care (VBC) goals. While we are moving toward a system where providers will be responsible for a population and payment is based on outcomes, today the health care system is still straddling two canoes. Many clinicians are still reimbursed in a fee-for-service model, even as the system moves toward more value-based reimbursement models.
Emerging technologies and devices are providing new opportunities to manage patients’ health. For example, digestible, embeddable, and wearable sensors that work like a thin e-skin can measure important health parameters and vital signs 24-hours a day. Yet, hurdles remain. There are upfront costs, data integration challenges, and privacy and security concerns.
Provider resistance to adopt new business models has been slowing cHealth adoption. For example, Deloitte’s 2014 Survey of US Physicians found that 38 percent of physicians are not convinced that monitoring patients’ conditions/adherence is a benefit of mHealth, despite a high interest in monitoring from consumers (60 percent). Privacy and security, underwhelming rates of payment for services provided via new technology platforms, inconsistent state-licensure laws, and a mixed bag of regulatory agencies with oversight of mHealth technology have combined to slow adoption rates even more.
But, some providers see the value that cHealth can add and are willing to face these hurdles head on. For these individuals and organizations, adopting cHealth strategies across all patients might not make sense. The opportunity for savings may exist in targeted high-need populations.
An aging US population and rising rates of chronic disease means increasing costs across the board. Adoption of cHealth strategies has the potential to reduce the costs certain patient populations by encouraging self-care, keeping patients out of the hospital and emergency department, increasing drug adherence, and reducing adverse drug interactions. But to properly incentivize these changes, health care organizations and clinicians should be able to share in the savings realized from cHealth strategies.
Deloitte researchers used data from the literature and input from a panel of physicians at Deloitte to estimate that using cHealth strategies, such as remote patient monitoring or telehealth for patients with congestive heart failure, could save health care organizations participating in accountable care organizations (ACOs) or global capitation payment models between $1,054 and $1,956 per patient per year.
Consumer survey data show that consumers are increasingly using personal health devices, websites, and mobile apps to track changes in their health, receive alerts, transmit health data, and pay their medical bills. Deloitte’s 2015 Survey of US Health Care Consumers shows that 74 percent of consumers with major chronic conditions are very interested or somewhat interested in monitoring technologies for health issues. The business case for adoption will need to emphasize the value cHealth can add to provider organizations’ bottom lines. But, if that’s not enough, consumers may step in.
Someday, we might see stakeholders across the health care system implementing the full spectrum of cHealth strategies across targeted populations throughout their patient journeys. Each would respect the needs and desires of each individual.
Back at my house, Sandy has figured out the best strategy for identifying recipes that she knows I’ll actually use. We have been enjoying weekly deliveries from a local farm cooperative. Last week featured fantastic golden beets, broccoli, and portabella mushrooms. Sandy saw what we had received and sent me an email with a recipe noting, “If you count salt and pepper as one ingredient, this meets your criteria.” It was delicious. My mother-in-law is awesome.