For a very long time, health care has been defined by the incremental or emergency care a person receives and the type of (or lack of) insurance coverage a person has.
So, if you’re a dual-diagnosis, high-risk, low-income, 3-year old whose parents are dairy farmers living in Wisconsin, you’re a “Badger Care Patient.” That is, you’re covered by Wisconsin’s version of Medicaid, so it won’t be easy for your mother to find an in-network specialist for allergies and asthma (because specialists prefer to treat patients with private insurance for 50-percent more income). As a Medicaid patient, you’re more likely to be discharged on generic medication routines and thus more likely to be re-admitted for hospitalization due to asthma. In this scenario, your health care (and cost) is defined by your health insurance coverage not your condition or circumstances.
Today, health care is being redefined by innovators in and around the category to value health over fees, to include social determinants in the creation of health, and to involve consumers as the most critical part of the equation. When health is defined in terms of consumer-centered goals, it focuses more directly on prevention, stronger clinician-patient relationships, and the “context” or social, environmental, and behavioral factors that account for an estimated 60 percent of health. These innovators are reframing the industry around the achievement of health-related goals, quality and cost reduction. It’s a process with the potential to make health care less mechanical and more human.
Customer-owners of health care
The Southcentral Foundation Nuka System of Care in Alaska, is recognized as one of the world’s leading examples of health-care redesign. “Nuka,” a native word used to describe strong, giant structures and living things, is a relationship-based, customer-owned approach to improving health, social conditions, and outcomes, and reducing costs. Founded in 1997, after legislation allowed Alaska Native people to take greater control over their health services, it is tribal-owned, nonprofit health care organization that serves 65,000 people living in Anchorage, Matanuska-Susitna Valley and 55 rural villages. Its mission is to achieve wellness of “customer-owners” through health and related services, culturally-respectful and team-based care. Hundreds of organizations have requested the ability to study the Nuka system of care which has shown tremendous success in reducing health risks and improving care outcomes:
There has been a 23 percent decrease in ER/urgent care use and a 25 percent decrease in primary care visits from 2008 to 2015. SCF's Healthcare Effectiveness Data and Information Set (HEDIS), which measures performance on important dimensions of care and service of more than 90 percent of America's health plans, exceeds the 90th percentile in board certification, diabetes care, tobacco screening and quit rates, and are in the 75th-90th percentile for screening rates for colorectal cancer, cervical cancer, breast cancer and depression. In addition, 2014 customer and employee satisfaction rates were at 93 percent.
Rather than being defined as “patients” or Medicaid recipients, Alaska Natives are considered customer owners of the health system and are actively involved in SCF’s management and governance structure. This approach is very different than “buying health insurance.” These consumers are truly “members” of a health-care system they own and are empowered to change.
Supporting super-utilizers beyond health care
In another disruptive example, Jeff Brenner, a family physician in Camden, New Jersey, took a microscopic focus to deliver health care to those who need it most. He used block-by-block data maps of the city, color-coded by the hospital costs of its residents to identify “hot spots” –two city blocks where 900 people in two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills. He focused care on the suffering — the super-utilizers of the health care system -- with health care, housing, social services and other contextualized services within the community to drastically improve the care of individuals and reduce costs to the health system.
Outside the category of health care, new partnerships are forming to tackle the challenges of providing insurance to their employees. Jeff Bezos of Amazon, Warren Buffett of Berkshire Hathaway, and Jamie Dimon of JPMorgan Chase have agreed to join forces to try to extinguish “the ballooning costs of health care” which Buffett called a “hungry tapeworm on the American economy.” This initiative is aimed at improving health care for the three companies more than one million employees in the most cost-effective way.
In another example, WEGO Health is bringing the voices of patient advocates, health activists, health community leaders, patient influencers and experts to life to help drive positive change in the industry. WEGO works with health care companies to incorporate the patient perspective and expertise into every stage of the “product” life cycle. Patient leaders use their own health journey to raise awareness, share knowledge and help others. They leverage social media to amplify their voice, connect with peers, and build community. They are the thought leaders and transformers industry leaders turn to for the insights and expertise they need to build a more patient-centered, consumer-driven health care ecosystem.
Taking a page from all these examples, a new model of health would have the wellbeing of the 3-year old mentioned above at heart—not his insurance type. The family would be members of a health care system where they had a voice in how care would be delivered. Their care team would have a contextualized view of the family’s housing, nutrition, environmental, social and cultural systems. Regular, ongoing care in their own community, prevention and education would be used to help the family and eventually the child himself, manage his disease without the risk of losing the farm.
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