The third and final piece of our blog series will take us on a journey from the 1850s through to the 2020s, concluding with a vision of what post-2030 healthcare could be as we discover new ideas and technologies.
While the progress from 1950 into the 2000s has been remarkable for the U.S. health economy in many ways, that progress has also resulted in a huge increase in health care expenditures. U.S. healthcare's share of the GDP quadrupled from 4.6% in 1950 to more than 17% in 2009. In similar countries, that share is 9 to 11%. Unfortunately, the health of the population has not benefited as expected; over one third of personal bankruptcies can be tied to medical debt.
U.S. healthcare's share of the GDP quadrupled from 4.6% in 1950 to more than 17% in 2009.
Third Party Payers Become the Norm
Private and public health insurance now covers almost 90% of the total healthcare costs. Behavioral economics shows us that buying decisions that are mediated by a third party can desensitize individuals to the costs of procedures. This desensitization produces the sense that medical procedures are the only course of action; lower-cost solutions that have been shown to be effective are not always deeply investigated or considered at all.
Other major changes to healthcare include:
The expansion of hospital outpatient services and, in turn, fewer inpatient admissions The shift in the workforce toward more women and more specialists More hospital-based physicians The deluge of new medical technologies confronting clinicians with a menu of 6,000 drugs and 4,000 procedures.
One of the largest shifts since 2000 has been the increasing transfer of both fiduciary and healthcare responsibilities to the individual. In simple terms, starting in 1929, the medical industry began to move towards extreme financialization by turning “patients” seeking help into “consumers” looking for solutions.
Primary Care Physicians (PCPs) influenced by business school principles and concerned about malpractice lawsuits became healthcare “consultants” with medical systems spreading this work across the vast number of “navigators” and “concierges” that provide advice at a lower cost, reserving doctor to patient interactions for the directly billable procedures.
Patient Responsibility Grows
This change in healthcare shifts the responsibility of purchasing the proper medical health care plan from the employers to individuals; the economic purchasing power is tossed to the consumer like a hot potato. Consumers were “set free” in this inflated market to make decisions with little to no way to compare value. For the first time in history, consumers were faced with a decision requiring them to weigh what they can afford with what they need - with no reliable information to base that decision on.
In short, healthcare consumerism's goal was to enable patients to become wholly involved in their healthcare decisions. This shift in responsibility came with very little incentive in the medical industry to make sure people made the best choices for both their finances and their health. Decisions are Difficult without Data
The inherent and undeniable asymmetry in the system now has untrained individuals forced into making difficult decisions in times of maximum stress. This is a major flaw in the expected behaviors since so many of the economic models were built with the assumption that health care is just another purchase to be determined by “rational thinking through all available information.”
The outcomes for consumers under this plan have been poor, according to a Forbes article in 2019. The healthcare industry is the fifth biggest in the United States, contributing more than \$1.2 trillion to the Gross Domestic Product. But according to the Siegal+Gale Global Simplicity Index, healthcare ranks dead last out of 25 industries in the United States for simplicity of experience.
Over 1/3 of personal bankruptcies can be tied to medical debt.
Adding to the problem is that no public consensus exists about how much care should be provided for the poor and sick or how it should be provided. Similarly, there's no public consensus regarding efforts to increase the efficiency of care and what measures would indicate that the system is starting to show the increasing health of the population while seeing “units” of care consumed decreasing.
Technology Drives Improvement
Affective.health’s Digital Experience Platform (DXP) can be integrated into any current healthcare delivery workflow. There are many complex cognitive processes that influence an individual’s decision-making process. The Affective.health DXP is built is help people make better decisions - whether those are about which health plan to choose or how adherent they are to prescribed care - resulting in better days.
The 2019 Consumerization of Healthcare Study by Econsultancy and Adobe of both insurance companies and medical providers showed that the medical industry is second from the bottom in clarity of options and offering choices for style and type of communications. If this was a negotiation between the healthcare industry and healthcare consumers, then before accepting the responsibility consumers would demand the same things they have in other purchases: price transparency, price consistency, the ability to understand the coverage and benefits, bill payments, and help with getting simple tasks completed.
The medical industry is second from the bottom in clarity of options and offering choices for style and type of communications.
In short, the healthcare industry isn’t working with or for the patient-consumer.
Meeting the Needs of the Modern Healthcare Consumer
Modern Healthcare Consumers (MHCs) are looking for highly personalized, connected interventions that easily give them real agency in their care plans and make them feel supported in times of stress and poor health. Modern healthcare consumers are you and me, and we want to feel understood and have a support network of family, friends, and healthcare experts. We want to receive quality care that is affordable and allows us to recover with “better days” versus the experience now of “bigger bills.”
“Prediction is really hard, especially about the future.” - Yogi Berra
We are committed to discovering what steps we need to take to reduce the suffering of people, especially those with major chronic conditions, with the application of our models and measures and the truth derived from high-quality data.
Affective.health Models and Measures
At Affective.health we know that many barriers exist to building a patient’s confidence; this confidence is the key to achieving better days through sustained behavior change. These behaviors often involve both short-term changes in activity and diet, along with a medication program - this is especially tough when adherence must be continued for an extended period of time. The Affective.health DXP measures an attribute, such as confidence, so messaging can meet each patient where they are.
Lack of adherence to care plans is about 30% overall in a single serious condition. Add in the common comorbidities - and non-adherence increases to at least 50%. Billions of dollars of care are being prescribed with no effective way of motivating, incenting, or assessing how well people are doing until conditions have progressed to more serious and costly conditions.
Affective.health Data Models
Our immediate mission is to collect and supply healthcare providers with a new set of data models that will increase the understanding of their population at less cost to the individual and the practitioner.
This addition of Affective Data provides a clear and concise “status” of each of the individuals under their care, adding to their Enterprise Risk Management (ERM) system and Internet of Things (IoT) device data so they can understand how the Modern Healthcare Consumer’s feeling of well being is fluctuating between appointments or treatments.
We partner with those who have a healthcare solution that can help people have better days. Shifting patients’ belief in their care plan and confidence in their ability to adhere to it is a critical piece to living the best life possible.
In an upcoming series of blogs we will explore realistic changes to make healthcare a true consumable that people can understand and achieve better results and lower costs.