Let Health Care Be About Health

Most of the activities of what we have historically called health care are focused on those who are already ill. Health care, even today, is primarily about evaluating and managing sick people who show up at a doctor’s office, a clinic or a hospital. This approach will continue to be necessary and when we really need care, we are grateful to have it. However, if we are to achieve better health and well-being for those we serve as either healthy members or as patients, we must extend our care outside of those traditional settings. And ideally, we would do so before a member falls ill or before a patient’s chronic condition worsens. Health care should be about helping people stay well in addition to rescuing those who fall ill. Achieving such a change in focus is a team effort and requires work outside of the occasional office visit.

Achieving optimal health, based on a patient’s circumstances, medical condition and wishes, can be accomplished when we create the right opportunities. For example, we must offer quality face to face health care close to home, but the care shouldn’t stop after leaving the doctor’s office. From online health resources, to 24/7 access to the local nurse on-call line, patients must feel confident that they have the tools needed to focus on their personal health in a way that is easy, convenient, and effective.

Because our goal is to set everyone up for success, we must facilitate and support ongoing relationships between patients and their care providers. Changing behavior has proven to be challenging. If we want our members and patients to have the best chance of success, and to believe that their doctors have their best interests at heart, then a relationship of mutual understanding and trust is foundational. For most of us, such a relationship is best developed over time and in the local community.

Creating these relationships between physicians and other care providers with their patients also helps create context. Getting to know a patient’s medical history, current health status and future goals will help the physician create a more comprehensive care plan and one that patients are more likely to embrace. The patient is the key member in team planning, and it is engagement that drives success. No matter where someone seeks care, whether online, via telephone, urgent care, retail or in their personal physician’s office, we must ensure that all the information provided and collected constitutes one medical record and that the member’s personal wishes and health ambitions are known and respected.

In addition, having this relationship and the related record of significant medical events, medications and treatments, effectively frames any current problems a patient may have. Certainly, interviewing the patient to obtain the history is important, but this is extremely time consuming if there is no foundation from which to work. Worse, as patients, we sometimes accidentally omit key pieces of information that can make a big difference. As a practicing physician for many years, it was always more difficult for me to accurately and effectively diagnose and treat patients who had no prior medical history to reference. Building trustworthy relationships and getting to know each patient also leads to more patient engagement and therefore more successful outcomes in “bending” behaviors towards health.

Driving engagement with technology

There are many ways to help our members engage. For example, we are getting closer to the ideal balance of dependably providing correct and timely care while always taking into account the unique needs of each individual. In short, we must both standardize and customize. This may sound a bit counterintuitive at first, but we must hone our ability to develop very reliable processes for ensuring that everyone gets the correct, evidence-based, health interventions at every encounter while simultaneously identifying the specific needs, goals and objectives of each member or patient. Obviously, this is not easy. Getting that balance right and the patient engaged requires a relationship of trust. A massive amount of information is also involved. This could include information about population health, about diagnoses, about evidence-based treatments, medications, individual allergies, problems, wishes and concerns, as well as information from many different sources in the system such as insurance claims, medical records from hospitals, clinics and urgent or even virtual care. Managing all that information requires sophisticated technology.

Technology can also help us drive timeliness and convenience. For example, we spend most of our lives outside of the doctor’s office, so seeking medical guidance and quick, reliable health information takes time out of our day if we must go see our doctor in person to receive it. In fact, most of us just keep putting it off until we can’t any longer. That’s where virtual care strategies come in. For example, many find online behavioral health strategies to be helpful, effective and convenient. Such strategies allow patients to get the services they need in the privacy of their homes and even after hours. Some may also prefer having the option of text-based virtual primary care on-demand. We are implementing a virtual care strategy with our care partners to make that not only possible, but also incredibly affordable. When these virtual strategies are connected to the rest of the system, the rest of the care team can stay informed and up to date and we can customize our care effectively without missing or duplicating any needed interventions. Others may want or need face-to-face services to feel great about the health care they receive. We must have a variety of local options to meet that need including primary care (with extended hours), urgent care, and retail. Finally, our needs can vary over time and by circumstance. These individual and contextual differences are important, and our health systems and physicians should be able to customize the care we provide to meet those variable and evolving needs. And because, with technology, we can connect all these services and keep both patient and doctor informed, we won’t have to sacrifice quality or coordination of care. 

Rewarding health

My personal experience is that Physicians genuinely care about the health of their patients. So why not reward them for supporting health? Historically, there has been little incentive, nor was the system designed to extend care much beyond the doctor’s appointment or the hospital. In the past, neither physicians nor patients were rewarded for engaging in or supporting healthy behaviors. Partly because we didn’t yet have the tools and technology as well as the research to know what to do, and partly because the fee-for-service system rewards volume and doesn’t provide the incentive to drive technology and change. Fee-for-service compensation is relatively simple to implement and maintain and worked “well enough” for many years, but times have changed. Today, we understand much more about what it takes to stay healthy. Patient expectations have changed as well. We need to be prepared to meet our patients and members where they are if we are to positively influence their health. We can’t get there if we only reward physicians for taking care of sick people. We also need to provide the right incentives and reward physicians for helping those people get better and maintain their health. We want individuals to stay healthy and have a sense of well-being as they live their lives, but sometimes that universal goal gets totally lost in the shuffle and complexity of today’s health care. The system is broken, and bad systems can indeed foil the best intentions. But we are committed to changing that by creating systems that reward healthy behaviors and reward physicians for supporting that strategy.

No one wants to sacrifice the expert delivery of care to those who fall ill. Instead we want to enhance that mission. Our strategy along with our partners is to improve health, make it simple and affordable and make it fit the needs of all our members wherever and whenever they need care or advice. We are excited about the opportunities unfolding over the next few months and years right here in Arizona and in each local neighborhood. This will not be easy or quick, but it is certainly possible. We invite you to join us in leading the change. Working together, step by step, we have the power to transform our broken system. Let’s let health care be about health!