“The first health revolution brought clean water; the third should bring clean information.”
— Gassmeir and Gigerenzer in Better Doctors, Better Patients, Better Decisions
During the recent InterSystems TrakCare 2016 Customer Meeting in Dubai, I spoke on the subject of patient engagement, which sparked a number of follow-up conversations. The starting point for my remarks was the worldwide growth in what are generally thought of as non-communicable diseases, in particular, diabetes, cancer, chronic respiratory conditions, cardiovascular conditions, and mental illness. Together, they account for around 65% of global deaths, 48% of the healthy life years lost, enormous direct costs, and sufficient lost productivity to eliminate poverty for 2.5 billion people living on $2 a day.
My thesis was that since many of the risk factors for these conditions have their basis in citizen behaviors and choices, patient engagement is an essential component of any population health management strategy, and of any health information technology strategy intended to address population health. I will save the details for another post. What is more relevant now are those follow-up conversations.
We had customer and InterSystems attendees from Asia, Australia, the Middle East, Europe, and the U.S., including both public and private provider organizations, so there was quite a mix of funding and delivery models represented. In regions with a strong social contract to provide healthcare for all, there is an obvious need to prevent and cost-effectively manage population health to ensure the long-term sustainability of national health systems. Indeed, NHS England has made “a radical upgrade in prevention and public health” a priority in the Five Year Forward plan to ensure the long-term sustainability of the NHS. This includes empowering patients, engaging communities, and exploiting the information revolution to deliver better value.
In the U.S., of course, much of the dialogue is around various forms of payment reform intended to align the incentives and behaviors of providers, patients and payers, to encourage collaboration, and to improve the health of populations. The Federal EHR Incentive Program (aka “meaningful use”) includes specific, albeit weak, milestones for functionality to support patient engagement. Employers, the source of private insurance for many Americans, offer incentives for weight management, smoking cessation, and other healthy behaviors. The overall theme of payment reform efforts is “pay for value” – that is, populations with healthier outcomes.
Yet private providers in many parts of the world, especially those growing quite rapidly in Asia, now have the same incentives for overutilization that the U.S. is trying so hard to change – patients who require more care generate more revenue. What then, motivates these organizations to pursue patient engagement? I heard two responses. The first could be considered the moral imperative, that is, the mission of healthcare providers to heal and to prevent suffering. The second is the business imperative – patients will be more likely to select providers who deliver high value – that is, outcomes relative to costs. Patient-centered care that engages through the same kinds of high value consumer services we have come to expect globally will help private healthcare providers to grow their businesses.
So cutting across all these differing incentives is the quest for high value. And of course, what brought us all together in Dubai is a belief that health information systems are essential to delivering that value. The international team of contributors to Better Doctors, Better Patients, Better Decisions (my homeward airplane read) contend that honest, transparent information and health literacy would make it possible to deliver better care for less money. They describe clean information as the next revolution in healthcare. This seems like a good summary of discussions I had in Dubai.
May 24 the InterSystems UK team will host its annual Joined-Up Health and Care event. I, for one, am looking forward to further exploring the ways in which we can create revolutionary healthcare value through shared health information, and better health information technology solutions.