Of course, that’s not true, but it sometimes seems to be, right? If you are working to enact a solution that promotes health within the context of our current health care system, there is no end to the challenges you will face. Let’s think about the different actors, why they should care and why they don’t.
I’ll start with you. No one care about your health more than you do. But as behavioral economists remind us, we are not rational beings. We’re more likely to focus on things that are tangible in the moment rather than uncertain long-term benefits. We therefore persist in participating in unhealthy behaviors that provide short-term pleasure and lead to downstream illnesses. In addition, we have been made to believe that once we are diagnosed we are victims and that we can abdicate all responsibility for our care. (see 5-17-2010, Are people with chronic illness more passive?). This insidious combination makes it difficult to take responsibility for our own health. Most of the time, we’d rather blame the environment, or bad luck, and ask if we can take a practical pill to make it better.
Then, what about your loved ones? These are the best targets. In most cases, our loved ones (the most common expression is “social network”) can and do affect our health (see Nicholas Christakis’s book, Connected and related articles). However, convincing your loved ones to open their wallets to pay for offers of services that improve your health has been difficult. In my experience, it is more often than not because of the same mentality that makes you a passive victim once you are sick. We feel that society owes a victim. We all feel that we have contributed to various insurance programs – public and private – and that they are the ones who should pay for health-related services, especially with chronic illness. So your loved ones care, but they have been trained not to open their wallets for your care. I can think of a dozen business plans that I have seen over the years where the service of helping a chronically ill person had to be paid for by the “sandwich generation”. There is a call to this on the surface, but I have yet to see any of these companies take off.
What about these insurers? They probably care the least. They see their role as spreading the risk over large populations. So they work to recruit and keep healthy people on their rosters. They work to be as efficient as possible in handling claims and mathematically predicting risks. They only entered the care management business because their clients (employers) asked them to. They invariably vote for commodities or ‘tick the box’. Reducing costs has a premium over improving health. Insurers find it difficult to engage in a visionary conversation about improving health, although they admit that in many cases the savings from improved health would flow to them.
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OK, so let’s move up the supply chain. Employers hire insurers to help them with employee health care plans. Employers are motivated to keep you healthy so for no other reason you will be a more productive worker if you are healthy. They even care a little that your dependents are also healthy, because you will be more productive if a sick parent or child does not distract you. And there’s the reason employers started paying for health care in the first place – because their benefits help them attract a more talented workforce. The latter has been largely forgotten over the past 2-3 years, as we have been adrift in a sea of employable people without jobs. The supply and demand curves to motivate behavior and with such a large supply of workers, the benefits are less important. This will change as the economy recovers.
A high-level analysis would therefore conclude that employers are good targets for new health improvement interventions. The challenge is that the direct customer is the HR professional. These poor and overworked souls are true generalists. They have to help you put money into a retirement plan, guide you through managing maternity leave, discipline a difficult employee, and, oh yes, choose your health plan. Few of them have a background in the health field, so it is only natural that they develop trusting relationships with the people of the health plans … so that they are convinced to buy product solutions. to check.
Well, for goodness sake, what about your doctor? Your healthcare professionals are there for you. But they too have perverse incentives. The most common of these is that they are trained and well paid to take care of sick people. The system does not reward them financially for improving their health at all. They are also big supporters of patient accountability and generally don’t buy this victimhood thing. So they quickly develop a treatment plan so that they can move on to the next patient who needs their help. They expect you, the passive victim, to be proactive in learning everything you need to do to execute and achieve this plan. They are not on the same wavelength as society when it comes to the responsibility of keeping you healthy. They would say it’s you, with their help from time to time.
Throughout this article, I have deliberately equated “caring” with “spending”. I guess this is also controversial, but I think the connection is right. What is the relevance for connected health? Simply put, connected health interventions promote health rather than disease management. In today’s healthcare market, they’ve been a tough sell. Most people I speak to cheerfully agree that connected health as a model of care makes sense. But there is this mystery about “who pays?”. I think this phenomenon of “no one cares enough about their health to pay the price” helps explain this conundrum.
So that seems to me a bit like a merry-go-round, or if you take a more sardonic point of view, a game of Russian roulette. So tell me: am I off base? Who really cares?