How Emerging Care Delivery Models Affect Connected Health
Tuesday, September 21, 2010
| Liz Boehm
About the Author: Liz Boehm is a Principal Analyst, Customer Experience for Healthcare & Life Sciences, at Forrester Research.
In the wake of health (insurance) reform and all the discussions regarding Accountable Care Organizations and Medical Home, I’ve been thinking a lot about care delivery mechanisms, connected health, and the complexities of rewarding both health practitioners and consumers for “good” health behavior. Let me start by sharing a core belief: We could all use a little health intervention. By that I mean that in the battle between good intentions and bad behavior, the more support we have on our side, the better. The question is, how do we put that health support together in a way that is appropriate, effective, and manageable in terms of costs? I usually draw the picture this way:
By “Technology-mediated engagement,” I mean connected health platforms, Websites, medical devices, and the whole gamut of tech-based solutions that help measure and message about health. By human-mediated engagement,” I mean nurse call centers, health coaches, social networks, community resources, and any institution or platform that links people in a one-to-one or one-to-many fashion for health improvement.
My first premise is that everybody belongs somewhere on the horizontal axis of this graphic. Where each person belongs will depend on their health status, level of motivation, personal and insurance-based investment capacity, comfort with technology, health literacy, geographic location, and other psycho-social factors.
My second premise is that the line between the technology-mediated and human-mediated engagement needs to be very blurry. We already see some of this happening in the work of the Center for Connected Health that marries tech-based monitoring with human-based reporting and coaching. I strongly believe this is the way of the future for connected health.
So what about reimbursement, accountable care organizations, and patient-centered medical home? I had a briefing a couple of months ago from a company called Qliance, which is advocating for and delivering concierge medicine for the masses. They believe that it doesn’t make sense to insure primary care because it is frequent, predictable, and has low variable costs. Insurance, they say, should be reserved for things that are infrequent, unpredictable, and high-cost. Their model delivers all primary care (including core disease management for conditions like diabetes and heart conditions) for an age-based sliding-scale fee that is significantly lower than the average insurance premium. Even more interesting, they are working with insurance companies to wrap high-deductible catastrophic coverage plans around their services that ultimately deliver better out-of-pocket protection for a lower monthly premium than the average plan that includes primary care coverage.
The reason I bring this up in the context of connected health is that this model doesn’t discriminate against care delivered in-person versus via email or video-conference or even via connected devices. There is no financial disincentive, only an unfettered desire to serve patients well so that they will stay with the practice and consume the level of practice resources that are appropriate to their care needs. And with smaller panels and no need to pack patients in to meet revenue targets, doctors, nurses, and other care professionals can take the time to educate patients on the diet, lifestyle, and device adaptations they need to make to stay healthy, as well as monitoring data and progress over time.
As health reform plays out, and we see increased pressure on the care delivery system to conform to the constraints imposed by financing mechanisms, I see an opportunity for the connected health community to augment and reinforce the delivery models that truly put the patient at the center. Not simply by constructing a model that we call “accountable” or “patient-centered,” but by bringing patient needs and patient data to the forefront.