Since 2002, and possibly before, there have been moments of clarity and innovation in the health care sphere, from patient-centered to consumer-driven to value-based to outcomes design, from iPhone texts to wellness to electronic medical records to blue buttons and transparency. Yet the year 2015 will certainly be the standout year of transformation, most noted for the interstellar collision of all of these siloed ideas into the supernova Triple-A.
This is the year that the person reclaims his or her health.
The Triple A is not exactly the Triple AIM of Dr. Don Berwick (his is patient-centeredness, cost effectiveness and positive patient experience). Instead, this Triple A happens within and is directed by the person, whom we will identify as over age 18 and able to make decisions for him/her self.
The Triple A is marked by the following dimensions: Awareness, Activation and Accountability.
Awareness. The person steps up to the leadership role for her health, identifying the goals that she seeks and the consultants that will support her efforts. Whether the goals are losing weight, managing a chronic disease, getting more exercise, managing her financial health better or creating time for social activities, this year is the year the goals determine her quality of life.
Because there are just enough voices on social media, in worksites, at churches and grocery stores, and from children, the adults who have not committed to a healthier life will hear stories of success and identify a few goals they want to achieve.
These adults are neither the pioneers nor the early adopters of emerging technologies. These are the sixty percent who have turfed their health and health care to their insurance company, employer or the government-provided health care of the past 30 plus years.
They are being bombarded with the transparency of the costs of health care, and it’s becoming very clear to them that the previous years’ “managed” care did little to improve personal health, wealth or stability. They are shopping with price-comparisons and asking each other to share the costs for procedures, visits, overnight stays and knee replacements. They have walked into a new land where the sticker shock of incomprehensible and unpredictable billing occupies a great deal of their off-time, and probably a large part of their work-time as well.
Activation. As sticker shock for costs wear off, determinism takes hold, and the person focuses on the patterns of care of her providers. She is most impressed when there is time to discuss health and, sometimes, financial impacts, but she is most upset to find that most of her providers are not listening, for a variety of reasons. She notices, too, that many are occupied with trying to use the electronic medical record and complaining about the contractual arrangements of health care (and no one ever mentions the taxpayer-paid incentives for installing the EMR and for better outcomes).
She starts to ask questions of her providers in anticipation of prescribed lab and radiological screens. She does research to learn through her transparency site that the costs of labs and tests can vary widely, and that some may have to be paid in their entirety out of her pocket.
She asks for her digital medical record. She does research to learn about the need to have a copy of her own medical record and bristles upon learning that her provider charges her for the access—even though the access is part of a suite of laws that protect her right to have her digital records in her possession.
She inquires about the difference between the brand and generic drug prescription, and is told they are the same. She pushes back at the pharmacy (or pharmacy attendant on the phone because she has been filling her prescriptions on a 90-day refill) when she is told that her insurance only covers a similar drug (or generic) to the one prescribed by her physician. Why, she wonders, does the attendant have the power to change my prescription when I trust my physician and do not know the attendant?
Activation of personal power is now part of her mission to manage her health. She begins accumulating her health history in almost any way she can, and she begins tracking it on her own while she explores answers to the questions above, and many, many more.
Accountability. She is now in charge. She is not argumentative, provocative, nor vociferous. She has goals, she has defined actions, and now she seeks the kinds of consultants and stewards of both her health care and her money to recognize and promote her success.
She is seeking both short term and long term goals, she is willing to change parts of her lifestyle behaviors to achieve these goals, and she wants a team that is ready to go the distance.
Some of the team will be in person or reachable through telehealth. She hopes to secure a quarterback primary care clinician that will clear the field of prescribers and naysayers so that she can achieve her goals. She will press to find the right quarterback, and, when disappointed, she will seek another.
She’s able to change because she has a good portion if not all of her health care records and because she has built the courage to switch roles from passive patient to confident consumer. She also can change because there are more options open to her, though she is acutely aware of the rising costs of deductibles.
She has grown more confident in online resources, too, vetting social media outlets and patient advocate communities. She participates in tweet chats to learn about the practice patterns of clinicians in other parts of the community or country. She is seeking healthier foods and safe walking-biking areas or fitness clubs.
Her wearables and websites coach her on questions to ask for each appointment, comparisons to make, and recording the answers. Sometimes there are reminders for workouts, but now, more reminders are about the choices she is making (such as eating out too often, or not walking enough) and their impact on her long term goals.
Most importantly, she has confidently moved from managing steps and recording her meals to new technologies that link her health behaviors and spending patterns so she can see where her time, talent and money go. She is becoming more skilled at managing all three, and at least one of her technologies tracks the accomplishments.
She even is able to earn incentives—and, because she has a longer vision, she now donates her incentives to the charities of her choice, and that makes her feel good about the helping others.
She is able to predict more of her preventive and prescriptive costs, and she’s teaching her family to do the same. She uses convenient care and urgent care clinics if needed, and she shares her success online and with co-workers, building a community of peer support.
The Triple A of Awareness, Activation and Accountability Changes the Culture
The story just told is not fiction. Each day, on social media, in emails, and in communities around the US and the globe, these changes are happening. The changes that happen are rooted in the old behavioral economics formula that has held up through the years:
DISTRESS X VISION X FIRST STEPS > RESISTANCE
There is no doubt that some folks in the US do not want the health practices of the 90s and earlier to change. Many of these folks are older, some of them are dealing with chronic disease, and all avow that they love their doctor, even while complaining of the outcomes, pain, costs, and more. They don’t recognize these lesser outcomes as DISTRESS.
But for those who are opening their eyes, who are uncomfortable in the distress, there is another reality. They are moving into the sunlight of transparency, travel and too-much-health-care-without-health-improvement. They are moving toward the VISION of effective health care and better outcomes. It is the first step, the awareness of a different kind of health outcome that demands their participation and is fed by hope.
They check out stories, ask questions in chat rooms, at worksites and even in waiting rooms. They are seeking the FIRST STEPS of success from others—peers—who have achieved some of the outcomes that they want to achieve.
These first steps are thought about, influence new questions, and begin to build courage to change. As the courage grows, these seekers of better health overcome their RESISTANCE. They make healthier choices, including the clinicians, labs, food, exercise and tech wearables that might help them. They test personal hypotheses, compare to others’, and either restate their course based upon findings or move on down the road to health.
The Triple A is the Path to Engagement
The Great Recession is behind us and the experts have laid out multiple choices for all of us. The greatest hope we can have is to change the outcome, but we must, as Albert Einstein said, change the thinking that put us into the turmoil we were in.
We cannot change is we do what we’ve done: turf our health outcomes to outsiders. Each of us must have a plan that will get us those short-term wins and long-term outcomes. We must engage in our care, create trusting partnerships with our clinicians, and ultimately evaluate the result as a component of the life we want to live.
By engaging in our health, owning our outcomes and promoting the health of others, we all win.
The rise of the individual in managing her own health and contributing to the community health is my greatest wish for us. It is achievable now that there is hope in our communities.
We must prevail in this journey, we must reach back to provide a hand up to those who haven’t defined their path their health, and we must push forward to increase our successes. Building a culture of health is dependent upon the largest percentages of our communities engaging in health and linking it to most, if not all, of the decisions we make to build economic strength.
Now is the time for health care and technologically driven solutions to come together in the supernova of health.