For both better and worse, COVID-19 has accelerated change, subsequently disrupting the current healthcare ecosystem.

 

Starting with a picture of the ideal future and working backwards is a productive way to facilitate change while creating hope. Placing the person whose goal is staying well at the center of the model displaces others whose economic interests overwhelmingly motivate the status quo.

 

Each person’s well-being will be the goal. Deloitte’s recent paper, “Breaking the Cost Curve,” includes physical, mental, spiritual, social, emotional, equitable, and financial well-being as defining attributes.^[1] In the past, getting an accurate picture of wellness was not easy. Now, in the information age with a digital device in almost everyone’s hands, the essential data is more readily available.

 

A perfect example of a free, motivating tool leading into the future is the RealAge test, facilitated by the digital revolution. This metric is an individual assessment by Sharecare, a digital wellness company. Comparing one’s chronological and physiological ages creates a presentation of one’s current well-being state, leading to achieving the desired goal—the first step to a better future. Moreover, these de-identified, confidential online measures taken by over 45 million folks are then pooled to create a community well-being index.

 

Once individuals “buy in” to better health, they are likely to find other like-minded folks. The combined power of individuals aggregating together in communities increases the likelihood for positive change. Humans mimic those around themselves. Healthy people are attracted to similar folks, and smokers aggregate as do overweight people. Nudging people in a positive direction is effective and currently practiced in more than 50 regions, helping almost four million Americans fortunate to live in Blue Zones Project communities.

 

Fortunately, metrics are now also easily available for all 384 Metropolitan Statistical Areas (MSAs). Depending on the population in a ZIP code or census tract, these regions can also be defined by ten summary metrics gleaned from over 600 objective facts.    

 

There is less need by smart consumers or desire by “head’s up” providers to dwell on the present state, which is currently stressed by transparency, consumerism, telehealth, digitalization, interoperability, science, and other disruptors that challenge providers, insurers, healthcare systems, pharmaceuticals, and device manufacturers.

 

This year’s Federal mandate to post hospital charges, prompted the headline, “How Much Does a C-Section Cost? At One Sutter Hospital Anywhere from $6,241 to 60,584.”^[2] “Consumerism in health care” may be the only process in which the person ordering the treatment, the one who receives it, and the entity that pays for it are all different. Two reasons consumerism in health care has lagged that of other industries are reimbursement confusion and problematic workflows. “Privacy concerns and relationship nuances further complicate any initiative,” states co-founder of Xealth, Mike McSherry.^[3]

 

Telehealth visits pre-pandemic increased annually by 261 percent between 2015 and 2017.^[4] Going forward, the global telehealth market size is projected to have a compound annual growth rate of 23.4% over the next five years.^[5] E-visits, teleradiology, remote monitoring, dermatology, psychiatry, many other specialties, and any type of care not requiring hands-on contact is expected to grow exponentially over the next few years. Traditional brick-and-mortar facilities with high fixed overhead will be challenged by remote providers, not all of which will be domestic. The “not in-person” medical experience will parallel the current demise of some “big box” stores and shopping centers facilitated by online shopping on the internet combined with facile delivery services.  

 

“The Patient Will See You Now,” published in 2015 by Dr. Eric Topol, described the coming revolution in healthcare delivery made possible by the decreasing cost and ubiquity of digitalization.^[6] Except for impoverished urban areas where cell phones are the most powerful digital connectors and rural regions without good connectivity, most of the U.S and the world are digitally connected. In the future, technological deficits will melt away.

 

Science has changed our lives for the better, with the most recent, admirable example being COVID-19 vaccines. In less than a year, four (and probably soon more) vaccines were created—a feat that previously would have taken years. Distribution was initially a challenge, but logistics are now being conquered.

 

“Follow the money,” a phrase commonly used to unravel a nefarious financial scheme, can effectively be applied to the future health economy. Imagine a spending shift from the 80% currently directed for treatment of avoidable disease to prevention with a concomitant marked decrease in total spend. Prevention is dramatically less expensive than repair.

 

The shift from a repair shop mentality to well-being approach will be welcomed by most people because they will avoid becoming “patients.” Currently successful incumbents—hospitals, physicians, insurers, pharmaceutical companies, and device manufacturers—understandably will be threatened while their past investments in facilities will need to be repurposed. The demise of the “general hospital” and the seismic shift of financing healthcare are just two trends that will provide assets available for prevention.^[1]

 

Simultaneously, increased healthy-life expectancy will add years of enjoyment and productivity for individuals, communities, and entire nations. Resources freed up from the healthcare “repair shop” can be redirected to addressing the social determinants of health, thus creating continuous positive feedback loops that benefit society. Addressing multigenerational inequities, climate change, and other major deleterious trends can become more successful utilizing these newly available resources.

 

“The future is here—its just not equally distributed,” attributed to William Gibson in 2003, captures our current state.^[7] Fifty-seven communities encouraging almost four million folks have embraced a healthier lifestyle, facilitated by an organized program based on common characteristics of people who have a longer and healthier lifespan—Blue Zones Project.^[8]

 

Change is challenging but inevitable. The current reward for society is greater than the discomfort caused for the incumbents. Buckle up for the ride during the transition because a better future is in store.

 

 

 

 

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