At the heart of the healthcare debate in the US is a profound quandary: how can we as a country spend more per capita but not have at least the same level of health as comparable nations spending 5%, 10%, 20% less? Emerging research indicates that how physicians treat patients, the “care model,” is a far more profound indicator of health outcomes than gross level of spending or utilization of technology.
Life expectancy at birth and health spending per capita
Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
This week, as part of the TEDMED conference in Washington, DC, I will lead a small group to tackle the issue of “Whole Patient Care”. We will explore whether clinicians and the health system in which they operate focus more on symptoms and disease, or on the patient who has them?
Take this real example that elucidates the issue. A 60 year old male presents to his physician complaining of mild gastro-intestinal bleeding. With a family history of cancer, the doctor springs into action, ordering imaging and tests to rule out the worst. No cause is found. Unsatisfied with the findings and with the situation getting worse, the patient visits the Mayo Clinic, known for their team-based approach to patient care. Again, after several consultations and a repeat of the previous battery of tests, no cause is found. The patient then visits his old doctor in another state, seeking another perspective. The doctor reviews the previous results and asks a simple question – why are you taking aspirin daily? The patient notes that he was told to do this, as a routine preventative step when he turned 55, despite no cardiac risk factors. The aspirin was discontinued and the bleeding stopped – 8 months, 3 medical systems, a few dozen doctors, and many tens of thousands of dollars later.
This story highlights the risk of a fragmented, specialist driven US healthcare system. A patient can be seen at some of the best medical centers in the world with doctors utilizing the newest medical technology, but the value this care is far less than the sum of its parts for a patient with a serious complaint that is unresolved.
There is hope. Innovation in this space is evolving rapidly and the implications on our health system and on individuals are significant. Exciting initiatives driven by a range of payor and provider organizations offer interesting solutions. Patient centered medical home and accountable care organization strategies are beginning to modify incentive structures that influence physician behavior. The growth in use of “care coordinators” is beginning to knit together disparate physicians and specialties to create virtual care teams. Health information technology and patient engagement strategies are breaking down care silos and creating market forces that demand low cost solutions.