Now it the perfect time to utilise technology in improving population health, says Glasslyn Health Solutions founder Dr Peter Mills.
Looking back over the last two decades it is truly amazing how technology has changed our lives. Computers, the internet, mobile telephony and digital media have transformed both the way we do business and how we socialise and spend our down-time.
This said, the technological revolution has all but passed us by in healthcare. We might have state-of-the-art scanners, robotic surgery and digital x-rays, but we have almost totally ignored using these advances in communication technology to engage with patients. This is not about point-of-care interactions, but rather using technology to help individuals feel connected with their healthcare provider in an ongoing dialog to optimising their health and wellbeing.
If you look at any population you find that about 15-20 per cent of the population incur approximately 75-80 per cent of the total healthcare costs. The typical medical approach is to exclusively focus attention upon these individuals. We have invented better diagnostic tests, better treatments and better pathways, but we still find, year-on-year, that 15-20 per cent of individuals incur the majority of the costs.
The reason for this is simple; those individuals we treat either get better or they die, but there are plenty of others waiting in the wings to replace them as “high-cost” individuals.
The UK model for delivering healthcare exacerbates this problem. Individuals only access the system when they have a problem, and once that problem is addressed they withdraw from any form of interaction until the next time something needs to be fixed. We make no attempt to engage them in any form of ongoing dialogue; indeed we probably actively discourage it. How can this be?
Look at almost any other consumer focused business and it’s clear that they go to great lengths to stay close to their customers. Those prone to cynicism will point out that this is because they want to extract more money from their clients, with the old adage of it being easier to sell to an existing client than find a new one.
However, what this really demonstrates is that it is easier to get your clients to act and behave in a way that you want them to if you stay close to them, and there should be no reason why this shouldn’t be the case with health.
Traditionally the main sticking point for enacting this kind of strategy has been time and resource scarcity; clinicians repeatedly state they do not have the time to adequately deal with the sick, let alone try and engage the well.
The consequence of this approach, however, is the inexorable rise in the cost of delivering population-wide healthcare witnessed by all developed countries over the last 20 years.
But this is where technology can come to our rescue. With almost 80 per cent of UK households now with internet access and more than 90 per cent having a mobile phone the argument that using technology for health promotion would lead to greater social disparity doesn’t hold true any more.
We now have a tremendous opportunity to leverage this technology to make a real difference to the health of the population as a whole.
It is now common place for US organisations to request their employees complete an online health risk assessment (HRA) questionnaire on an annual basis. Indeed some employers mandate completion in order to receive full healthcare benefits.
The data from the HRA is then amalgamated with historical healthcare utilisation and cost data allowing for the stratification of the population into groups based upon the likelihood of future high-cost utilisation of services. Individuals are then offered coaching and self-management programmes, with varying degrees of intensity and input, based upon their categorisation. For many this involves automated or semi-automated online e-learning initiatives.
There is no reason why this model could not be adapted to the provider-patient relationship, and indeed could potentially be more effective by engendering greater trust than the employer-employee dynamic.
Imagine a scenario where all patients of a GP practice were invited to complete an annual online HRA, with the amalgamated results being visible in real time to the practices doctors, nurses and commissioners? Not only would this help with the forward planning of services needed for the population, but it would allow a communications channel to be opened where relevant local services and initiatives could be surfaced to appropriate individuals. You might recognise this sort of approach as it’s not too dissimilar to how Amazon suggests products that you might like.
This use of technology is not as far fetched as you might think. MDVIP is a group of primary care practices throughout the United States. Mark Murrison, president of marketing and innovation for the group states they want to change the doctor-patient relationship, “Wellbeing and prevention is at the heart of the service that we offer to our patients. That is why every MDVIP patient has an extensive annual wellness visit with their physician where they co-create a step-by-step wellness plan for the year ahead”.
He goes on to say: “…technology is an integral part of this process; physicians can communicate with patients via our bespoke portal and patients can also communicate back. This creates an ongoing dialogue outside of the doctor’s office”.
Andrea Klemes, group medical director, goes a step further, “we have shown year-on-year that this approach reduces utilisation of expensive hospital resources. Our patients have 65-75 per cent fewer admissions compared to standard medical practices. These superior outcomes are also reflected in levels of patient satisfaction; with 95 per cent having a positive experience compared to an average of about 50 per cent.”
Closer to home there seems to be a gradual awakening to the fact that we are going to have to start doing things differently, with the only way of achieving this in a cost-effective and scalable way being the better use of the technologies at our disposal.
Organisations like Patients Know Best and NHS Info are leading the way with applications that both physicians and patients can use together. Although still in its early days, they have the potential to save the healthcare system significant amounts of money.
One of the new breed of integrated care organisations, Whittington Health, are using the closer links the hospital now has with the community to put in place a pilot inviting all patients to complete an online HRA and sign up for regular targeted text and email communications.
Consultant radiologist Caroline Allum secured funding from the London Deanery for a fellow in clinical leadership to run the project. She says, “We need to have a much bigger presence in the lives of people in our community. We have a responsibility to help our local population understand how they can improve their overall health, how they can make better choices and where they can get help to achieve these goals”.
It is clear our current approach of managing the health of the nation is not working; both the increasing prevalence of lifestyle related health issues and the escalating cost of delivering comprehensive healthcare make it imperative we innovate. The huge NHS Connecting for Health IT project may have made us a little wary, but there is no doubt that technology has changed our lives over the last 20 years; the question is can it now help change our healthcare system?