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Creating health: Healthcare should be about more than treating the sick

Our healthcare focuses on sickness. Let’s challenge ourselves and create a true health system. Don’t believe me? Let’s take a look at the existing healthcare system.

The Challenge
The American healthcare system is not a health system. It’s a patchwork of government and private payers and providers that was created out of a desire to treat illness.

Our insurance system, which is designed to protect us from financial peril when we need healthcare, is focused on acute disease. Likewise, the Medicare program was conceived as a hospital insurance program, and it still is not well designed to manage long-term conditions such as diabetes and high blood pressure, which tend to be our most prevalent killers.

A true healthcare system would be designed to do both parts of the job: treat sick people, and prevent illness and create health. The need for that dual approach is even more pressing now, since demographics have changed within the population. We Americans are older, sicker and fatter than we used to be. We are living longer with chronic, progressive disease. According to the Centers for Disease Control, two-thirds of all Americans are overweight or obese, and the American Cancer Society estimates 43 million Americans still smoke despite knowing the health risks. If we could be convinced to live healthier – that is, eat less, drink less, smoke less, and walk more – we would suffer less disease.

A true healthcare system would be designed to do both parts of the job: treat sick people, and prevent illness and create health. The need for that dual approach is even more pressing now, since demographics have changed within the population. We Americans are older, sicker and fatter than we used to be. We are living longer with chronic, progressive disease. According to the Centers for Disease Control, two-thirds of all Americans are overweight or obese, and the American Cancer Society estimates 43 million Americans still smoke despite knowing the health risks. If we could be convinced to live healthier – that is, eat less, drink less, smoke less, and walk more – we would suffer less disease.

So as we talk about healthcare reform, one goal should be to create a structure that is a true healthcare system. After all, the only way to really reduce the cost of healthcare is to reduce the need for it by helping individuals and populations improve their health.

The Solution
We must cut costs and improve health through behavior change; by all participants in health and healthcare. Our current approach to changing behavior is ineffective. That’s why diabetes rates are climbing, and why improvements in heart health that was the results of lipid lowering agents have begun to fade. Prevention in America today amounts to preaching and scolding and “adherence to guidelines.” The new system we create, if it is to be successful, will have to have interventions that draw from other disciplines that offer a little more insight into what motivates people to change.

We need to take an ecological view of all the influencers on health – for example, the psychological barriers to healthy behavior, and the social context in which we all operate.

We need to find ways to meet people where they are: to embed interventions in everyday life and make them feel easier and more natural. We need to develop more attractive and encouraging messages than “sacrifice,” and build on what people already are inclined to do.

That means getting creative, designing a system that borrows tools from businesses outside of medicine. Lots of interesting experimentation is going on – using a variety of these approaches to motivate people to change.

Innovation
To accomplish this, we’ve got to think innovatively, to lend support and make exercise fun. We need to meet Americans where they already are, and show them the fun in healthy, everyday activities.

Techniques that have been proven to work to motivate positive behavioral change include:

  1. Inducement – use incentives and rewards, as hotels and airlines do
  2. Coaching – help people plan and follow through
  3. Feedback – data feedback (from a pedometer, for example) to help track performance
  4. Social support – use buddies, social networks, peer support groups – on the Web or face-to-face
  5. Fun – use games, competition, dancing and other common activities to increase activity levels

Here are a few examples of how these techniques can be combined to engage people to improve health:

  1. The Freewheelin bike-sharing program linked to a social networking systems like Facebook, Twitter and Flickr for the Democratic and Republican Party conventions. In just eight days, 7,523 rides were taken, 41,724 miles were ridden, and 1.3 million calories were burned.
  2. Group Health in Washington State is expanding their medical home model. By adding staff, enhancing EMR, and increas-ing proactive management of patients, they have lengthened the time they spend with patients, reduced ER, urgent care, and hospitalization stays of those with chronic illness, improved quality indicators across 22 measures compared to their traditional model, and improved the care experience of the patients and providers.
  3. Personal health coaching has proven very effective on a wide variety of topics demonstrating the power of expanding support around patients that are trying to change their behaviors. After nine months, a morbidly obese population participating in health coaching lost an average of 12.4 pounds, and their BMIs dropped an average of 2 points. And, of those participating in the tobacco cessation program, 53 percent quit smoking and 92 percent who quit smoking indicated high confidence they will continue to not smoke.
  4. Increasingly, employers are adding incentive programs that reward members that receive recommended health screenings, maintenance care for chronic conditions, utilize educational support services, and choose lower cost but equally effective treatment choices.

Acute care will always be a necessary component of the health care system. But, to make the American system better, we must focus more resources on prevention and wellness. Information must be more accessible to caregivers and patients yet remain secure. Providers must be more collaborative regarding care delivery and remain actively involved with processes designed to measure their effectiveness. Finally, patients must become more responsible for their own health. Today’s system “rewards” those that practice poor health habits with heroic clinical rescue efforts. Our future system must instill healthy lifestyles in our young and provide ongoing encouragement throughout life to achieve optimal health.