Written and Contributed by Harold Paz, M.D., M.S., Executive Vice President & Chief Medical Officer, Aetna
In 1993, would anyone have predicted that in just 25 years we could have almost any type of food delivered to our homes, watch our favorite movies with the click of a remote, or buy a car using a handheld smartphone? Would we have foreseen that Toys R Us, Blockbuster Video, Borders Books, and other venerable stores would be bankrupt and gone?
Just as innovation has transformed our transportation, food, and entertainment services, there are indicators that medicine is also realigning its future landscape. Physicians are a critical part of this transformation, and they are well-positioned to help usher in this new era.
Disruption is Imminent
What is so unique about today? There are two current factors driving an impending transformation. First, new technologies have resulted in the cultural rise of personalized, consumer-centric services. Secondly, the U.S. health care system is finally hitting a tipping point: the growing demand for its services, combined with its unnecessary complexity and unsustainable costs, have made the status quo untenable.
The rise of the information age has allowed individuals to become more informed consumers of health care. Patients now compare clinicians by reading online reviews, and an ever-growing coterie of digital applications allows them to engage health care services in fundamentally new ways. The industry is also only beginning to harness the possibilities of telehealth, a modality that will undoubtedly rise as remote care becomes more culturally acceptable.
As consumers’ demands increase, the system will need to discover how to do more with less. As our nation’s health care spending approaches 20 percent of GDP, other societal services, such as transportation and education are being degraded. Disruption seems inevitable.
Physicians are a critical part of this coming evolution. For many years, they have felt increasingly pressured by burdensome paperwork and administrative tasks. A 2018 survey by the Physicians Foundation uncovered three main factors that doctors found least satisfying about their practice: 39% named Electronic Health Record (EHR) design and interoperability, 38% listed regulatory/insurance requirements, and 30% deemed professional liability/malpractice. Navigating the mazes of EHRs or completing administrative tasks were never the inspiration that steered clinicians into their profession. The new disruptions must find ways to return clinicians to doing what they do best: taking care of patients.
“Convenience” and “access” will be the new watchwords of this new health care transformation, echoing retail sector changes in which small independent stores gave way to large national chains. Today, those same nation-wide stores are being challenged by logistical companies that ship directly to customers’ homes. Similarly, the past decade has seen solo practitioners and independent hospitals consolidate into larger health care networks (in an effort to improve efficiencies while lowering costs). Now, the next phase of disruption is here.
At the turn of the century, health futurist Ian Morrison coined the term “the second curve” to describe the radical shift away from conventional business models to new ones driven by disruptive innovation. This term has become popular in the context of health system consolidation and the move toward population health initiatives. These are important advancements, but we need to now push forward into a truly personalized delivery model — a “third curve” of health care.
In the third curve, health care leverages the doctor-patient relationship, precision medicine, big data, artificial intelligence, and innovative digital technologies to create a new and improved patient experience. Working together, these factors will build upon the traditional physician-patient information exchange by making medical information easier to access and more transparent.
Health Care Transformation Through Personalized Care
In this coming future, health care will become increasingly personalized. Clinicians will provide individual care plans that guide the patient through their health ecosystem via real-time, real-place analytic coordination. Ultimately, wasted health dollars will be more efficiently repurposed to address behavioral, social, and environmental health determinants.
Working with physicians, health plans are trying to tap the promise of a third curve approach. Recently, Aetna launched a personalized program called AetnaCare, which identifies the most complex members and connects them with local health and wellness services. Nurse case managers work with each member and his or her physician to help members develop the knowledge, motivation, and confidence to manage their own health. In addition to meeting patients in their homes, AetnaCare nurses coordinate customized care for each member, helping them make health choices that dramatically improve clinical outcomes. While early, results have demonstrated significant promise: Engagement rates are above 65 percent, with reduced inpatient utilization and per-member, per-month costs. Just as importantly, physicians have welcomed the new care model - It has alleviated many of the typical care coordination burdens they previously faced.
With the systemic and demographic challenges on the horizon, the third curve in health care is both inevitable and necessary. By providing greater transparency, leveraging new analytic capabilities, and empowering patients to take charge of their own health, health plans and physicians can collectively tackle the quality and cost challenges that lie ahead of us.
