17 Dec The Three Waves of Healthcare by Author Nicholas J. Webb
Three Waves of Healthcare
I’am almost halfway through my book that will be released next fall on the future of healthcare. As a management consultant living in the space for over two decades I have seen three distinct phases aka (WAVES) the first WAVE lasted for about 60 years. I call this WAVE the treatment WAVE. Since the 1940s after eradicating most infectious disease we begin the process of developing treatments, surgeries, clinical models, drugs and medical devices to attack every human disease possible. The incentive for this WAVE was for product/drug developers to produce more products and drugs, hospitals more procedures and surgeries, doctors more reimbursement favorable interventions. We were simply incentivized to treat, treat, treat. The good news is we help a lot of people the bad news is we completely took our gaze off of health while focusing squarely on treatment intervention.
Meanwhile our population continued to get sicker and sicker. The cost of health care since the 1950s increased by over 250%, we more than doubled prescription medicines over the last decade or so while our population continues to get sicker. Most notably we became much fatter in fact 40% of Americans are obese and three out of four Americans are overweight, this is driving significant and more importantly unsustainable costs. In fact some studies suggest that 70 to 80% of every dollar that is spent in healthcare is the result of what is now called lifestyle disease.
WAVE two suggested that the healthcare crisis was all about increasing access to more patients. Personally I think everyone in America should have access to healthcare, but if we believe that, we have to be realistic about its affordability given the epidemiology of chronic disease that is almost completely self-inflicted. We were told that we could redo the healthcare system and make health care available to everyone, the problem is it’s not financially viable. When you combine the increased incidence of obesity that’s escalating, chronic disease and the silver tsunami a rapidly aging population you have the tipping point. what I call WAVE three.
In this WAVE we will leverage connection architecture, wearable technologies, influential social communities, game mechanics to once and for all begin the process of addressing the causality of chronic disease rather than the intervention. But wait, how do you get people to participate in this? Here’s the scary part that angers many – punishment– that’s right we will develop a National Health Value Score (NHVS) that punishes patients that are over consuming healthcare based on lifestyle decisions. It won’t be a punishment from the classical sense there will be a new gatekeeper that requires patients participate in major lifestyle training and prevention programs in order to get access to treatment. The throughput of healthcare will change beginning with prevention and wellness and will look to treatment as a last resort. This view of the future angers many for two reasons one they are in the 80 percentile and don’t want to get punished or two they are economically benefited from the old system. If 80% of your business costs were preventable you would be out of your mind not to fix them. Yet in healthcare we spend a lot of time rearranging the deck furniture on the Titanic without meaningfully addressing the core cause. Psychologist and behavioral experts know that if we want to change the consumption of healthcare which of course is our biggest problem, we need to rearrange the incentives and disincentives. PS please don’t shoot the messenger I know this idea angers so many people and remember I’m not here advocating anything I’m just suggesting that this is in fact the likely future.
Lastly but not least we will have to address many of the logistics associated with healthcare and healthcare ecosystem including: interoperability, improved clinical efficiencies, reductions in overall infrastructure cost, more intelligent reimbursement models and of course the list goes on. But for many organizations they believe this shopping list is the totality of how we fix healthcare and I am suggesting that we have to start with its core cause.