From Patients to People

From Patients to People

Lucien Engelen 03/05/2020 2
From Patients to People

COVID-19 has shown us how to make health(care) relevant again.

I’d like to begin with two startling observations mentioned in my previous article of this series. 

Observation 1. From a patient perspective, healthcare is 80 per cent blunt logistics. In other words, just 20 per cent of any interaction with the system is meaningful.

Observation 2. Of all the factors that influence the average person’s health, such as genetics or birthplace, access to care accounts for just six per cent. Yet the healthcare system soaks up 90 per cent of all related expenditure. 

Clearly, something isn’t right. And the COVID-19 pandemic, despite the incalculable disruption and horrific death rates, has shown us that we can actually do something about it.

As things stand, I believe the future of healthcare is at stake. With healthcare demand projected to double over time, a growing shortage of skilled personnel, increasing burn-out rates, and decreasing budgets, the system won’t even come close to providing quality care to everyone who needs it. In short,  healthcare is set to implode.

From Patients to People

I think the main problem is seeing things from the wrong perspective. Rather than a narrow focus on healthcare, we need to step back and see the bigger picture of health in general

The time has come to shift our mindset from system-centric to patient-centric healthcare. Healthcare has always been organized from the perspective of the institution – and years ago this may well have been the right approach. Yet it has resulted in a fractured system of silos rather than synergies. GPs, medical specialists, mental health, birth control, consultation… the list goes on and on. Every silo has own mantra, its own finance model, its own set of regulations. It’s a bewildering web of inefficiencies that soaks up precious time, money, and effort. 

Mindshift needed! I like to refer to a “Copernican moment” for healthcare, where we (mind)shift from systems that revolve around the professional to systems that revolves around the patient. Technology could be a powerful driver for this. 

From Patients to People

Yet for the patient, this by the by. People rightly expect healthcare to be seamless rather than separated. Hence the hype (for want of a better word) around value-based healthcare. 

This value-based healthcare is built around ‘patient journeys’ that bring together everything needed to treat a certain condition – let’s take a hip replacement for example. The trouble is that these journeys take place in a specific institution. And even then, only in a particular department, say internal medicine in this case, and often also with only one doctor or nurse. In reality, of course, hip replacement patients have different needs. They may be suffering from another condition such as diabetes that also requires attention. So yes, so-called value-based healthcare is a good thing - but it is not so much a journey as a one-way street with no turnoffs. 

From Patients to People

Or take those with a chronic condition. They will typically go for an annual one-hour checkup, but what about the other 8765 hours of the year (picture credit Sara Riggare) ? Shouldn’t care follow them from that appointment and into their lives in general?  The long and the short is that even with the best intentions, the system is continuing to organize healthcare around itself rather than reach out into the world of the patient. 

From Patients to People

This brings us back to access to care as a ‘black hole’ absorbing 90 per cent of expenditure, yet representing ‘just’ (albeit a very important) six per cent of the mix of factors that determine a person’s health. Why are we so fixated on funneling the bulk of our resources into an area that offers such a limited impact?  The answer is simply: ‘because that’s what we’ve always done.’ Well, that answer is no longer sufficient. 

It’s time to set a new trajectory that takes us from sick care to health care and onto health aware. I envisage a far more holistic and joined-up approach that reaches out into society and fits into patients’ lives. Or to be more exact, that adapts to people’s lives, since the aim would be to prevent them from becoming patients in the first place.

Today we are well aware of the need to invest in prevention, but mantras and silos and regulations have built a seemingly impenetrable wall that keeps practitioners and institutions at the heart of the system. I often see this within innovation practice, where opposite forces dissolve each other (a kind of Newton’s law).

From Patients to People

Yet with the onset of COVID-19, we have seen the first cracks in this wall start to appear. Indeed, the current pandemic is showing that we have the tools and technology necessary to make the shift to a truly patient-centric approach. 

From prevention truly personalized care: a more sustainable model. So, things simply can’t go on as they are. We have already touched upon the shortage of skilled personnel, the projected growth in demand, and dwindling (real term) budgets. The anxieties we feel about overloading healthcare system are misplaced. In actual fact, the system is already overloaded.

Then we have yet another startling statistic: citizens in the Netherlands currently spend an average 27% of their net income on healthcare, insurance premiums, co-payments, and certain procedures such as, say, dentistry. If nothing changes, this figure could rise as high as 40%. This would clearly be a no-go area for people. So the need to create a more sustainable model is clear. Perhaps the current pandemic will provide the shock to the system we need to drive meaningful change.

The answer lies in moving from institution-based healthcare for the patient to society-based health for the population.  

This holistic approach to health would bring into play a far wider ecosystem wider involving players from all aspects of society, opening up truly exciting opportunities across a number of fronts, linking ongoing health to other aspects of life.  

As noted in my last article, food and nutrition data would help to make beneficial foods cheaper than non-beneficial ones. As an example, I talked about patients undergoing chemotherapy who receive a good level of care in hospital with all the right foods, but are then left pretty much on their own once they are discharged.  Yet it’s so easy to make sure they continue to receive the correct nutrition after they return home.

I also mentioned the proven link between health and finance, with people in financial debt more likely to use the healthcare system. I suggested that banks could offer support by spreading debt and lowering interest rates to help those in need cope better with the burden. This would be underwritten by healthcare insurers who, in doing so, would be reducing their own costs. 

As the edges between healthcare and nutrition, finance and technology (and why not mobility, retail industries and workplaces too?) begin to interconnect, we would build an integrated foundation for sustainable, personalized, people-centered healthcare.  And we would start to shape a holistic approach where the touch points on a patient’s ‘health journey’ are not measured in isolated one-hour time slots but in multiple moments every single day, as we combine the data from medical records, grocery stores, financial institutions etc. to support people in staying fit and well.

Yes, of course this brings in questions around privacy and ethics. But that is a study in itself and not one we have the time or space to deal with here. Needless to say, the appropriate safeguards and legislation would have to be built into a people-centered health system.

And if a new approach to health is driven by the power of technology, we should also take care to avoid a digital divide and invest in the promotion of digital literacy. That means bringing the right tools, education and coaching to those who need them. From kindergarten onwards, society would teach people to use digital confidently and safely. Fraudsters taking advantage of the coronavirus outbreak to fool anxious, worried and vulnerable victims into clicking fake links have underlined the importance of developing a high level of online awareness. Cyber-wise has to be the new street-wise.

Digital first, physical next. This is our opportunity to unlock a better way of working.

I am calling for a shift from reactive to proactive care. From centralization to distribution. And from system-focused to people-centered. 

Supported by powerful technology and new eco-system players, this fully-connected and society-based health eco-system would be able to address the needs of every single person in all communities at the right time and place. Other industries helping improve the health of citizens. 

From Patients to People

It would truly be a revolution for the people - and it would revolve around the people. Maybe we can learn from the approach of organizations such as Walmart Health, Amazon, Berkshire Hathaway and JP Morgan, who focus their work on the end-user whether that be their patients or their co-workers. 

From Patients to People

This revolution is no longer a theoretical debate. It’s going to happen and indeed, has already started. COVID-19 has taught us some hard-earned lessons that are teaching us how to put individuals at the heart of a better, more holistic, and more personal approach to healthcare. We cannot afford to let them go to waste. 

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  • David Goff


  • Martin Bond

    At least this crisis taught us some valuable lessons

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Lucien Engelen

Chief Health(care) Optimist

It is at the intersection of technology and patient empowerment, which is where Lucien Engelen (1962), director of the Radboud University Nijmegen Medical Centre REshape Center and advisor to the Board of Directors (since 2007) feels most at home. The two worlds combined into the Radboud University Nijmegen Medical Centre and Singularity University in Silicon Valley & the Netherlands and in the Nordics, his modus operandi is always challenging, sometimes provocative but always techno-realistic. Writing on a new book that will be titled "Augmented Health(care)™ : The end of the beginning" (May 2018, Barcelone Spain) as he thinks we're at the end of an era of creating awareness, pilots, proof of concepts etc in the digital transformation of health(care). More on that on, his Linkedin Page has over 750.000 followers. He is Faculty Global Health(care) & Medecine since 2011 at Singularity University's Exponential Medicine in the US and in the Netherlands.

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