Is there a business case for promoting wellness? People on a higher socioeconomic scale will pay for it in a microsecond, says Lee Hood. But can we push it down to ordinary people, and eventually to the poor?
“The critical point is to be able to reduce the cost. I’m utterly confident from the technology point of view,” Hood says, citing the genome sequencing, which they reduced by 6 orders of magnitude from 2000 to 2016, as an example. But if — and when — wellness is accessible to everybody, how do you educate individuals so that they will want it?
Providence St. Joseph Health is setting up two kinds of programs for doing this, one of which includes making modules for systems medicine and P4 medicine so high school biology students can learn about it. But the challenge is — how do you get to the consumers and patients?
“What I’d love to see is a TV program that’s a mystery in solving interesting medical problems. Get great writers, get great actors, and I think you could teach people an enormous amount,” Hood says. As for the physicians and health care people, there we have a more focused audience. “What I always thought would be great for freshman MDs is to have each of them get their dense dynamic data clouds and have them analyze their own data and figure out what systems medicine and P4 biology is all about,” adds Hood.
Scott Weingarten also believes there is an emerging business case today for wellness. “We’ve been talking about the shift from fee for volume to fee for value or risk-based reimbursement. The fundamental principles of MACRA include that providers are at risk for the quality and cost of care. So quality may include wellness, preventative care, and cost of care certainly relates to how well we keep our patients. And we’re seeing that with Medicare, and a number of the commercial insurance contracts are shifting from fee for service to shared savings, to shared risk. The risk will undoubtedly be tied to both quality of care and cost of care.”
Investing in wellness, adds Amy Compton-Phillips, was a focus point during her time at Kaiser Permanente with initiatives such as “exercise is a vital sign” and “sleep is a vital sign”. “We collected the kind of socioeconomic information that lets us know about the social determinants of health, so we could be sure we were caring for the whole person, and keeping them well, so they would be less likely to need health care services. Because it made economic sense.”
“As we get closer and closer to accountable care models where you have shared savings, we can flip toward focusing on wellness, rather than only taking care of disease,” Compton-Philips says.
Hood believes that part of that can be done through dense dynamic data clouds. “We can estimate your genetic risk for about 70 different diseases. Some of them are actionable, and you should know about those. Many of them aren’t, but if we know what you’re at risk for, we can follow the potential transitions for that disease at the very earliest stage.”
From the NEJM Catalyst event The Future of Care Delivery: Relentless Redesign at Providence St. Joseph Health, January 19, 2017.