Care Redesign
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An Image of Medical Complexity

Article · February 6, 2017

Humana 90 pieces of paper medical complexity health care finance

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As my elders (parents, aunts, uncles, mentors) enter their twilight years, I’ve become convinced that there is a variation of Moore’s Law (a doubling of computing speed every 2 years) in medicine. The complexity of health care doubles each year for a person over the age of 75, with multiplicative variability for the number of chronic conditions. That complexity in and of itself adds mental distress and anxiety to a generation raised during the Depression, who have always been self-reliant and independent, and who care deeply about how their hard-earned dollars are spent.

My father-in-law is an example. He was an 86-year-old widower, becoming frail but still reasonably healthy. He had a past medical history of high cholesterol and more recent mild cognitive decline. He lived several states away from his only child in an assisted living facility, who was incredibly helpful in organizing his life and his care.

Despite that (or because of that), the photo above illustrates the 90 billing statements (not actual bills — Medicare paid) for treatments rendered in the last 100 days of his life. He had fallen a couple of times, causing him to become combative one evening as his confusion progressed, resulting in a few trips to the ED. No one intended overtreatment or poorly coordinated care or making his life more complicated, but the result of the disaggregation of each point of contact with the medical system yielded yet another unintelligible document, making it near impossible for him to make sense of the treatment he’d received. He assiduously tried, but there was no hope. Neither I (an MD) nor my husband (a PhD) were any more successful.

A foundational tenet of health care is primum non nocere: first, do no harm. When we disassemble care into its components, translate the elements into an unbreakable code, then dribble out pieces of the encoded message bit by bit, it’s no wonder the general public sees the complexity of health care finance as some type of water torture. Selling care by the bundle, and keeping the complexity of care behind the curtain for the end user — the way we do with other highly complex products purchased every day in the U.S.­ — would go a long way to simplify health for everyone.

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