At least one in three people who have tried out virtual health care have done so because they use technology in all aspects of life and want to do the same with their healthcare. This data point has informed my vision for self-care and the home as our health hub, bolstered in part through the research of Accenture from which this first graphic comes.

A common theme at health care meetings these days is how and when health care will meet its Amazon, Apple, or Uber moment? Lately, one of my speaking topics is the “Amazon Prime-ing” of health consumers, which is also a chapter in my book, HealthConsuming: From Health Consumer to Health Citizen.

This very question is addressed in this week’s New England Journal of Medicine in an essay, Toward Facilitated Self-Service in Health Care

David Asch of the University of Pennsylvania’s Penn Medicine Center for Health Care Innovation, and fellow researchers, recognize the fact that industries outside of health care that have lowered their cost structures have enabled consumers to DIY some of their consumption or service access. Think: ATMs in banks supplementing or replacing human tellers; booking airline tickets, hotel rooms and restaurant tables online; and, pumping petrol at the gas station in “self-service” lanes in 48 of the 50 U.S. states. In each of these scenarios, financial services, hospitality, and petroleum operators have bent their industry cost-curves while engaging consumers in self-service.

Asch and team write, “aligned financial incentives, better customer centricity, and technology have been motivating and enabling forces for change, but the transformations themselves came from operational changes that enhanced productivity — mostly by finding ways to use fewer people….Because of easy ­to ­use software, fewer people now use travel agents. Yet despite increased use of EHRs by clinicians and smartphones and wireless technology by patients, the fundamental approaches to managing hypertension, diabetes, and chronic lung disease have remained the same for 50 years….The physician–patient encounter is health care’s choke point. So long as we continue to think of health care as a service that happens when patients connect with doctors,  we shackle ourselves to a system in which increased patient needs must be met with more doctors.” 

When might self-service in health care happen in the way consumers have fast-adapted to making stock trades online becoming their own traders, making photographs online via Shutterfly like a local photo lab, or using software like Quicken to file taxes as a patient dealing with Type 2 diabetes could track and manage blood glucose data?

“The challenges facing facilitated self-­service are likely to be less technical than socially constructed,” Asch et. al. believe.

Three factors could, together, foster self-care that’s safe, effective, and cost-impactful:

  1. Foster payment systems that support self-care through new channels like telehealth, preventive screenings at home, and lower-cost sites for care
  2. Open up regulatory regimes to enable cross-State border care, “untethered from the in-person context” 
  3. Expand regulatory expertise that ensures self-service approaches meet safety and effectiveness standards similar to those for drugs, devices, and providers when cleared, accredited or credentialed.

For U.S. healthcare to bend that cost curve and become sustainable, we must ultimately facilitate patient care without, or beyond, a doctor, the authors conclude.

Health Populi’s Hot Points:  GMDC held a webinar today on self-care, discussing the opportunity for health@retail to support consumers in doing more for themselves to engage in health. Consumers are seeking care outside of the legacy health system given their growing role as payors, GMDC’s consumer research shows. “The New Retail Health” chapter in my book identifies the proliferation of touchpoints for health where we live, work, play, pray, learn and especially, shop….where health services can be found in malls, shopping strips, gyms, grocery stores, retail pharmacies, beauty retailers and barbershops, and combinations of these: for example, the recent news that Kohl’s the department store would collaborate with WW (the newly-rebranded Weight Watchers) and Aldi, the value-priced grocer, on real estate co-location opportunities.

Why does this make sense? Because Kohl’s is a huge retail channel for wearable tech and athletic clothing; WW is growing its role beyond “dieting” to wellness and health coaching; and Aldi is enhancing its food supply chain with healthier and more organic food items.

On the health data supply side, we’ve met the advent of consumers’ access to their personal health data via digitized electronic health records (EHRs) and OpenNotes, cloud computing, Big Data analytics and AI, and wearable tech generating personal biometrics that fall outside of the claims and encounter data captured by doctors and hospitals.

The supply side @retail for health and consumer-facing tech is maturing and penetrating our homes, held in hands, stored in pockets, and worn on wrists.

The demand side among consumers is growing for self-care, engagement and empowerment.

Remember Asch and team’s observation that “the challenges facing facilitated self-­service are likely to be less technical than socially constructed.” We see green shoots of the “social de-construction” of the obstacles in the health care landscape now: Medicare Advantage supports social services for older people enrolled in these plans; Kaiser-Permanente is making a “bold move” to channel social determinants of health in collaboration with Unite US; and, Dr. Sachin Jain promotes these approaches in his medical practice at CareMore Health, supporting self-care at home.

We believe in the Quadruple Aim, that we hold four ideas in our hearts and minds at once: to enhance the health care experience for both patients and clinicians, to bolster health outcomes for individuals and community health, and to lower medical spending per capita. The audacious goal of QuadAim can’t be done without patients – now consumers and payors — engaging in self-care at home, away from the high-cost medical system.

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