by Mike Critelli

December 2011 –  We are at the beginning of a potentially transformative way of thinking about health and the role of healthcare and health insurance in our society. We demand the best care at the lowest cost, but we are using health management tools that are obsolete and inadequate in enabling our society to afford healthcare and health insurance.

The traditional model of healthcare is based on the assumption that we all get sick randomly, without warning, and through no fault of our own. The model assumes that we go to a doctor who, in the space of 7-10 minutes, through the combination of a form we complete, a quick physical examination, and an interview with us, diagnoses our problem and identifies the right treatment.

Aside from the wildly inadequate opportunity this process gives to any healthcare professional to deliver high quality care in 7-10 minutes, there are three other big problems with it:

• We bring to the healthcare professional very little useful insight as to what caused us to need care.
• The process puts no responsibility on us to behave in ways that reduce our risk of getting sick or injured.
• We are neglecting the opportunity to use both tracking and diagnostic tools that will enable us and our healthcare providers to do a much better job managing health, healthcare, and the cost of health insurance.

Today, we are at the beginning stages of a revolution in health information technology that will change all of that. I am excited about the potential of personal health management systems that create the opportunity for better data and better tools for individuals and those responsible for making healthcare and health insurance decisions to manage both daily activities and healthcare interactions far better than they have ever been managed.

The first set of tools are those that allow far better continuous capture and tracking of data about both how we live our lives and the effect our daily activities have on our vital health indicators. Most of us show up at a doctor’s office, get weighed, get our blood pressure taken, and, in the context of a more in-depth analysis, get a blood test and some diagnostic imaging tests. These information-gathering tools give us and our doctor a lot of information about our state of health at that moment, but they tell us very little about what led up to that time, or what kinds of health risks we face going forward.

Several things contribute to our health: our diet, exercise patterns, lifestyle decisions such as tobacco, alcohol and drug usage, our sleep patterns, the stress we face every day, and the environmental exposures that can damage our health. Today, there are new and improving tools to capture data about all these activities automatically as they happen. More importantly, we can use a personal health management system to provide an incentive for individuals to make good decisions, such as a coupon for a healthy food decision or an incentive for an exercise program. We can also use such a system to measure the physiological effects of our daily activity decisions, such as our weight, blood pressure, cholesterol, glucose and hemoglobin A1c.

What is remarkable about these new tools is that they provide great information without requiring us to go to a lab, a doctor’s office or a pharmacy to learn about our state of health. We can capture and track our health daily over a long period of time and provide our doctor with far better information than he or she can possibly capture in a short visit. In fact, the beauty of these tools is that, just as cars have technology that provides an alert that we need to replace a tire or get a maintenance check-up before the tire or engine fails, we can get an early warning that we need to call our doctor. A few years ago, I saw an expensive computer system in use in a patient’s home that alerted a nurse that the patient was suffering from chronic obstructive pulmonary disease because of excessive weight gain over a 24-hour period. Today, that same system could be used on an online personal health management system for a fraction of the price.

Aside from better care at lower cost, this new technology offers another huge benefit: it maximizes the value of increasingly scarce healthcare professional resources. We have a shortage of trained doctors and nurses today, which is going to get worse if we continue to require everyone to get diagnosed and treated through face-to-face visits. As our aging society experiences more health problems, the healthcare system will collapse of its own weight.

Substituting more self-care tools and remote health monitoring systems will enable one healthcare professional to manage far more patients than has ever been possible. It will also enable more efficiently and effectively delivered care because professionals will intervene at the right time with the best information. We have no choice but to redesign our healthcare system to compensate healthcare professionals who do more effective remote care at a rate that makes it financially rewarding for them to do so.

About the Author

Michael J. Critelli is the President and CEO of the Dossia Service Corporation, a for-profit corporation committed to the design and implementation of a portable, lifelong, secure patient-controlled health record. He retired from Pitney Bowes after a nearly 30-year career, at the end of which he served as Chairman for 12 years and CEO for 11 years.

He is an innovator in employer-based health programs, having created a “culture of health” at Pitney Bowes. The Company created an environment highly conducive to prevention and wellness, to superior health care delivery, and to value-based health insurance plan design to drive optimal plan participant and provider behaviors.

He is also a member of the for-profit boards of Eaton Corporation and Mollen Immunization Clinics and the non-profit boards of the Partnership for Prevention, RAND Health Advisors, the Institute of Medicine’s Roundtable on Value and Science-Driven Health Care, and the Boston University Alzheimer’s Disease Center Advisory Board. He is also a member of the Executive Advisory Board for Opera Solutions, a provider of predictive analytics solutions and Alexander Proudfoot, a leading operational consulting firm, and a board observer at Navigenics.

He graduated from the University of Wisconsin with a BA in communications and political science (1970) and from the Harvard Law School with a JD cum laude (1974), and is currently a Senior Advanced Leadership Fellow at Harvard University.

You can reach Mike Critelli at 617-621-7670