Lowery's setback amid the fledgling effort at Carolinas HealthCare System points to one of the central issues facing healthcare system officials as the nation struggles to coordinate care to improve health and slow the growth in U.S. healthcare spending.
The daily decisions patients make outside the reach of hospitals, clinics and physician offices on what to eat; whether to exercise or quit smoking; and whether they take their medicines profoundly affect their health and how they will respond to medical intervention, be it therapy to maintain health or complex disease management to prevent rehospitalization.
That's why a growing number of health systems, doctors and insurers are looking to expand the reach of healthcare from the hospital and pharmacy into patients' homes and lives. Their goal is to keep patients with chronic conditions—which today includes nearly half of U.S. adults—healthy enough to avoid the emergency room or hospital.
Many are investing heavily in education and social work to reach beyond patients' immediate clinical needs. Health systems such as Carolinas HealthCare and fledgling accountable care organizations—new healthcare networks that stand to profit or lose based on the quality and cost of patients' care—are pouring resources into tackling barriers of income, transportation and health literacy to encourage healthy choices among the chronically ill.
But that might not be enough. Resistance to change has led providers and insurers to delve into the fields of psychology and economics in their search for more effective and efficient interventions that can overcome the powerful societal forces that undermine health, whether from inadequate income or a lifetime of lousy habits.
These new interventions pair strategies from the emerging field of patient engagement—which builds on a person's existing resources and knowledge—with behavioral economics, which seeks to understand why people make illogical choices. The goal is to develop incentives that nudge the chronically ill to make decisions that promote personal health.
The obstacles to changing behavior are significant and most of these new approaches are only beginning to take shape. “It's not an easy fix,” said Jessica Greene, a nursing professor and researcher on patient engagement at George Washington University. “Anyone who has tried to lose 10 pounds knows how hard it is.”
This first installment of Modern Healthcare's Channeling Choice series looks at the decisions people make that affect their health, the factors that influence those choices, and the challenges facing the healthcare industry as it seeks to sway those decisions. The next part will investigate how patient choice contributes to underuse or overuse of prescriptions and other therapies. The final article will offer profiles of patients grappling with three powerful influences on decisionmaking: money, health literacy and emotion.
Chronic diseases such as diabetes and heart disease, which are linked to smoking, poor eating and exercise habits, are among the most common and costly contributors to the nation's rising healthcare costs. Adults with chronic diseases account for 75% of the nation's healthcare spending, according to the Robert Wood Johnson Foundation. Two-thirds of the rise in healthcare spending is attributable to the increased prevalence of chronic disease and new technology to fight disease, according to the Partnership to Fight Chronic Disease.