Over the last three decades the US has consistently outspent comparable OECD countries on healthcare two to one and our outcomes are worse. Nearly half of the US population already has a chronic disease and the Milken Institute has projected the already high prevalence of chronic disease to become even worse in the next decade: by 2023, cases of cancer, mental disorders and diabetes are projected to grow by more than a 50% and heart disease more than 40%. Unless I’m missing something, it’s looking to me that as a nation, the more we spend the less healthy we become.
And, in fact, as a nation we are getting less healthy. According to a recent Population Health Metrics county-by-county report¹,a full 80 percent of U.S. counties lag behind other leading nations in terms of life expectancy, and the gap is getting bigger. The report found that life expectancy in some areas of the United States is actually decreasing, whereas it's increasing in the world's 10 leading nations.
And for the last three decades of rising health spend and declining health, digital technologies have made our lives richer and more convenient but unfortunately, digital technologies have done little, if anything, to make our lives healthier or for that matter, reduce the spiraling rise in the cost of healthcare.
At Microsoft we believe that’s about to change.
Based on what we see ahead, we believe we’re on the cusp of a pivotal era in technological history. Within the coming decade, we expect to see a number of innovations that will actually equip consumers to improve their health and manage their risks and make care safer, more efficient and more effective at a lower cost point. Some great thought leaders have already classified this as the triple aim
: the optimal balance of good health within a defined population, positive patient experience of care by the people in this population, and a lower cost per capita of providing that care. What we lack are the building blocks.
One of the primary reasons that digital technologies have not delivered on the promise of the triple aim is that, up until recently, the vast majority of health information technology solutions (HIT) on the market today have targeted our existing, acute care delivery system - the hospitals, clinics and emergency departments that are in the business of caring for but not preventing acute conditions and complications of chronic diseases. Acute care is, of course, an information-intense business, so it’s no surprise that most of the solutions to date have focused on digitizing, organizing, and moving health record information around the ecosystem. The problem is, our existing acute care delivery system is mired in its own inertia around reimbursements, cost shifting, low primary care to specialist ratios, and local turf wars and is now so consumed with acute care that it doesn’t even have the capacity to refocus on health.
As a consequence, our current delivery system only plays a very minor role in contributing to our overall health—current estimates are around only 10%. The other 90% is what happens outside the hospital, emergency room or doctors’ offices: genetics, our personal behaviors, our health literacy levels, and our community and living environments.
The good news here is we see the convergence of three transformational forces that will provide the building blocks the industry needs to design higher leverage solutions to achieve the Triple Aim. These transformational forces hold the potential to positively influence our behaviors, our self-management skills, and environments where we live, work, learn and play in ways we never before dreamed were imaginable. At Microsoft
, our focus is to collaborate and innovate with industry, business, academia, government, and consumer leaders to bring innovative, scalable and higher leverage solutions that improve care and population health at a lower cost per capita to the environments where we live, work, learn and play. Here are the three transformational forces that we believe will enable us to achieve the triple aim:
• The Internet of Things: The number of connected devices already exceeds the number of people on the planet. It’s no longer about an Internet of interconnected devices but an Internet of things where almost any object—your car, your clothes or advertising billboards—can connect. All of these will be interfaces to the computational power of the cloud that can follow us across the workplace, home and anywhere in-between.
• Natural User Interactions (NUI): By enabling us to move away from keyboards and controllers and toward natural human senses like voice, touch, and movement, NUIs will bring computing power to the masses. NUIs such as the digital pen, voice, touch, multi-touch, gestures, body motion, facial/skeletal recognition, surfaces and the phone (which will become the most personal device) will make technology invisible to users, making our interactions with people, things (screens, devices, cars, homes) and processes more natural and even enjoyable. NUIs will break through the digital divide by opening computing power up to the masses, including those with lower computer and health literacy skills because keyboarding and mouse handling skills will no longer be mandatory. NUIs will make computers adapt to us and how we live and work rather than the other way around.
• Social Networks and Behavioral Economics: In no other industry do the behaviors and decisions made by individuals, namely consumers and providers, have a greater impact on costs and outcomes than in the health industry. Consumers want to fix unhealthy habits and providers want to practice cost-effective medicine. Unfortunately, inertia often trumps intent. Social networks and even gamification--the use of game mechanics and game-based thinking to drive consumer engagement--will play a key role in driving the kind of positive behavior change needed to improve health outcomes and drive down costs.
In the upcoming weeks I’ll be digging deeper in these three areas and how the convergence of these transformational forces will empower and equip consumers, providers, and payers to work together in fundamentally new ways to achieve the triple aim.
1. Christopher J.L. Murray, M.D., Ph.D., director, Institute for Health Metrics and Evaluation, University of Washington, Seattle; S. Jay Olshansky, Ph.D., professor, public health, and senior research scientist, Center on Aging, University of Illinois at Chicago; June 15, 2011, Population Health Metrics, online; "Falling behind: life expectancy in US counties from 2000 to 2007 in an international context" published in Population Health Metrics in June 2011