Redefining Access to Healthcare

26 February 2012 | Dr. Dennis Schmuland, Chief health strategy officer, U.S. Health and Life Sciences, Microsoft
​An embarrassingly high percentage of our nation’s citizens are caught in a cycle of poverty that’s intertwined with a lack of access to education and healthcare. Education impacts poverty, poverty impacts health, and poor health impacts workforce participation, productivity, and innovation. These, in turn, impact income and economic growth.
 
In this series of related blog posts, “Redefining access to healthcare,” we will explore the role of technology in democratizing education and breaking the poverty cycle, as well as reversing the runaway growth in U.S. healthcare spending, by addressing three root causes of medical cost growth: the shortage of primary care physicians and allied health professionals, low health literacy, and disengaged consumers.
 
Primary care and allied health professional workforce shortage
 
The Patient Protection and Affordable Care Act promises to extend healthcare to more than 30 million uninsured citizens. There’s no question that a major overhaul of our healthcare “non-system” is necessary to increase access, improve the quality and safety of care, and reduce costs. But according to Kaiser Family Foundation CEO Drew Altman, CEOs of some of the largest corporations in America aren't even confident in their ability to control costs. And with the imminent surge in the volume of newly insured―many of whom have postponed needed care because they lacked insurance—demanding more services from the fast-retiring and dwindling supply of primary care and allied health professionals (especially in rural areas), the question is no longer one of scaling access, although that remains an important issue. Instead, the question becomes how we can leverage technology to scale the capacity of healthcare professionals to care for and coordinate the care of increasingly larger panels of patients.
 
According to the Association of American Medical Colleges, “The nation must begin now to increase medical school and GME capacity to meet the needs of the nation in 2015 and beyond.” Over the longer term, we will need to train more primary care physicians and allied health professionals and place them in communities where they are desperately needed. But the inescapable reality is that our present educational system simply cannot mint enough new medical and allied professionals to meet the surge in demand that health insurance reform will create. In the near term, we need to improve the way patients consume health services.
 
Low health literacy as a barrier to health
 
It is more expensive to treat sick people than it is to keep people healthy. And for the 47 percent of U.S. adult citizens who have a chronic condition—like heart failure, diabetes, and high blood pressure—health literacy skills are a major factor in whether they will develop the complications of their conditions that result in the need for costly interventional care.
 
According to the 2007 National Healthcare Quality and Disparities Reports, only about 1 in 10 adult Americans have the ability to use the health information available to them to make decisions that will lead to better health. People who have trouble understanding health information are more likely to end up in the emergency room and are less likely to get cost-saving preventive care, such as flu shots or mammograms. According to the Agency for Healthcare Research and Quality, low health literacy leads to more emergency room visits for all patients and an increase in mortality for seniors. And patients with low health literacy are less likely to comply with medication regimens than those who had a better understanding of medical information.
 
Disengaged consumers
 
The well-intended “consumerization” of the health industry over the last decade has produced the unintended consequence of marginalizing the responsibility of the consumer in making value-based decisions about their health, improving their health habits, and self-managing their conditions. We now commonly refer to people seeking care as "health consumers," implying that the consumer should be able to shop for health like they shop for shoes and home appliances. But health is more of a product of personal choices and health behaviors, health literacy, and community and living environments.
 
Health care “consumerism” won't succeed unless consumers start thinking less about "getting care" from the medical system and more about "taking care" into their own hands and staying as healthy as possible—by proactively improving, managing, and monitoring their personal health behaviors, lifestyles, and chronic diseases.
 
How can technology help consumers become proactive in slowing the unchecked growth of obesity and chronic disease?
 
Over the next several weeks, we will explore these issues of access to healthcare. We’ll explore how technology fits into the current model of healthcare, and we’ll look at barriers to digital solutions. We’ll also talk about technologies that show promise. We’ll focus on how we can both remove health literacy as a barrier to health and how we can help consumers to become more proactive in slowing the unchecked growth of obesity and chronic disease. In our explorations, we hope to rethink with you the concept of access to healthcare. We’d love to hear your thoughts on the subject: Leave a comment below, or chat with us on https://twitter.com/#!/Health_IT with the hashtag #DigitalDivide.
 
Dr. Dennis Schmuland
Chief health strategy officer, U.S. Health and Life Sciences, Microsoft