By David Harlow
First Posted at HealthBlawg on 10/18/2013
In the midst of this year’s Joslin Diabetes Center’sDiabetes Innovation conference, even acknowledging that many people with diabetes are joined at the hip (literally) to some pretty hi-tech tools, it was worth slowing down for a moment to consider the value and efficacy of decidedly low-tech solutions.
Earlier this year, Susannah Fox (a speaker at this year’s conference) coauthored a report published by the Pew Research Center entitled Tracking for Health. This report collects survey data showing that while 60% of U.S adults track diet or exercise, and 33% track their own health — 49% track only in their heads, 34% use paper and only 21% use technology (web, app, device) for personal tracking.
People with diabetes are certainly well-represented among the 33% of the population who are self-identified health care self-trackers — but remember, most self-trackers are decidedly low-tech.
Another example of low-tech innovation: primary care on steroids.
Several speakers at the conference came to share the successes of their innovative approaches to primary care. They all share certain characteristics articulated by Rushika Fernandopulle of Iora Health: by creating a high-touch primary care practice — which costs about twice as much as a typical primary care practice (i.e., the spend is doubled from the typical 3% of health care spend) — one can achieve a net savings of at least 15% of the total health care spend. Medication costs go up as adherence improves, but prevention and care management are the order of the day. Similar approaches have been put in place at practices as diverse as Stanford Coordinated Care (Alan Glaseroff), Whittier Street Health Center (Osagie Ebekozien), Cornerstone Health Care (Grace Terrell)and Cummins workplace clinics (Dexter Shurney). (Follow the links for interviews,) They are patient-centered practices that focus on addressing the needs of the individual, that meet each patient where he or she is. These practices, their practitioners and their patients may use some hi-tech tools, but the cornerstone of their success is the human touch.
After hearing so many versions of this story over the past several months, I have wondered: Why doesn’t everyone adopt this model of care? The short answer, of course, is the economic incentive structure baked into our fee for service health care system. The innovators in this space are dealing with pockets of forward-thinking payors — self-insured employers, or payors embracing global payment strategies, for example. As our entire health care system moves away from fee for service payment and towards global payments of one sort of another, the allocation of funds to primary care should be rethought, because the extra investment on the front end will yield dramatic savings on the back end. When prevention and management of chronic conditions can be addressed in this way — at the system level, instead of in an ad hoc manner — there is a real opportunity for improvement in health status of an entire population, bound together with an opportunity for significant cost savings. I, for one, eagerly anticipate the broader dissemination of the forward-thinking ideas already being implemented by the Diabetes Innovation speakers. The benefits are clear.