Holistic care teams can finally revolutionize healthcare

The U.S. healthcare sector is by far the world’s most expensive per capita — about two times higher than the U.K., Canada, and Australia, with chronic conditions such as diabetes and heart disease accounting for more than 75 percent of spending. At the same time, the quality of care Americans receive is increasingly unequal and depends more and more on their incomes and where they live.

Proposed healthcare policy changes are aimed at merely shifting rising costs around the system — missing the true nature of this multi-trillion dollar problem. A better path forward would be to make healthcare more affordable by repairing the fundamental disconnect between what patients need in order to maximize their health and what they actually get from the existing system, which often seeks to maximize treatments and transactions rather than health itself.

{mosads}Good news comes in the form of an effective business model — called holistic care teams — aimed at lowering costs while boosting population health in surprisingly simple ways.

One of the best parts of this emerging approach to healthcare is that it is supplying a fast-growing category of new jobs — helping increase employment while also reforming the system. And there are steps lawmakers can take right now to support holistic care teams and revitalize our healthcare system.

Where disruptive solutions are taking root

To truly transform healthcare, we need to start with the causal mechanism of how to improve the long-term health of a patient while also lowering costs.

Enter the world of primary care. Studies have shown that regions with the highest density of primary care physicians have better health outcomes, with lower rates of general mortality and lower rates of premature death from heart disease and stroke.

Yet we all know there’s a shortage of primary care doctors, leading to an average of 24 days to get an appointment and typical visits down to 15 minutes or less. Still, everyone can use more health guidance and everyone has health questions. Am I getting enough sleep? Are my meds working? What type of diet should I follow? How can I create a better routine? How do I know if I’m making progress?

More importantly, many serious long-term health conditions lurk just below the surface. For instance, about 50 percent of patients who suffer symptoms of depression do not talk to their doctor about it or seek professional help.

How health coaches can disrupt transform and improve primary care

Recognizing this giant gap in the market, startups such as Iora Health, Oak Street, Omada, Docent, ChenMed, WellMed, Landmark Health, and Aledade are gaining traction with a model known as holistic care teams. These teams typically include a physician, a behavioral health specialist, nurses, and a registered dietician — all supported by technology that tracks a consumer’s health. But most essentially, the teams are quarterbacked by health coaches who do things that doctors typically don’t —and at much lower cost than they ever could.

This is a classic disruptive model, which typically begins with inferior performance along traditional dimensions — in this case, coaches appear inferior because they have no formal clinical training and, according to the Bureau of Labor Statistics, make an average of about $21 per hour. Yet the care team model is superior in different ways, such as in helping consumers take more responsibility for their own health. Health coaches follow up with patients and engage in an ongoing dialogue. These individuals are hired for their empathy and demonstrated experience in solving problems for consumers in order to advance their health journeys.

The first health coach hired by Iora Health previously worked at a local Home Depot store. The Boston-based company has formed partnerships with insurers like Humana and now operates three dozen care practices in eleven states serving more than 40,000 patients. The model not only makes intuitive sense but saves money. Iora points to a study showing hospitalizations are 37 percent lower and healthcare spending 12 percent lower than with a control group using a more conventional healthcare system.

Setting the right context for disruption

Yet holistic care teams do require upfront investment and need to happen on a wider scale. That’s where public-private partnerships such as Medicare Advantage provide the context for disrupting the prevailing system, because they have emerged as a key way to pay for holistic care teams.

Medicare Advantage is a popular direct-to-consumer model of care for seniors. With enrollment more than doubling to about 17 million over the past decade, it now accounts for 30 percent of the total Medicare population. A 2016 JD Power survey showed that members scored the program at 790 on a 1,000 point scale, significantly higher than the 679 satisfaction rating among commercial health plans. Kaiser Permanente’s version of the program received a score of 851. This big, satisfied patient pool encourages large-scale experimentation and innovation, which can be directed toward holistic care team programs.

For example, one pilot called the Diabetes Prevention Program has saved Medicare an estimated $2,650 per beneficiary over a 15-month period by helping patients lose an average 5 percent of their body weight by eating healthier and getting more exercise, significantly reducing their risk of developing the disease.

It is delivered through primary care groups, hospitals, and at alternative settings such as tele-health networks and YMCAs. The core benefit is a series of weekly, hour-long maintenance sessions with members of a care team led by a health coach. More people in Medicare Advantage and programs like it could mean more opportunities to create innovative healthcare programs that really work.

How to up the ante on holistic care teams

While some in Washington continue trying to shift rising costs around, we advocate stepping back and looking at the more fundamental goal of lowering costs by improving health. To meet that challenge, we recommend four policy imperatives:

• Continue incentivizing the shift away from fee-for-service payments toward value-based care, to meet the CMS goal of 50 percent value-based payments for Medicare by 2018.
• Increase funding for health coach training, which is expected to become one of the fastest-growing job categories — with more than 120,000 coaches in the field now and with openings increasing at double the rate of the average job category, according to the BLS.
• Increase funding to scale the Diabetes Prevention Program and other pilots that have proven to save substantial costs by averting disease.
• Gradually lower the enrollment age for Medicare Advantage from 65 down to 55 in order to have more time to make investments in wellness and prevention that can pay off.

Taken together, these changes would drive a more holistic approach to managing long-term health. Results already indicate that these investments would be recouped many times over through costs savings. Like other industries, healthcare needs to be disrupted — and it can be done by serving consumers better and creating new jobs at the same time.

Clayton Christensen is the Kim B. Clark Professor of Business Administration at the Harvard Business School and co-founder of growth strategy consulting firm Innosight. Andrew Waldeck is a senior partner at the growth strategy consulting firm Innosight, where he leads the firm’s healthcare practice.

The views expressed by contributors are their own and are not the views of The Hill.