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Health plans, self insured employers and service providers have a generational opportunity to address points of life. Some wisecrack aptly said that the definition of insanity was doing the same thing over and over again and expecting different results. The US healthcare paradigm is a living example of that definition, given there is bout $4 trillion spent annually on healthcare (or $11,000 per capita, which is three times that of OECD countries) and does not have much to show for it when looked at it through the lens of the triple aim (cost of care, health outcomes and experience of care).
Data in Exhibit 1 shows the US performs poorly, with increased prevalence of chronic conditions, lower life expectancy, and cost of care increasing two to three times faster than.
Survey sample, bottom center: 2,411 US healthcare consumers
Sources: CDC, OECD, HFS Research
A primary reason for the poor showing is that we focus predominantly on healthcare rather than health. Solutions across all legacy distribution channels (health plans, self-insured employers, etc.) are designed around points of care while essentially ignoring the causes of diseases and sickness. This is despite the fact most health consumers spend most of their life away from points of care. Life’s cradle-to-grave journey, framed by the social determinants of health (SDoH), significantly influences the need for care and, more importantly, avoiding it.
SDoH has a major impact on health, wellbeing, and quality of life. The US Department of Health and Human Services frames SDoH against five elements, however commercial solutions are biased toward healthcare (see Exhibit 2):
While SDoH directly impact communities’ and individuals’ health and wellness, very few solutions connect the dots across an individual’s life. There are plenty of healthcare solutions (points of care) that are reactive and preventable if approached holistically.
Source: HFS Research, 2021
Navigating life is a challenge for the best of us. The choices we make to address challenges and opportunities can impact various aspects of the SDoH, such as what we learn in school, jobs we engage in, where we live, and what we eat. In addition to our choices, there are often decisions made for us early on such as where are born, race we belong and communities we are part of or that reflect where we grow up.
Various factors determine choices: some emotional, some data-driven, and some based on experiences. There is nothing scientific about this, and there are no guarantees for expected outcomes—but certainly the weight of the consequences.
It is, therefore, necessary to have a health planner, like those that help with financial planning, augmented with technologies. The health planner’s remit will be to guide individuals through choices, educate them of the implications, navigate their resources, and increase the likelihood of a healthy life. While mentors, counselors, and coaches of a different ilk play such roles, there is not an integrated approach that likely harms more than helps.
A predominant reason there are insufficient solutions addressing SDoH opportunities is that they are not known to be commercially viable. That is not to say they are not, however. Rather, it’s a lack of imagination and entrenched thinking that prevents the exploration of SDoH solutions.
Any solution needs two key ingredients: a problem to solve and distribution channels to deliver solutions to users. Points-of-life solutions had both, but they are not always self-evident and require some effort to discover (see Exhibit 3). Furthermore, there is a notion that the government must address SDoH. Traditionally, that could be, but given the impact on the triple aim, points of life solution will succeed only if it is a public-private partnership.
We will outline three points-of-life solutions with commercial viability, assuming redistributing care dollars could fund these solutions.
Source: HFS Research, 2021
Addressing the complete human journey is the only way we change the trajectory of the triple aim. We must reduce the costs we repeatedly put into reactive healthcare at the expense of addressing SDoH and minimize gaps in understanding corrective steps toward healthier points of life. Adopting emerging technologies or new models of care are, at best, a flash in the pan, and they do not have the legs to fundamentally change Triple Aim outcomes.