| | December 20189UTLOOK HealthcareTech While the train has clearly left the station, there are many, many challenges that remain to be solved as the population health engine changes how we engage in and pay for care, including:· Can all health systems manage population risk as well as thesmall minority of those doing so today?· Will the reimbursement system--both commercial andgovernmental--transition fast enough to push the pivot to population health but not so fast that safety-net providers fail? · Can we facilitate enough real interoperability among the myriaddark corners of our health IT infrastructure to actually manage population outcomes on a national scale?These are significant challenges, though largely solvable with time, energy, and resource. The biggest remaining question though isn't solvable with time, energy, or resource, and it's the one that as a nation we haven't really asked. Will Americans really accept it?While Americans have granted Facebook, Google, Apple, and Amazon nearly universal access to everything we do everywhere we do it, will we be just as open when Alexa is telling us to take our beta-blocker and auto-reorders a week's worth of kale instead of laundry detergent and ice cream bars?When you really get down to what it takes to prevent disease and nurture health, you reach both incredibly complex social issues (like medication affordability, transportation, and housing) along with relatively basic decisions we make each day. Decisions like whether to eat a carrot or a bag of chips, walk the dog or smoke a cigarette, go for a run or go back to sleep. To truly improve population health outcomes, we must unleash the creative power of disruptive innovators working with providers to actually make America healthier, and that means accessing and influencing these kinds of everyday decisions.Until the Obama administration, healthcare providers largely measured outcomes under their control inside the four walls of a hospital. A classic example is CLABSI (central line bloodstream infections). CLABSIs happen for the most part inside the walls of a hospital and are nearly 100 percent preventable when doctors, nurses, and other caregivers follow well-prescribed insertion and maintenance bundles. To drive success on other metrics, like surgical site infections and unplanned readmissions, providers by necessity have learned how to extend their reach beyond their walls through care management and better connectivity among inpatient and ambulatory physicians.The great ACO experiment has gone a step further. Meeting a metric, like "attributed beneficiaries with controlled hypertension" requires not just seeing a patient, diagnosing hypertension, prescribing the most appropriate therapy, and following up at the appropriate intervals. Instead, it means making sure each patient fills his prescription, takes his medications as prescribed, and doesn't do other things that could make the medication either not work at all or work too well. It also means repeatedly documenting that his blood pressure improves and stays improved, meaning continual assessment, reassessment, and tweaking of his management plan over time.With accountability for actually achieving this level of control over chronic conditions, ACOs have become increasingly creative in accessing and influencing patients where the opportunity to do is greatest--in their homes. Mission Health's Caramedic program is one example, bringing care coordination literally and physically into a patient's house via a community paramedic to directly impact the social determinants of health that really drives population health outcomes.And yet here's the rub---on the whole, how far will a nation of generally independent people allow the healthcare system into the parts of their lives that until now have remained generally private?Like all things, better population health outcomes will come with a price--making and keeping America healthier will require a level of personal, technology-enabled daily interaction with accountable parts of the healthcare system in ways unimaginable to our grandparents. It will mean balancing incentives and penalties that go far beyond paying a higher health insurance premium for choosing to smoke, and trading intimate access inside our homes for the opportunity to live longer, healthier lives.Do you think America is ready? HT
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