Greetings from sunny Aspen, Colorado and the Spotlight Health Conference at the Aspen Ideas Festival. The opening session for the conference yesterday afternoon featured a lively discussion between Larry J. Merlo, Chief Executive Officer, CVS and Bernard Tyson, Chief Executive Officer, Kaiser Permanente, moderated by Bertha Coombs of CNBC. The discussion centered on the evolution of the U.S. health care system-from an “episodic model driven by fee-for-service” and “a sick care model” (as described by Mr. Merlo and Mr. Tyson) to a “whole health community-based system connected by technology and delivered by a team of professionals.”
I have always considered Kaiser Permanente to be the health insurer/health delivery system that is furthest along in this transition (see Kaiser Permanente To Invest $200 Million Into Community-Based Efforts To Tackle National Homeless Crisis, Target Partners With Kaiser Permanente On 31 Southern California Clinics, and Half Of Kaiser Permanente Patient Encounters Took Place Through Virtual Visits In 2013). So I was surprised that when asked where he thought Kaiser was in their transition to this new community-based model, he replied “We’re in the third inning.” Which lead Mr. Merlo to respond, “Then, we must be in the top of the second.” My takeaway was that even the leading organizations realize how far they have to go.
Where is the system at now? Mr. Renfro summarized the current state of affairs when he said: Health care is now a series of transactions with the health care system. He discussed how, over the years, we have trained consumers to come to us for a service—now we need to change that model and come to the consumer. Currently, most consumers get a “care plan” from their physician in a series of office visits, but there is no system to help the consumer follow that plan. To accomplish that, we need to move to a consumer view, with the system “connecting the dots” for the consumer. This is part of the “retailization” of health care, with consumers making decisions about the value proposition of health care offerings at every point in the service continuum. Great scientific developments need to be knit together with community-based care.
Mr. Dyson spoke about Kaiser’s goal of being an integrated model of care, with end-to-end responsibility resting with the health system and with payment focused on producing outcomes and driving the need for services. But, he went a step further, talking about the bigger footprint needed for health. The new health challenge is that human bodies were not built for (and need to be in great shape for) our current competitive environment, with its job stress, long hours, and 24/7 tech connectedness. In this view, “health” involves not just treatment, but prevention by engineering the human environment—food, housing, stress management, and more. From the health system perspective, this means the use of electronic health recordkeeping systems that can integrate social ecosystem data and data from passive consumer health status monitoring.
Looking ahead, both executives spoke of a vision of a delivery system where “care can be anywhere,” facilitated by both active and passive technologies. Will this new model—of Kaiser and of CVS/Aetna—replace the work of current office-based physicians, and of hospitals? Both were adamant that the new model is complementary—enhancing the work in primary care offices and hospitals, and making it more effective. Mr. Dyson was quick to point out that the technology investments being made by Kaiser were not a replacement of human touch, but an extension of human touch. Mr. Renfro talked about the merger of CVS and Aetna as an opportunity for his organization to offer new plan designs and options for health benefits.
When asked how long it would take to realize this new “whole health community-based system connected by technology and delivered by a team of professionals”, there was a pause in the discussion. They then spoke to the challenging task of reengineering and reorganizing the delivery system to make this possible—how to measure productivity, how to measure access, and how to prevent professional burnout. These are the unanswered questions brought by this system evolution. And they gave the “ultimate” example of how far we have to go—noting that currently the U.S. health system doesn’t have the functionality to tell consumers what their health plan pays—and what they will need to pay out-of-pocket-for any particular service or medication.
Not surprisingly, this transition is going to be a long ballgame—with different challenges to overcome in every inning. And, if leading organizations like Kaiser are only in the 3rd inning, there is still time to get in the game—because the 7th inning stretch isn’t coming anytime soon.