New discoveries are ushering in the era of personalized medicine, and as a person diagnosed with Crohn’s disease, this is especially good for me and others with incurable diseases. They offer the potential to be less symptomatic or perhaps even cured one day. However, clinical care is not the only area that should be rigorously applied at the individual level.
Research shows that 70 percent of what drives overall health status and costs exists outside of the clinical system and are based on a person’s environment and lifestyle. This presents a massively valuable, but under-applied opportunity for the healthcare industry to guide and support consumers’ choices that impact their health status and lower healthcare costs.
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Jeff Margolis Jeff Margolis is a recognized healthcare IT leader based on his 30-year track record of applying technologies to address the complex problems facing the healthcare industry. Jeff is currently Chairman and CEO of Welltok, a consumer health enterprise SaaS company. Previously, Jeff founded and served as CEO of TriZetto, the leading healthcare management […]
Personalized wellbeing – systematically understanding and predicting individual needs and providing highly-relevant and actionable health and wellbeing programming that respects and complements clinical care – is no less crucial than personalized medicine! But all too often, wellbeing is overshadowed by the dramatically higher mindshare captured by the better-understood clinical world of patients.
Now is the time for the healthcare industry to embrace the opportunity and necessity of personalized wellbeing, here’s why:
The definition of health has changed…and the industry had best keep up
Today’s consumers have redefined health to be all aspects of life that effect their overall total wellbeing, including physical, emotional, financial and spiritual wellbeing. In a new national survey we did, 1,000 adults ranked financial stability as their no. 1 health and wellbeing priority. Other top health priorities in order included healthy eating habits, positive relationships, and getting the appropriate level of physical activity.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The majority of people at any given moment are consumers making choices that impact their health rather than being patients receiving care from a provider. And, with consumers shouldering more of the cost – and therefore the responsibility – of healthcare, every day they are taking a more active role in making decisions that impact their health. Thus, the need for personalized wellbeing is accelerating even as it is presently underserved.
Advancements in data science, machine learning and AI enable personalization
The industry has embraced the concept of applying advanced information technologies to assist healthcare professionals for clinical purposes, but have not applied the same rigor to how those technologies could be applied to support consumers. That may be because the complexity of data science around consumers is even more complex than for patients. While valuable, clinical information is largely retrospective and provides only a partial view of a whole-person. Thus, organizations that have an interest in driving healthy populations must supplement these data sources with consumer data (e.g., household composition, educational background, purchasing behaviors). Simple logic tells us that the sources and types of this consumer data set are many times larger than either patient or health plan member data sets. We also know that this consumer data describes 70 percent of what drives health status. Of course, making this massive range of consumer data useful and applicable to achieving health goals and relating it to clinical care is not so simple, which is what makes it a perfect candidate for applied machine learning and artificial intelligence (AI).
Personalization must be dynamic
Technology can also assist in making personalized programs dynamic. Healthcare organizations must be able to combine relatively stable attributes about a person and layer in input regarding their current health goals and preference, as well as actions they are taking (or not taking) towards improving their health and wellbeing. This combination of data enables more accurate, predictive insights, and will create the most holistic picture of an individual that supports truly personalized wellbeing.
AI can also be applied to identify and understand triggers that suggest changes in a person’s situation. For example, if a person tears their ACL, healthcare organizations could act in real-time and alter their recommendations. Even if no behavior changes occur, they can learn from a person’s actions or inactions. What wellbeing activities are they participating in and what is not resonating? This information can surpass traditional segmentation methods and enable dynamic, personalized experiences. Machine learning can also be applied to understand the consumer experience and predict an individual’s health and wellbeing needs throughout the year.
The economics of healthcare are shifting to consumers
With out-of-pocket healthcare costs for the individual rising almost 230 percent between 2006 and 2015, and more than 40 percent of consumers having a high-deductible plan, today’s typical commercially-insured American is paying so much out of their own pocket. There is thus a major shift towards consumers wanting to better understand the cost of care and making more decisions about care based on cost. Therefore, being consumer-oriented is also profitable in value-based arrangements. Treating people, the way they want to be treated to deliver the type of interventions they want, can realize an estimated $530 billion in total annual health system savings.
Personalizing wellbeing is a greater challenge due to the magnitude of data required to individualize recommendations and the volume of resources available. Yet the impact would be exponential in helping consumers achieve and sustain optimal health, complementing and possibly reducing their interactions with the clinical system. To truly transform the industry and wrangle burgeoning spend, we must do the same for all aspects of a person’s health and wellbeing and bring it all together.
Photo: canovass, Getty Images
Jeff Margolis is a recognized healthcare IT leader based on his 30-year track record of applying technologies to address the complex problems facing the healthcare industry. Jeff is currently Chairman and CEO of Welltok, a consumer health enterprise SaaS company. Previously, Jeff founded and served as CEO of TriZetto, the leading healthcare management services company. He led TriZetto through a successful IPO and $1.4B private equity buyout. Jeff serves on boards for non-profit and for profit organizations. As a health futurist and visionary, Jeff is a frequent speaker, guest lecturer and author.
