Individuality In Healthcare, Part 2 - Does It Expose An Individual's Vulnerabilities?

07/09/2018 03:58PM

This is the second article in a series on individuality in healthcare, pulling largely from interviews I conducted and sessions I attended at the HLTH: The Future of Healthcare conference in Las Vegas in May, 2018.

In the first article I shared my own definition of what it takes to achieve individuality in healthcare: a concerted effort to know and account for the realities and the values of individual patients and employees. I shared a few examples of organizations that are using innovative ways to get to know individual realities and values, and I closed the article with a challenge to the industry: a call to turn individuality into better outcomes with an approach that embraces inclusion. Individuality is here.

But is your organization ready for it?

This article will explore that a little further and dig into why the inclusion piece is so important.

First, here’s how I define inclusion in this context:

  • Inclusion is a system for making sure the organization is welcoming at every level to every individual.

“Every individual” encompasses patients and employees of a healthcare organization, though I’ll keep this discussion focused on patients for now.

To be able to account for the realities and values of individuals, organizations have to build enough trust so people will accept – and even welcome – being known on that level.

I had an interesting conversation on this subject with Maayan Cohen, CEO of Hello Heart, a company that empowers people to understand and improve their heart health using mobile technology. Hello Heart provides participants with an FDA-approved Bluetooth blood pressure monitor and a mobile app that tracks blood pressure, activity, sugar and weight. The app also supports clinically based digital coaching, medication adherence algorithms, and auto-imported lab results from clinics.

“Giving people tools to improve their own health in between doctor visits is becoming more and more critical, especially with chronic disease,” said Cohen. “When a patient is diagnosed with diabetes or hypertension, that's one thing. What he does with that from that moment on is the critical part. Is he exercising the way he should? Is he eating the way he should? Does he have the tools to identify risky situations and get to the doctor in time when he's in between the yearly doctor visits? That is the critical part in managing chronic disease like diabetes and hypertension.”

But here’s where this level of individuality – giving people the tools to take charge of their own health – meets with the challenges of inclusion.

Hello Heart works with large employers to make the app available to employees. Cohen said that making it a mobile app and deciding how they would manage the data were decisions made expressly with inclusion in mind.

As she put it: People feel safer when they are not forced to expose their vulnerabilities.

I couldn’t agree more. All the innovation on display at the HLTH conference is exciting, but how can leaders make their organizations ready to use those new ideas and capabilities in a way that leads to evolution rather than mere substitution? There’s value in exploring the thought process behind Hello Heart’s approach, because it represents  the kind of thinking all organizations need to be doing.

Build Trust By Letting People Control Their Own Data

Give people tools, but let them have complete control over their data. Employers care about their employees and they also have financial incentives to help their employees live healthy lives. According to Cohen, many solutions and apps offered by employers automatically send the employee’s health data to the on-site nurse and to other vendors within the employer ecosystem. After all, it’s the employer that’s providing and paying for the app. But Hello Heart decided they would not do that. The patient can choose who sees their information.

“Of course there would be a benefit to a physician seeing that information,” said Cohen. “But there's a bigger interest for us to get the trust of the patient and have them use the app and educational materials that we provide on a daily and weekly basis – rather than to have a smaller set of users who are willing to share their information with everybody.”

Connect Where They Are

Hello Heart chose mobile technology because it’s the most ubiquitous tool that exists today and also because many people rely on mobile devices to access the internet.

According to Pew Research Center, one in five American adults are “smartphone-only” internet users – meaning they own a smartphone, but do not have traditional home broadband service. Pew said reliance on smartphones for online access is especially common among younger adults, non-whites and lower-income Americans.

Don’t Put Them on the Defensive 

The words you use can either draw someone in or turn them away. Certain words can put people in a defensive mode unnecessarily. Cohen explained that many people don’t perceive diabetes or hypertension as a condition that they need to manage. Even if they’ve been diagnosed and they know they need to do something about it, they don’t perceive it as a condition.

“So if you ask them to participate in a ‘disease management program,’ they will shy away very quickly,” said Cohen.

Give Them Tools, But Don’t Tell Them What To Do

According to Cohen, people respond positively when given a tool that gives them ownership by letting them track things like sugar levels and hypertension levels, and information that helps them understand and improve their condition on their own.

If you go further and tell them what to do, said Cohen, “it brings you back to fourth grade and not doing your homework, and the teacher slapping you on the wrist or just shaming you – and people don't want to be judged.”

This takes me back to the original discussion of individuality, and the fact that healthcare – and every industry, actually – is moving from an era when the business defined the individual to one in which the individual defines the business. People have a say in how they want to be served in nearly every aspect of their lives today, and that includes health. They want to have what they need to make informed decisions, and when they do they are much more likely to follow through.

Make it Affordable and Accessible

I also interviewed Dr. Jessica Grossman, CEO of Medicines360, a non-profit organization working to expand access to medicines for women regardless of their socioeconomic status, insurance coverage or geographic location. Medicines360 is addressing another aspect of inclusion – how to make costly drugs accessible to people who wouldn’t otherwise be able to afford them. Right now the organization is focused on providing affordable contraception.

“Today, the most effective forms of contraception are something called long-acting reversible contraceptive,” said Dr. Grossman. “They're implants and intrauterine devices, they last anywhere from three to five years. But those types of contraception were the most expensive – about $1,000. For women who are uninsured and underinsured, that was completely out of reach. And so that set up this disparity around unintended pregnancy. So we got FDA approval for a hormonal IUD called Liletta. And we make it available to public health clinics that serve vulnerable patients, for $50.”

Dr. Grossman said something in our discussion that ties back to the imperative of making informed decisions. Decisions can’t be informed if a patient doesn’t know something exists. The question of access is not just about the price itself, but also about how a high price might influence whether or not a doctor even mentions a certain drug as a possibility.

“Physicians are really still gatekeepers in this space,” said Dr. Grossman. “They decide what they talk to their patients about. And I absolutely believe they are doing their best job in a difficult situation. But one of the things that we do is to educate physicians that this product is available at an affordable cost.”

She said physicians often tell her: “I've always wanted to offer IUDs, but how am I going to put a thousand dollar product on the shelf in my community clinic?” Now they can put a $50 product on the shelf.

In my first article of this series, I introduced some questions for organizations to consider – indicators of whether or not an organization is operationalizing individuality and inclusion. Here are a few more:

  • Do you have strategies, processes or partnerships in place to help you identify and resolve health disparities and inequities in our communities?
  • Do you have strategies in place right now to help you better understand the factors that influence the health and wellness choices made by a particular demographic you serve?
  • Can you think of an example of when someone at the organization learned something about how a particular population takes action to promote health (or doesn’t take action), and then applied that lesson to the way you promote prevention or deliver care?

Thought-provoking questions? Indeed, because these are just a few examples of what leaders need to be thinking about in order to be ready to turn individuality into better outcomes through inclusion.

Are you ready to lead inclusion as a growth strategy?  Click here to find out.

Coming up in this series in individuality and inclusion in healthcare, I will explore more innovation and the role of the employer.

Navigating Uncertainty Summit October 14 | Clemson University