The Patient is the Sun

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As healthcare providers struggle to transform themselves into organizations that deliver value based on outcomes rather than creators of service transactions, whether they deliver value or not, the importance of engaging the patient cannot be overstated.  The mental and conceptual shift is no less dramatic than Copernicus, during medieval times, placing the sun at the center of the universe, rather than the earth.  Fortunately, there is an increasing number of efforts in-progress to alter this relationship.  According to a Health Affairs blog post, on January 15, 2016, Community Catalyst, a national consumer health advocacy organization, launched its Center for Consumer Engagement in Health Innovation to advance the role of consumers in health system transformation.  Amy Berman, a panelist at the launch event and senior program officer for the John A. Hartford Foundation who also has terminal breast cancer, captured the salient point.  She stated, “We live in a pre-Copernican model where all of the planets float around the health care system; the patient is just one of them. What we need is a shift …an entirely new frame, and this will shift everything when we do it….We need the person at the center. We need to put the sun where it belongs.”  

Physicians as individual clinicians generally do have a strong ethical and professional focus on the patient as the highest priority.  However, in the typical illness model of care delivery where the patient comes to the physician, the source of all expertise and knowledge, to be “cured”, the physician is the sun.  This reactive model has worked for centuries but now we understand much better the upstream antecedents of disease and we recognize the complexity of the interplay of genetic, environmental and lifestyle factors that trigger illness.  The patient has the central role in maintaining health.  Precision medicine will offer more opportunity to prevent illness and customize care.  In addition, in the United States, the reactive illness model combined with a fee-for-service third-party reimbursement mechanism has driven up costs way out of proportion to the value and quality our citizens receive.  Delivering more value relative to cost is an imperative and patient engagement is the critical success factor.

Providing truly Patient-Centered Care is incredibly important today.  As reimbursement becomes more and more value-based, ACOs and other risk-bearing organizations will live or die based on how well they engage their defined population.  This transformation must be systematic, fully committed, cultural, pervasive and, today, technology-enabled.  For full effect, it must also be expansive.  It should engage the patient as well as the caregiver(s), the consumer and, ideally, the community.  The design principle should be to surround the community with care and resources to enable health and healthy behaviors to permeate families, consumers, caregivers and patients.  We want to make the illness system less relevant and necessary.  There is evidence that the Patient-Centered Medical Home and truly redesigned primary care, such as Iora Health, are moving the needle on this goal.

Patient engagement is essential because regardless of how good the doctors are or your technology is, the patient must take the pill, show up for the test, change their diet, take the stairs instead of the elevator, convince their spouse to stop smoking for their sake, find a safe place and time to walk in the neighborhood and so on.  The evidence that effective patient engagement will reduce costs, improve quality and improve satisfaction (the triple aim) is well established and compelling (1).  The challenge is actually doing it.  Because it involves cultural change and redefining value and incentives for all involved, it is difficult and takes time.  However the payoff is too important and necessary to not fully commit to this goal.  This will require many providers to move beyond the gravitational pull of their hospital or clinic comfort zone.  They will have to really talk, listen and change according to what the patient says is important (2).  Putting the patient, the consumer, the community at the center of the healthcare universe and surrounding them with resources, tools, access, empathy and support in sickness and health will make a difference.  

  1. Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. mcr.sagepub.com; 2013 Aug;70(4):351–79.
  2. Mohammed K, Nolan MB, Rajjo T, Shah ND, Prokop LJ, Varkey P, et al. Creating a Patient-Centered Health Care Delivery System A Systematic Review of Health Care Quality From the Patient Perspective. Am J Med Qual. SAGE Publications; 2014;1062860614545124.

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