By Dr. Francisco Velázquez
The cost of health care in the U.S. is approximately $3 trillion—more than what we spend in education, transportation, or defense. We as consumers also spend $502 billion a year on health care-related services, products, and devices. This is projected to grow almost 50 percent over the next five years to over $737 billion.
We consumers spend close to $300 billion a year in products and services in the fitness and wellness markets. This alone is about 10 percent of the total health care spend and growing at an accelerated pace.
Is this indicative of a change in the way we view health and wellness? Does this mean that we as consumers are taking assertive steps to improve our health and wellbeing? I would argue that the answer to both is a resounding yes.
Traditionally the provision of health care has been a disease-based, interventional activity; in other words, to participate you must be feeling sick, getting sick, or sick. Over the recent past, the focus in many ways is shifting to health, not just defined as the absence of disease, but overall physical, mental, and emotional wellbeing.
To accomplish that, you must by definition attain a level of physiologic wellbeing consistent with our individual definition of “being healthy.” For most of us not being sick is not good enough. We want to be active, physically, and mentally challenged, and able to participate in any and all activities that make us “happy.” It seems that we finally are embracing the concept that our physical harmony requires a healthy mind, body, and spirit.
Enter the next technological revolution: consumer tools that place control of our mind, body, and spirit—with a big emphasis on body—in the palm of your hand, your pockets, clothing, car, home, and office.
It’s important to make a distinction between health care-driven consumer tools and consumer-driven tools with health and wellness applications. Examples of the former are telemedicine, smartphone-based schedulers and consultation tools, and portable devices such as whole blood glucose monitors and C-PAP machines.
The latter is exemplified by wearable technology, food scanners, transdermal testing devices, self-contained diagnostic devices. It also pertains to the fast-evolving segment of the market that includes numerous web-enabled comparison tools that enable the consumer to shop based on quality outcomes, service, and cost metrics for providers, procedures, and institutions.
All of these are aimed at giving us more control of our lives, and for the most part these tools didn’t originate in health care. They came about because technologically or consumer savvy people and businesses saw a need in the market and translated consumer technology into health-oriented tools.
Think about the smartphones that coincidentally aren’t designed around the need to make phone calls, but rather the need to carry real-time, and with immediate gratification, anything and everything you need to feel complete. That includes a calendar, contacts, pictures, favorite recipes, pet videos, and, yes, important health information, such as allergies, medications, emergency contacts, etc. It’s anticipated that over the next three years up to 30 percent of primary care consultations will take place using a smartphone. And why not? These devices have more computational power than the technology that guided American astronauts to the moon in the 1960s.
If we consider that 90 percent of the world population lives within cell phone signal range, and that there are more than 5 billion cell phones in the world and more than half are smartphones, it makes perfect sense for this ubiquitous tool to be deployed for more than social contact. Of course, there are issues to be addressed such as privacy of the information, but technology isn’t waiting for these issues to be addressed. It’s moving forward.
Two of the most striking differences between traditional health care and technology-enabled wellness are where it takes place and who participates.
To discuss the “where,” we need to look at historical responses to the delivery of care in this country. In the earlier part of the century most care, acute or terminal, occurred at home or at a substitute place based on access. Halfway through the century, with the advent of antibiotics, aseptic surgery, and many other interventions it became important to move the care from the home to the institution.
At that time, we built close to 9,000 hospitals in this country. By comparison, we currently have approximately 5,000. Thus, people became patients in the hospitals, filling these to capacity in many cases.
Something strange happened: Patients came and stayed in hospitals for long periods of time particularly for chronic or terminal conditions, or conditions that required constant monitoring. The response was to build other types of institutions: nursing homes, long-term acute care facilities, followed by assisted-living facilities, skilled-nursing facilities, and specialty facilities like those for people with cognitive or memory conditions, or physical or mental impairment. That’s not to mention all of the ambulatory and specialty clinics that also began opening over the years.
It almost seems that the most immediate response from traditional health care to a changing environment requires construction of a “facility.”
Please don’t misunderstand this observation as a criticism of health care facilities; on the contrary, as a physician and member of a family with a long tradition in medicine, I have the outmost respect for institutional care, when necessary.
However, I think the movement to a more decentralized access point is a great improvement on the efficiency and cost of health care. The basic difference with health and wellness is that the need to go somewhere specific like an institution is nonexistent. Why go somewhere when you have in your hand, or easily accessible, most of the tools you need?
You can even build into your routine some physiologic monitoring in the many deployed health stations in supermarkets, superstores or even airports. As we go about our daily routine, if we have a question about a skin blemish, a sprained ankle, or a sore throat, help is just a couple of key strokes away. Virtual sites for dermatology, sports medicine, and primary care—to name a few—are easily accessible from your smartphone or tablet.
Now there are amazing clinical applications of this technology being used in many parts of the world where access or availability is not as great as what we have. Two examples come to mind: HIV testing in Africa with a smartphone-based application and a plug-in testing module commonly referred to as a dongle, and a similar application for cervical cancer evaluations using smartphone-based colposcopy.
The difference and advantage or disadvantage in great part rests on with whom the interaction occurs or for what purpose. In other words, who participates?
In traditional institutions, we have the highly skilled providers necessary to address most if not all human ailments. On the other hand, as consumers, we have a strong motivation to learn and to master those aspects of our wellbeing that will result in better health, thus enabling us to become engaged and active participants in the outcome, as opposed to a passive observer.
Many years ago we empowered patients with diabetes to monitor their own blood glucose and administer their own insulin. We also armed them with nutritional information and tools, and tons of knowledge about their condition as well as, more importantly, accountability for their status, and what happened? A dramatic decrease in morbidity and mortality.
That is without a doubt one of the best examples of empowerment in the history of medicine. Most doctors will tell you the best patient is an engaged and interested patient that wants to learn about and understand his or her condition.
The corollary in health and wellness is clear. Provide consumers with more information, better tools, and better options, and the outcomes in prevention, as well as the overall health quotient of communities, will improve.
Today the average American household spends close to $148 a month in products, and services with a health and wellness halo. As an example, we spend $93 billion a year on nutritional products, including $45 billion on organic food, $30 billion on vitamins and nutritional supplements, $16 billion on nutritionally enhanced beverages containing everything from electrolytes to antioxidants, and $1 billion on power bars. That’s not to mention more than $1 billion spent on health-related apps, of which there are over 7,000.
There is an obvious market need that’s being driven not only by of our collective desire to be mentally, physically and emotionally fit, but also by the intergeneration transition taking place between the baby boomers and the Millennials.
In 2015, Millennials surpassed baby boomers as the long-term predominant workforce, a change that’s being felt in consumer products and markets. Boomers learned technology; Millennials were born with it. The concept of calling, making an appointment, and waiting in line is foreign to this new generation that has been enabled by technology.
The direction is clear. Technology will enable consumers to actively participate in and control all aspects of their lives. Gone are the days of passive participation. Technology is and will continue to empower consumers to levels never imagined. This is an opportunity for all of us to partner for better health for all.
Dr. Francisco Velázquez is the president and CEO of Spokane-based Pathology Associates Medical Laboratories and PAML Ventures.
Reprinted from the September 8, 2016 issue of the Journal of Business, Spokane, Washington.
© Copyright 2016 - Northwest Business Press Inc.