"Joy," not convenience, to connect patients to health care, panel says

by Brendon Nafziger, DOTmed News Associate Editor | April 16, 2012
Much like the way people buy gossip magazines in the checkout line of the supermarket, most people who get a flu shot at Target's retail clinics or pharmacies do so on impulse: about 70 percent hadn't planned on getting a jab before they walked in the door, according to the company's medical director.

"They came into the store and saw these signs, and said, 'Aw, I'll get a flu shot,'" said Dr. Joshua Riff, while introducing a panel on consumer connectedness in health care at the 9th annual World Health Care Congress meeting in Washington, D.C. on Monday.

What Riff calls "impulse preventive care" is part of a number of tried-and-true retail strategies Target is bringing to health care. And while these and new technologies that make health more convenient will connect more patients to the health care system, they likely won't make a huge dent on the growing chronic disease load or the system's skyrocketing costs unless they change people's behaviors, panelists said.

"Convenience will reduce the barriers," observed Jay Walker, the founder of Priceline and the chair of Walker Digital. But it won't be enough. "I can make a colonoscopy as convenient as you want, but it's not happening."

Technology does, of course, play a role. Mark Bertolini, the CEO of Aetna, a health insurer which is moving deeply into the mobile health space, said he recently had an epiphany after using a smartphone app to buy his daughter a sweater. The app, which eventually led him to Macy's, let him find nearby stores and compare prices to find the cheapest sweater at the closet location. He said he later showed the app to his team at Aetna.

"Why can't we have this for health care?" he asked. "No matter how hard we try, no matter how smart our underwriters and actuaries are, unless we engage people with technology...we're not going to change the health care system."

But while making the health care world as consumer-friendly as retail could help improve the efficiency of the U.S. health system, it won't get at the real problems, according to Walker.

"Being connected to the health care system will not motivate us to change our behavior. We'll be more connected, badly behaving people," he said.

Walker said many of the deadliest and costliest diseases in the U.S. are, to some degree at least, behavior-based. For example, he said 90 percent of type 2 diabetes cases are caused, in part, by bad diets or lack of exercise.

The problem is not one of simply access or knowledge, he said. Walker pointed out that sleep deprivation is the "perfect example," of a chronic health care problem: one that's widespread and that takes a significant toll on people's well-being. But even though most people know it's dangerous, the knowledge has little effect on their behavior. A poll conducted at a recent TEDMED conference found that 65 percent of audience members had nodded off at least once behind the wheel, he said.

Bertolini backed up this point, saying that fewer than half of Americans floss their teeth daily, although most probably know how important it is to their health, and how a lack of flossing is linked to not just tooth decay, but decreased insulin sensitivity, heart disease and even, for pregnant women, low birth weight babies.

For technology to succeed in connecting patients to health care, it has to work on motivation, and the way to change people's motivation is by influencing the group, Walker said. "We change our behavior when families, friends, communities, churches help us change," he said.

"We'll need more than convenience," he added. "We'll need joy. People do things that make them joyful."

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