Health on Demand: Insider Tips to Prevent Illness and Optimize Your Care in the Digital Age of Medicine

By Ramesh Subramani and Bill Frist

A doctor reveals how to break through the confusion and find faster, better, lower-cost healthcare.
 
Annoyed with healthcare? So is Dr. Ramesh Subramani. In this book, the physician introduces you to over 250 apps, devices, and blood tests designed to prevent illness, take the confusion out of healthcare, find the best care, save you money, and even lose weight.
 
As patients struggle with issues like finding cheaper medications, getting second opinions, finding the right specialists, and knowing what to do next about a medical condition, this guide—including forty-three insider tips, can help you take control.
 
Whether you have a chronic medical condition, are caring for aging parents, or just want to learn the latest technologies to stay fit, discover how to upgrade your health—without breaking the bank.

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Jan 26, 2016
• ISBN: 9781630476779

Book preview

PROLOGUE

How We Got Here

Medicine over the past 50 years has gone through a grand and brilliant evolution; now humans live almost twice as long as they did just a hundred years ago. But we also live in a time of limited access, high costs, and confusing inefficient processes. This is my take on the key issues that have brought us here.

In short, the demand for healthcare is outpacing our capacity and resources. One reason for this is that our 80 million Baby Boomers are entering their high health-consumption period. We don’t have enough doctors, nurses, physician assistants, nurse practitioners, or field health workers to meet demands. In the U.S., there is an estimated shortage of 100,000-200,000 physicians.¹ As a result, doctors are seeing 40 patients a day in many clinics, which, shockingly, equates to about seven minutes spent with each patient.

Another reason demand is outpacing resources is that life expectancy has gone up by 12 years over the last 20 years. People continue to live longer despite complex medical conditions such as heart attacks, strokes, and infections—conditions that were automatically fatal in the past. By 2050, there will be over one million people living past the age of 100 in the world!² This is good news, but unfortunately, longevity comes with a hefty medical price tag.

Our investments in medical research actually worked

Diseases that were life-ending just two decades ago can now be survived thanks to technological advancements. For example, heart transplants and Left Ventricular Assist Devices (LVADs)—a mechanical pump that is surgically attached to a heart—are each good examples of how technology can extend lives. Up until 10 years ago, LVAD didn’t exist for individuals with failing hearts. In this way advanced medical technology is contributing to an older, more complicated population.

We have an intellectually bottlenecked system

In short, medical knowledge and know-how are—for the most part—the sole province of doctors. This is how it’s been for the last 200 years. In that time, patients have become trained to "go see the doctor" whenever they need an annual exam, have a sore throat, injure their shoulder, or experience other minor illnesses. They have been trained to let the doctor take the lead in determining which medical tests they should get, which specialists they should see, and what types of follow-up appointments they should make. The underlying assumption has remained the same: the average patient does not have the intelligence to digest medical information, or interest in being the driver of their own care. The dynamic is very one-sided and this asymmetry needs to change.

We are over-dependent on doctors

Having the doctor do it all is one of the biggest cost drivers. Consider that it costs about $1 million to attend medical school and go through residency training. Many of the tasks a doctor performs can be done more economically by a mid-level provider (e.g., nurse practitioner), or through technology that is connected to less costly training. Given the shortage of doctors today and the exorbitant cost of training a single doctor, this is absolutely the wrong model. It will not deliver the care we need, or deserve, at a price we can afford. This theme is also called right sizing care.

Our system architecture is not responsive to innovation

Exploding medical science and options make it impossible (and impractical) for a single physician to know it all. So, more so than ever before, general practitioners and family physicians must rely on their specialists and refer patients out in order to assess, diagnose, and address many medical problems. But there is also a huge deficit of specialists in many medical fields, especially in rural areas, creating additional inefficiencies and bottlenecks. Moreover, this current model of encounter-driven medicine is also outdated and inefficient. Patients are not encounters. Yet this is the way the system sees them.

Healthcare’s biggest Achilles heel is communication and coordination

Healthcare, by all parties, is notorious for poor or non-existent communication practices. People may not share their worries or health concerns with their families. Rushed by a seven-minute visit, patients withhold information from their doctors. Doctors have varying degrees of patient communication skills. Patients are afraid of asking their doctors important or embarrassing questions. Patients often forget what their doctor tells them. These issues keep people from engaging—they stay on the sidelines in many cases and may think, why bother?

Absent of significant changes, our current infrastructure will not be able to keep pace with the complexity and demands that will be placed upon it. Given its importance, we cover communication in later chapters in more detail.

INTRODUCTION

I wrote this book for my patients, friends, and colleagues. It collects my observations and experiences across emergency medicine, venture investing, strategy consulting, and health entrepreneurship. Over this time, I had the opportunity to invest in revolutionary innovation and work with the broad ecosystem that is the engine of our system: namely for insurers, pharma, health systems, diagnostics, & medical device companies. Most recently I serve as Chief Medical Officer for a leading digital health company that has transformed the patient experience by lowering costs and improving access and quality.

This journey transformed my view of how to help patients and improve our health system. It is from these combined experiences, and from seeing everyday people in the ER, that I hope to make this insider view relevant for you.

The digital health revolution has offered a singularly unique time in our history where all people can truly become engaged in their own health. In fact, I outline and discuss how over 250 companies and technologies are transforming the health industry landscape. This notion that patients (like you) can finally take better control of their health destiny is how this book was born. The digital health promise is faster, better, smarter, and lower cost care that will help you to stay healthy, pre-empt disease, and receive optimized care.

Patients are confused about their care options. They don’t know how to access care in an effective way. They are tired of being nagged about their eating or exercise habits. They are worried about their increased cost burden. They are worried about healthcare reform, but they don’t really know much about it. They are unsure about how to communicate about health concerns and needs. By empowering patients, this book aims to fix these problems.

To define digital health from a patient-centric view, I would say it is the combination of the hardware (devices, sensors, platforms, diagnostic tools) and software (apps, websites, algorithms) that together create solutions that enable patients to become more active co-pilots in diagnosing conditions and receiving care more efficiently.

Even though I have been in healthcare for almost two decades, ironically, I personally am in search for a better health experience. So in many ways this book is for me and for my fellow physician and nurse colleagues. I hope they use it to help their patients and themselves.

In fact, I find that most doctors don’t know what is contained in these pages. They’re busy keeping their practices going: dealing with the ever-increasing patient loads & the huge amount of often conflicting scientific information being thrown at them. Most were trained in the medical practices of the 1970s, ’80s, and ’90s—long before the remarkable technological changes that were brought on by the Internet and other advancements. So don’t expect your doctor to be up-to-date with all these innovations. In this sense, you may have to coach your doctor.

So this book is for you, them, and me. We are all health consumers in the end.

In contrast to books about fixing the system, this book is also about changing the game. And empowering patients is the only way this game will truly change! With $2 trillion of health expenses providing life support for the current system, all stakeholders need to focus on patient empowerment. This concerted focus is the only way the system can change course. For those of you who are wondering, we have already lost—the current system won’t get us to where we need to be.

This book, however, will not attempt a detailed discussion of how expensive healthcare is. Too many other books have already covered that topic. The current focus of the system is that we need to control costs. But singularly focusing on and struggling to control costs in a broken system doesn’t fully make sense. We now have options to actually change the system.

That said, I don’t want to make light of the complex organization needed to deliver healthcare. We want smart and incentivized doctors, safe and effective medications, technologies that will keep us well, and hospitals that focus on healing and providing outstanding care.

There are real improvements and notable trends happening:

Patient safety initiatives; preventing errors like wrong medication or surgeries on the wrong limb

Navigation & coordination efforts for better patient experience and more efficient flow through hospitals and clinics

Reducing hospital purchasing costs and waste

Improving clinical trial efficiencies so that drugs can be developed faster

These are some of the innovations, I believe, that will dramatically improve our current system. I applaud all the scientists, doctors, nurses, hospital workers, innovators, technologists, and all the stakeholders who work tirelessly to improve healthcare.

But in the end, to save healthcare, we need a consumer revolution! In fact, what you do as an engaged consumer may likely be more important than what your doctor does toward ultimately having a long and healthy life. Don’t expect the change we need to only come from the current system; it has too many conflicted dependencies and is ultra-focused on high utilizers of care. Because of all of these issues the current system is too clogged to truly get us to the transformed health experience that we deserve.

From my vantage point as an emergency physician-turned-strategy consultant, venture capitalist, and now entrepreneur, I see digital technology enabling the development of 4 major changes in the delivery of healthcare. Let me briefly sketch them here. In short, medical care, with your help, will become:

Faster – in diagnosis, treatment, and outcome realization; less centralized, more distributed and available on demand in bite-size units of care.

Better – more predictive and pre-emptive, rather than, reactive care.

Smarter – meaning treatments customized to your genes, cells, culture, gender, and ethnicity. This initiative is also known as precision medicine.

Cheaper – providing more value for your healthcare dollar and better utilization of resources.

You Are The Solution

I strongly believe that Smart Patients (you) can actually save our healthcare system. Demand the system to produce more innovation, convenience, and quality—and in doing so achieve a lower cost for health delivery. Since every one of us will become a patient one day, this means all of us are leading this change.

What are the characteristics of a Smart Patient? They…

Are connected directly with all the new ways to become empowered (engaging in online resources, digital health offerings, etc.).

Understand the kind of innovations that will likely make the biggest difference for their own or their family’s health.

Know how to engage with the different facets of the system such as accessing the right care at the right time. They are also better equipped to receive the care that is delivered.

Demand the right set of changes that will transform the model from one that is dependent on physicians to one that enables patients to be active co-pilots.

Smart Patients will be able to drive down the overall cost of care. According to Dr. Michael Roizen, 70% of US medical costs and about $1.3 trillion worth of related costs stem from problems that are amenable to health education and coaching.³ In short, Smart Patients will cost healthcare less.

What’s The Catch?

Asking the patient to take charge and take responsibility is a revolutionary change, one that will forever alter the dynamics of the patient-doctor relationship. The answers to the questions What does it mean to get healthcare? and Whose responsibility is it to keep the patient healthy? are changing. It’s becoming the patient’s responsibility to maintain good health. Because patients will have so many more choices than ever before, they’ll have to learn how to discriminate between options so they get the right care, at the right time, and at the right price.

So Why Read This Book?

In addition to providing a framework for the future of healthcare and a roadmap for how to navigate through it, this book also incorporates hundreds of examples of companies actually building this blueprint. You will be provided specific examples of how, as patients, you can get the most out of this new delivery system. This book also includes sections that make it very practical:

Patient Stories–provide real-life examples of how people use technologies to improve their health experience.

44 Insider Tips–offer practical takeaways from each chapter.

List of Promising Startups–allows you to find the latest companies transforming healthcare. Over 250 different companies and technologies are discussed in this book.

Condition Specific–coverage of over 13 different medical conditions-the last chapter gives examples by condition (diabetes, pregnancy, etc.).

Let’s start by taking a peek at how the new future will look and the important principles to understand in this digital age of medicine.

The first section, digital revolution,provides an important overview of the key premises that are transforming healthcare. It discusses what approaches and factors will lead us to faster, better, smarter and lower cost care.

The second section, digital prevention, discusses in detail the prescription to having the right mindset and how to use digital technologies to prevent and pre-empt illness.

The third section, digital optimization, goes into how to improve your care if you have a medical condition or become ill. It will discuss how you can take better care of your children and your older parents. It provides shortcuts, tips, and an approach to making sure you can make the best decisions in the shortest time.

*****

Disclaimer: In this book, a number of companies, products, and technologies are mentioned. They are primarily used for illustrative purposes; and also because they embody the very essence of why and how healthcare is changing. No company has provided compensation to have its product, services, or technology included.

And given the rapid change in the industry, my review is not exhaustive nor a top ten list. In fact, many companies will fail and some that are included have already failed! I’ve chosen to leave them in, in part to showcase the difficult nature of the changing industry, and to highlight all the hard work of some early pioneers.

SECTION I:

DIGITAL REVOLUTION

1

CEO OF YOUR HEALTH

You wake up one morning in the