Welcome to Prosumer Health, which we created to help you take control of your health and care, and in so doing become over time both a Provider and Consumer of much of your own health and care activities and efforts – or the new Prosumer of Health and Care within a new Distributed, Individualized, Collaborative, Continuous Care Model that takes into account each individual’s social determinants of health which we now know explain about 80% of a person’s health status.
In almost every direction we look in healthcare/health – whether it is rising medical errors, related mortality and morbidity, inaccessible care even if you have insurance whose premiums, co-pays, etc. keep going up, poor health outcomes with rising levels of chronic disease around the world, rapidly rising healthcare costs, etc. etc. – we are at yet another health and care crisis with no end in sight. Past and current efforts have not and are not working because they have not addressed the underlying causes of these ongoing crises - e.g. the healthcare industry is the only industry that does not have standards for the quality of the data inputs, processes, documentation, auditing, etc. Similarly, we have asked clinicians to do tasks that are humanly impossible. No one can remember all the data in a person’s health record, nor all of the relevant data in the health/medical literature, nor do the combinatorial analytics that links these two data sets to come up with a list of possible diagnoses to explain a person’s problem.
As a result, clinicians make many diagnosis errors, which set off a cascade of downstream errors with respect to related images, labs, tests, treatments, and that cause untold morbidity, mortality, heartache and billions of dollars of preventable healthcare costs. The EMRs we now have are ill suited to address these problems. Finally, we have outsourced our most personal endeavor, our health and care, to distant providers and payers who use population-based “best practices and protocols” rather than using individualized approaches that are more precise and accurate and that flow from each person’s entire health and care data, and their own particular circumstances of life, family, work, and health. As a result, we have not given individuals the tools and agency that they need to become more involved in their health and care. Individuals are the greatest unused resource in healthcare.
But we know that care and health are, more than any other issues we deal with, the ultimate personal and intimate of endeavors that vary from one individual to another in terms of our individual circumstances of genetics, physiology, family, work, preference, etc. In a word, we believe we are pursuing the wrong objectives in care and health with the wrong tools, approaches and care models. We need a new distributed, collaborative, continuous care model delivered with new tools, a new financing deal and a new system that reflects the basic individual, personal nature of care and health.
Yes, everyone should have the right to access care and the opportunity to pursue the maintenance and/or improvement of their health. But with that right also comes some responsibilities – personal responsibilities to try to take care of ourselves as best as our conditions, resources and situation allow. Accidents and serious diseases will occur and for those we should all have access to comprehensive but relatively low cost calamity insurance. But for many of our other care issues, we now have the data, tools and care models to enable each of us to become much more involved and more complete stewards of our own care and health. It is our body and our health. Why shouldn’t we be expected to take as good care of it as we can?
We started Prosumer Health to provide over time a progressively more sophisticated set of data, tools and care models that you and your family can use to take care of more and more of your own care and health needs. Come join us and work with us to improve upon what we have done so far. We look forward to establishing a relationship with you to hear your suggestions for improvng what we have developed over the past several years.
What if everyone could have 24/7 access through their smartphone and other digital devices to their own evidenced-based, AI-guided Individualized Health Platform (IHP) that initial tests indicate could take care of up to 75-80% of an individual’s acute and chronic healthcare/health issues at the same or higher quality and safety with better clinical, health and cost outcomes than existing best practices without the intervention of a nurse and/or physician? Other tests have shown that as a result, use of traditional healthcare services drops by about 60% and associated costs by about 40%.
This vision is possible to realize right now because we have been able to bring together into one system advances in several domains including HIT, the data, learning and decision sciences, behavioral psychology/economics, etc. For the first time, the Prosumer Health approach (see below) can take care to you so that you can begin to be more proactive and take back control of your care and health as you should for these most personal of activities, by organizing, integrating and coordinating care around you (not distant providers and payers) and encouraging you, the most underutilized resource in healthcare, to become more involved in your care and health the way that you want and that works for you within the particular circumstances of your life, your physiology, genetics, family, work, etc. The data, tools and resources that your Prosumer Health IHP will make available to you will empower you to take more personal responsibility for your own care and health – an effort for which we think you should be rewarded in a new deal/contract between you and your or new insurers/payers – see below.
Tests done on these kinds of approaches show that they significantly improve convenience of, access to and engagement in care, reduce errors and duplicative, unnecessary care, accelerate achievement of behavioral/clinical/health goals (e.g. be able to walk up stairs, play with your children, reduce blood pressure, blood glucose, etc.), prolong maintenance of those targets, reduce ER, PCP, specialist and other visits to clinicians’ offices by 60% and thus reduce associated costs by 40%.
Beyond this first round of direct improvements in behavioral, health, clinical and cost outcomes, there are a number of subsequent rounds of improved outcomes and results that will come to you as a result of using your Prosumer Health IHP, as follows:
Earlier Detection, Better Prevention and Slowing Down of Disease Progression: Because you are able to interact with your own IHP, virtual health coach, home health monitors (e.g. blood pressure, blood glucose, INR, etc.) on a continuous daily basis if needed, you can detect emerging issues earlier, which enables you to take preventive measures earlier – all of which will slow down the progression of existing chronic diseases to more serious, debilitating and expensive phases, and prevent the onset of some new acute and chronic problems;
Individual Productivity Benefits for You, Your Employer and Your Care Givers: In turn, these first two rounds of care and health benefits will lead to a third round of improvements – namely, you will lose fewer days of school/work, have better performance when you are at school/work, and the lives of your loved ones and your care givers will be less disrupted as a result of your more effective advocacy and management of your own care and health;
Your Body as an Integrated System of Biological Systems: in our discussions with you it is clear that you understand that your body is an integrated, interdependent system of biological systems, each linking to and dependent on other systems. Your care and health platform should mimic this system of systems as much as possible for the simple reason that what goes on in one system, say your digestive system or respiratory system, will effect what goes on in your central nervous system or cardiovascular system, and those interconnections should be considered when making assessments about the clinical/health meaning and implications of new symptoms, changes in vital signs, etc. Unlike our current healthcare non-system, which farms out consideration of our various systems to different specialists, your Prosumer Health IHP will enable you to consider a specific new acute and/or chronic issue in the context of all the other things going on in your body and in the context of the relevant health/medical literature.
Comprehensive, Surround Sound Care Platform: we have also heard from you that you want one place to be able to go to be able to organize, integrate, coordinate, aggregate and manage your care and health data and activities. You are now faced with an exploding number of care venues, sensors, wearables, portable home digital monitoring devices – all of which are generating streams of data about you of unknown quality, safety and security. You have told us that you do not want to have to keep worrying about the quality and safety of these new data streams and your existing data. Nor do you want to have to keep jumping in and out of different apps and systems to monitor your health. It is too chaotic and inconvenient and works against giving you an integrated, holistic and accurate picture from all your data feeds of your changing health. Because of its very granular, flexible, modular health/clinical data dictionary, language and architecture, your Prosumer Health IHP will enable you to vet, curate, aggregate and analyze new data coming in from a new app (say on diet and/or on exercise, etc.) and bring it into your base IHP platform in a secure and safe manner. It will also allow you to detect new data from new apps that does not make sense and is not safe and secure and prevent that data from entering your IHP. In other words, it will separate the signal from the noise and tell you what are the apps that meet the quality, safety and security standards you need to maintain in your care and health data, tools and resources. Having a seamless IHP like this is not just a question of convenience, it is also one of the attributes that contributes to the efficacy of your IHP – e.g. you will get a more accurate reading on the meaning and implications for your care and health of a new piece of data if it is being assessed in the context of everything else that is going on in your body and with your care and in the context of the relevant medical/health literature
You as a Healthcare Force Multiplier: Your greater involvement in your care and health, as the new healthcare force multiplier, and these associated first three rounds of improved outcomes will begin to address the shortage of nurses and physicians as you are able through the use of the Prosumer Health tools to take over more and more tasks, that clinicians have traditionally tried to do, such as initial data collection about you and your changing health circumstances, asking of refinement questions on your symptoms, analysis of this data in the context of your other care and health data and in the context of the relevant health and medical literature, preparation of guidance options and management plans, documentation of everything that has/is happening to you, preparation of outcomes data, etc. Taking these tasks off of the hands of nurses and physicians, (which they are not optimally suited to carryout compared to the recording, documentation, memory and information processing power of evidenced-based, AI-driven clinical decision support systems, such as Prosumer Health’s IHPs), will enable nurses and physicians to focus more of their time on complicated patients and shared decision making with patients about the guidance options produced by each patient’s IHP, and analysis of outcomes data for best practices and lessons learned. You, your IHP and your health coach thus become three new providers of primary care at a time when the demand for primary care resources is far outstripping supply.
Improved Referrals and Scheduling: All of these benefits and improvements will also make it possible for you, working with your virtual health coach, to address another frequent problem that individuals have with the current way we deliver care – that is, being triaged quickly and effectively to the right physicians, specialists and care venues that are convenient for you to access. How many times have we heard the complaint that “I was referred to the wrong type of clinician;” or “I have been shuffled around from one specialist to another without getting an answer to what is wrong with me;” or “I have not been able to find a clinician/care facility that has an opening in the next two weeks, and who will accept my insurance. They can’t see me until 3-4 months from now. I have my problem right now and I need help right now.” Using the Prosumer approach will also help you to mitigate these frustrations in getting access to the right care at the right time with the right data;
The New Healthcare Delivery/Payment Deal: More and more we also hear that you and many others are growing increasingly frustrated not only with healthcare delivery issues but also with a healthcare payment system that is asking you to pay more and more in the way of healthcare premiums, co-pays, deductibles, co-insurance, but is providing less and less in terms of the kinds coverage and the kinds of care that your policy covers. Pay more – get less hardly sounds like a sound formula on which to base relationships between you and your payers/insurers. What if Prosumer Health could work with you to put together a new Individualized Healthcare Delivery and Insurance/Payment Platform, in which there is a new contract between you and your insurer – e.g. the more involved you are in your care through your IHP and the better care you provide for yourself and your family, the lower will be your premiums, co-pays, deductibles, co-insurance down to a certain level. The cost of serious accidents and diseases would be covered by traditional low cost calamity insurance. Come, join the discussion – let’s not just take back the improvement of our health and the delivery of our care, let’s create a new health movement, a new healthcare payment plan and deal whereby we are rewarded for the efforts we make to take better care of ourselves.
Prosumer Health – Your Platform for Improving Your Healthcare and Your Health: As is becoming more and more apparent, access to healthcare insurance does not give one access to healthcare, and access to healthcare does not necessarily give one access to good care, and finally even access to good care does not always lead to good health. As Figure 1 below indicates, of all of the determinants of an individual’s health, healthcare only influences less than 10-20% of a person’s health status and outcomes, and yet many more resources go into the provision of healthcare than into the provision of the other more important determinants of health, such as healthy habits of exercise and good nutrition, adherence to medication schedules, etc. The vision of Prosumer Health is to provide each individual with the data and resources that they need to manage in real time their healthcare and health needs. We have started by building out and testing the health and care delivery part of this vision, and have put in place the foundations to build out the other determinants of an individual’s health -e.g. genetics, value-based approaches, etc.
Learning IHPs: it is also important that your IHP be able to learn and improve over time. As your IHP accumulates data on your experiences with various health and care issues, the longitudinal record of all of these activities and their outcomes is documented and analyzed by the AI-guided health/clinical analytics engine to identify which approaches work best for you, lessons learned and best practices for you. The IHP system continually feeds this new learning back up into the analytics engine so that there is continual improvement in system processes, practices and health, care and cost outcomes.
Future Proof Prosumer IHP: Another problem with past attempts to build reform tools, systems and approaches is that various stakeholders often find that some unanticipated change renders the new the tool and/or approach less useful or completely useless compared to when it was first developed and deployed. Because of the granular, modular and flexible clinical/health data dictionary, language and architecture mentioned earlier, your Prosumer IHP will be able to incorporate new developments and integrate them into your basic platform without having to re-engineer the entire data architecture and platform. Examples include personal genomic, metbolomic and other -omic data that are already beginning to influence healthcare delivery and that we are beginning to integrate into the underlying architecture mentioned above. Below are a number of diagrams that further describe your PH IHP and how it can help you improve your health and care.
Your Path to Health: Story Board Showing How Your IHP Can Help You Improve Your Health, Care and Cost Outcomes:
As Figure 3 shows your IHP has many interdependent resources that work together to help you find your own path to better health and care that works best in your own particular circumstances of your life, family, work and health situation. These resources finally give you the agency to be able to take more personal responsibility for improving your own health and care in a way that works best for you. As a result, you now have the tools you need to improve your access, quality, safety, engagement, health, care and cost outcomes as follows:
Getting Started, On-boarding and Collecting Your Health and Care Data: to get started with the on-boarding process (see Figure 5) you will be introduced to your health coach who will help you with downloading the various IHP apps, registering and beginning to pull together all of your health and care data into one Problem Oriented Health Record (POHR) that overtime will house all of your health and care data in one electronic record that you own. See Figure 2. Rather than put in vertical stacks of data from different providers - e.g. images, labs, tests, treatments, etc., the POHR organizes your data horizontally by problem and chronologically by problem so that you, your health coach and other members of your care team can quickly see how things are going with your various health and care issues.