Did you know that nearly 40% of the doctors that are in practice right now are 55 years old or older? About a third of the present nursing workforce is 50 years or older and 55% are considering retirement in the next 10 years. That comes to a shortage of about 100,000 physicians and 300,000 nurses in the near future.
Sixty-six million Americans are in the baby boom generation. They were born between 1946 and 1964 meaning they are between the ages of 66 turning 67 in 2013 and 48 turning 49 this year.
These numbers may not seem like anything to worry about…they’re just numbers, right? Wrong. What will happen when there are even fewer physicians and nurses available to treat and to monitor patients? After approximately 50% patients right now are not complying with their treatment or taking their medications as prescribed.
Mary Beth Chalk is one of the people thinking about these figures and trying to create solutions now. One of the areas she focuses on is the time between office visits. “The negative spaces of treatment are what happens between office visits…Treatment is what occurs in the office – managing is what a consumer has to do once they return to their lives…. think what technology can do to paint in the negative spaces of treatment! ”
Partners Healthcare has a lab that is searching for how we can solve the problem of not enough doctors for all the baby boomers. Connected-health is one of the answers. “If we measure something about you and feed it back to you in a contextually relevant way, then we can motivate you to a healthier state,” says Dr. Joseph Kvedar, Director of the Center for Connected Health. He is also co-founder with Ms. Chalk of Healthrageous, an m-health company that is an off-shoot of the Center at Partners Healthcare.
Ms. Chalk is also the Chief Engagement Officer at Healthrageous and she’s been learning a lot about what motivates people. “We found that very few people are inspired to ‘manage their condition.’ Health is a requirement to realize hopes and dreams,” she says. Patients must manage their health through medication or lifestyle changes, “what if [managing] is placed in the context of “’living’… what if we could join with and support their aspirations for their lives – rather than placing a burden of ‘managing’?”
Since Healthrageous’ was incubated inside of the Center for Connected Health –they are part of the tele-monitoring work that is being done there. However Healthrageous is “leveraging personalized computing, biometric feedback, segmentation, and digital coaching to help people be successful.”
“Our work is currently focused on monitoring and digital coaching for consumers with hypertension and Type 2 diabetes,” Ms. Chalk acknowledges.
With 59 percent of US adults looking online for health and drug information yet only 12 % of adults having proficient health literacy, self-monitoring may have significant educational benefits. If health is made personally relevant to a person’s real aspirations, it becomes meaningful. Self-monitoring can motivate, The patient question we ask at Healthrageous is ‘What is your inspiration for getting/being healthy?’” In other words self monitoring can teach an individual “ that my blood sugar is standing between me and seeing my daughter walk down the isle”,. Ms. Chalk states. ”Consumers are able to leverage our platform to manage chronic conditions (Type 2 Diabetes, Hypertension, etc) in a personalized way.”
Ms Chalk believes that next year, 2014, will be a new dawn in health consumerism in the US with the health insurance exchange. “Nationwide Insurance Corporation provides a discount for safe driving – what if I was incented for good health? You can scream “not fair,” yet Ms. Chalk believes that “every person can do something to improve their health.”
Are poor health outcomes the fault of the individual? There are some who may be concerned about this idea. The Food Research and Actions Center’s review of the literature on obesity indicates that there is a greater risk of obesity for women and children (especially White women and children) of low-income who are suffering from food insecurity.) Neighborhood factors include a lack full-service groceries and farmer’s markets, expensive healthy food and inexpensive refined grain, high fat and sugary foods, greater availability of fast food restaurants, and, finally, fewer opportunities for physical activity because of crime, traffic, and unsafe playground equipment. Research also reveals that cycles of food deprivation and overeating may also cause obesity because those who are eating less or skipping meals to stretch food budgets may overeat when food does become available, resulting in chronic ups and downs in food intake that can contribute to weight gain, especially metabolic changes that promote fat storage. Other factors include high levels of stress and exposure to more marketing and advertising of fast food, sugary foods and sugary beverages. Finally, the research notes that the poor have limited access to health care.
Ms. Chalk is sure that “technology will allow us to personalize the ‘something’ that we can each do to measurably improve our health.” She suggests that “health disparities will be the engine of segmentation strategies – one size fits all no longer works.”
Are physicians and nurses ready for this revolution? Clinician buy-in will come when Healthrageous demonstrates that “a solution can effectively engage patients in evidence-based lifestyle changes that result in improved clinical outcomes and reduced office visits, “ Chalk says. Healthrageous is interested in “integrat[ing] physician approved alerts into their normal workflow to alert the physician…when a patient is not achieving optimal clinical outcomes.” Finally, being able to see data trends over time is a big incentive for physician buy-in. “Physicians will have to see how new solutions improve their ability to impact patient outcomes without creating undo burden on their daily practice pattern,“ Ms. Chalk believes.
With the Baby Boomers aging, fewer clinicians and paid caregivers and 2/3 of our population overweight or obese, there is a need for many changes. The CDC’s Thomas Frieden suggests policy changes to reduce the problem of obesity like instituting a tax on sugar-sweetened beverages; increasing subsidies for fruits and vegetables ane using zoning to keep fast-food restaurants away from schools. He has proposed completely eliminating children’s exposure to food advertising on television. Add to these changes the innovative technology that Healthrageous can provide and we may have a winning combination. As Ms. Chalk says, “We are in a time of reformation! And reformations require courage and great minds!” M-health, tele-health and connected-health initiatives can provide the support that is needed for big changes to come.
This summary is based on #HCHLITSS twitter chat held Thursday January 24, 2013
1) Fears, D. (2010) Retirements by baby boomer doctors, nursese could strain overhaul Washington Post Monday, June 14, 2010 http://www.washingtonpost.com/wp-dyn/content/article/2010/06/13/AR2010061304096.html
3) The Food Research and Actions Center (http://frac.org).
4) Frieden, T. ,Dietz W., & Collins J. Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity HEALTH AFFAIRS 29, NO. 3 (2010): 357–363. http://w.banpac.org/pdfs/sfs/2010/reduc_child_obes_11_04_10.pdf
50 March 20, 2012. Healthrageous CEO Rick Lee speaks at Stanford University VLAB Event: “The Uploaded Life” http://youtu.be/6_sj89cxuvo