The amount of variability in healthcare is staggering. Patients engage with doctors for an incredible number of conditions. Yet the vast majority of these interactions are one and done encounters: the patient experiences symptoms, they engage with the doctor, a course of treatment is prescribed, and the condition resolves itself after one visit.
Chronically ill patients have ongoing interactions with the healthcare system yet the course of treatment for most chronic conditions is fairly consistent. The real variability in treating and preventing chronic illness is not the treatment path. It is the wide variety of patient languages, education, and cultures that affects health literacy. This makes the ongoing nature of patient treatment and interactions the real challenge when treating chronic illness.
How consistent is treatment?
Let’s take a look at two of the most prevalent and expensive chronic conditions: diabetes and heart disease:
The Mayo Clinic documents that management of type 2 diabetes includes:
- Healthy eating
- Regular exercise
- Weight loss
- Possibly, diabetes medication or insulin therapy
- Blood sugar monitoring
Variability may show up in the type of medication, but for the most part the treatment is consistent.
How about heart disease? The real focus here is on prevention. The Mayo clinic documents ways to improve heart disease or even prevent it:
- Don’t smoke.
- Control other health conditions, such as high blood pressure, high cholesterol and diabetes.
- Exercise at least 30 minutes a day on most days of the week.
- Eat a diet that’s low in salt and saturated fat.
- Maintain a healthy weight.
- Reduce and manage stress.
- Practice good hygiene.
For both diabetes and heart disease, the focus is on improvement or prevention to reduce expensive hospitalizations or treatments. The actual recommended treatment paths are fairly consistent – regardless of the patient background.
Patient variability affects outcomes
In the first blog post, I talked about two-way communication where you provide relevant information but also seek to gather patient feedback as a way to improve the accuracy of your patient data. The CDC also documents that patients want bi-directional communication. The system as structured right now, however, does not easily support two-way communication at all touch points within a healthcare encounter. This is magnified for chronic illness. Beyond their primary care physician, people with chronic illness may interact with a wide variety of personnel: therapists, dietitians, care managers and a multitude of other personnel. These providers may even be in different organizations and that makes coordinated two-way communication difficult.
Why is this important? Imagine our healthcare system as a manufacturing process. We have inputs (patients) that form the raw material moving into the system. We have a system that interacts with those patients and processes them to a finished (healthy) product as an outcome. In manufacturing, variability increases the potential for process breakdown. Healthcare is no different and there is already focus on reducing process or clinical treatment variability.
For many chronic conditions there may be variations in medication types or levels. But the rest of the recommended treatment path is similar for most patients. The real variability is within the patients. Given the growing diversity of the United States, let’s examine a sample population of potential patients to highlight the amount of variability that could impact health literacy, so critical for improved outcomes and lower cost.
Let’s examine New York City, a geographic area with a highly diverse population. The population breakdown would look something like the following:
Even though these numbers look simple enough, they hide the fact that there is incredible variety in every single one of these categories. For example, Hispanic or Latino populations consist of people who are from Puerto Rico, Mexico, Ecuador, Columbia, El Salvador, the Dominican Republic, Cuba, and more. How many variations exist within their common use of the Spanish language?
The Asian populations include a very large group from China, but also people from Japan, Korea, Vietnam and elsewhere. There are also South Asians with people from Pakistan or Bangladesh. Every one of these groups have their own language and culture.
Patient diversity is the real focus
The healthcare system must manage all of these differences in language, culture, and even education when it comes to treating chronic illness. The variability and complexity of a diverse population impact communications and treatment at every interaction. How much could we improve health outcomes and lower costs for the chronically ill if we made every attempt to accommodate their differences and support them with communications at every touch point in their preferred language and in a way that is culturally sensitive?
Again, this is really the core of what I will examine throughout the topics I’ll cover in this blog.
- How can we provide two way communication to a diverse population of chronically ill patients in clinical and non-clinical environments in ways that improve health literacy?
- How can we balance the cost of implementing new communication technology and platforms against a strategy that maximizes the effectiveness of all the CURRENT touchpoints that we already have in place?
We must answer both questions because healthcare payers and providers do not have unlimited funds to build or implement a new population-health application or platform for every single touchpoint or communication that exists. If we are successful, we will find a way to create personalized, cost effective communication touchpoints that resonate with the targeted populations in ways that improve health literacy, lower cost and generate better outcomes in chronically ill populations.
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