Doctors must be paid on the basis of outcomes, not for how many services they provide – and patients, too, must be held accountable for their health, says Joseph Kvedar, MD.
"Fifty percent of healthcare is from irresponsible behavior," said Kvedar, who heads the Center for Connected Health, part of the Partners Healthcare system in Boston, during Wednesday's opening of the sixth annual Connected Health Symposium in Boston. "We all sort of whisper about it. We need to make people accountable."
There are a number of ways patients might be held more responsible for their own diseases, but obesity was clearly the biggest elephant in the room.
"Obesity has increased dramatically over the last 30 years in our society," said Nicholas Christakis, MD, in his presentation about the non-biological spread of disease among groups of people.
Today, 66 percent of the population is obese, he said. "It's becoming called an epidemic, literally spreading from person to person."
Peter Tippett, MD, vice president and chief medical officer for Verizon's business security solutions group, said the nation could be successful in taking on obesity and hypertension if it addresses the issues in much the same way it tackled smoking.
Jonathan Linkous, CEO of the American Telemedicine Association, agreed.
"A number of years ago, it wasn't bad to smoke," he pointed out. "All of a sudden, it's a shameful thing. It's not something you do."
Kvedar said patient engagement is the secret to better health, and the Internet is making patient participation easier than ever. He offered proof and a call to action.
In a program conducted by the Center for Connected Health, patients with diabetes regularly uploaded their hemoglobin A1c numbers online so that both they and their care providers could monitor them. Those who uploaded their numbers did better than those who didn't, he said, and those who uploaded their data and also received automated coaching messages did even better. Those who did the best were patients who uploaded their numbers and received coaching from their physician.
"Engagement equals better outcomes," Kvedar said. "Active patients do much better. Involvement with the doctor is best."
Kvedar said the diabetes program and a Partners program for heart failure patients offer opportunities to change the roles of both patient and physician on a national level – or, as he put it, "kick it up a notch."
"Connected health changes behaviors," he said.
When an IDN (integrated delivery network) like Partners develops the programs, he said, "it starts to change the role of the patient, the role of the provider and the role of the employer."
"Where we want to get is participatory medicine," he said.
To speed things up, Kvedar recommended:
* Management fees for provider practices – not as a long-term strategy, but as a run-up to bundled payments;
* Patient incentives for taking charge of their health;
* Choosing the right patients for engagement programs; and
* Organizational commitment.