Getting upstream of chronic conditions - Learning from shooting a probe on a comet

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What is your healthcare flight plan?

As much of a stretch as it might seem, space missions into the depths of the solar system have strong parallels to healthcare. Take the European Space Agency’s (ESA) Rosetta mission to a comet called 67P, or Churyumov-Gerasimenko (not the most awe-inspiring name in the galaxy). Rosetta made three flybys of Earth, and one of Mars, to get enough speed to travel 5 billion miles and land on an object only 2 and a half miles long. Think about that – I can’t reliably shoot a billiard ball four feet across a table to hit a hole that’s not moving! ESA hit a tiny pinprick in the immensity of space 11 years after launching its probe – and the comet was moving 84,000 miles per hour. Impressive.

Imagine that ESA technicians had altered the trajectory of the rocket carrying the Rosetta probe by just one degree on the launch pad back in 2004. They would have missed the comet by literally millions of miles. Or, assume ESA launched Rosetta and realized 10 years into the journey the mission was significantly off course. They wouldn’t have the time or fuel to make the necessary adjustments to hit their target.

So what does this have to do with healthcare? Just like the space agency had to set Rosetta’s intricate course years before arriving, so must we address our biggest healthcare problems years before they actually become problems. We need to move upstream of chronic conditions in order to help solve America’s healthcare ills.

Any physician can tell you the catastrophic effects of chronic conditions – both to the health of individuals, and to healthcare costs. Diabetes alone, for instance, costs Americans $322 billion a year, not to mention the hordes of related health problems it causes. Carefully managing chronic conditions is an absolute imperative, and a huge part of that flight plan involves people making better lifestyle choices. The only way to hit our proverbial Churyumov-Gerasimenko years down the road is for each of us to eat better, be more active, get our screenings, and so on right now. Very small course corrections now will help us get where we need to go and avoid or minimize disease, let alone complete mission failure.

Kedar Mate, MD, Chief Innovation and Education Officer, at the Institute for Healthcare Improvement (IHI) said, “This is healthcare moving from a sick care management system to one that’s truly looking after the health of the communities in which it is active. We are certainly seeing more of this "upstreamist" behavior from health systems but we like the way Intermountain is approaching this--enabling and supporting  individual responsibility as well as working across sectors (grocery and insurance) to bring about the changes needed to help people take charge of their health and improve their lives. The collaboration with employers, insurers, and the health system is another good example of how the incentives can be aligned to drive better health in our communities. Although we know that much of what leads to health outcomes are socially or economically determined, the steps Intermountain is taking by working across sectors and making it easier to make healthy choices are pioneering. Too often the cards are stacked in the other direction.”

At Intermountain, here’s some examples of how we’re getting upstream of chronic conditions and helping people live the healthiest lives possible. What are your ideas to do better?

  • LiVe Well is our wellness program that includes clinical protocols, patient education, community outreach, and a multi-media public service campaign.  
  • Partnership with Associated Foods grocery chain in our service areas.
    • LiVe Well Lanes - is a fresh alternative to traditional check stands. In all 42 Utah stores, check-out lanes feature healthy fruits, snacks, and drinks instead of candy bars, sweets, and sodas.
    • Dietitian Approved Healthy Foods - Dietitians from Associated Foods and Intermountain Healthcare are in the process of extensively reviewing every product on store shelves. Once finished, shoppers will find dietitian-preferred tags throughout Associated Foods grocery stores to help people find the healthiest options.
    • LiVe Well Park Farther – Associated Foods stores’ parking lots feature messages painted on parking stalls as far from the store entrance as possible that say, "Park here to walk farther and be healthier." The program is a reminder to customers that daily physical activity is an important part of a healthy lifestyle. Intermountain and Associated Food randomly surprise customers who park in the designated spots with various prizes.
    • LiVe Well Healthy Foods Program - Employees of Intermountain Healthcare earn points when they buy healthy foods at Associated Foods stores, and can redeem them toward their next healthy purchase. These include fresh produce, lean meats, natural and organic products, and bottled water.
  • Digital challenges. The 100-day Heart Challenge is an online campaign to help people take care of their heart. People sign up for free, pick one of six challenges, then check in weekly to get education, motivation, and prizes. They post their progress throughout the 100 days of the challenge.
  • SelectHealth Share is our shared-risk insurance plan. Employers who choose this plan agree to a series of commitments – like having a wellness program for employees. SelectHealth agrees to commitments as well, including low rate increases for employers who meet all their commitments.

We aren’t the only ones working to make a difference. IHI (The Institute for Health Improvement) introduced us to health teams across the globe demonstrating community involvement for better outcomes. The two videos recorded from the recent IHI conference focused on getting upstream:

The challenge: Focusing on patients – not hospital procedures – during discharge from the hospital.

Sheffield Teaching Hospitals flipped things around for patient discharge. They focused intently on the patient’s specific needs at home rather than the traditional hospital rehabilitation protocols. This lead to more accurately meeting the care needs of a patient’s home life, which reduced in-bed days and lowered the overall cost of care. Watch the full story https://youtu.be/6rSEM_OwLRI:


The challenge: Reduce ER visits and lower cost of care.

At University of Texas Southwestern Medical Center, just like thousands of hospitals like it, the Emergency Department is intensely busy, rotating through hundreds of patients every day. To better serve its community, and to be able to accommodate health needs, the medical center created a program around self-care, teaching patients how to administer some levels of care at home. “We’re able to tap into the greatest potential of all, human potential, to lower readmission rates and improve bed availability,” Kavita Bhavan, MD. Watch the full story https://youtu.be/NR0OIhzKTfo:



What are your ideas for individuals and health systems to move upstream of chronic conditions?