Why do we need help buying and using healthcare? It’s complicated.


Feb 6, 2018

Some products and services are simple to understand and use. But the more novel, complex and/or expensive an offering is, the more help people need understanding how it adds value to their lives or businesses, and what they need to do to realize that value.

The galloping pace of change in cell phone features, capabilities and service plans can drive even the tech-savviest of shoppers to consult expert tech reviews before making their selection. Many prospective home buyers rely on mortgage brokers to find potentially suitable deals and compare them across numerous, varying dimensions to determine a winner. And business leaders contemplating expensive enterprise software purchases will spend thousands or even millions of dollars on specialized technology consultants to analyze their organizations needs, then recommend solutions that will deliver the necessary return on investment.

This phenomenon raises an important question for the healthcare industry. Given that all health improvement processes, from clinical interventions to self-care regimes, depend on the informed and competent efforts of the people they’re designed to help, why does today’s predominant care delivery paradigm afford them so little support in playing their part?

After all, healthcare is one of the most complex, expensive and valuable investments an American can make. And deciding on particular treatments and regimes often requires a breadth of expertise that few individuals possess. So we need coordinated, multidisciplinary support throughout the care continuum.

What if we had the same kind of support in engaging with healthcare that high-performing sales representatives provide to business leaders shopping for expensive, complex products? Such professionals don’t just dump some leaflets on prospects’ desks and follow up later to book the sales. Nor do they subject prospects to self-serving monologues, telling them what they need, or why they should want what the representatives are selling.

Rather, they take the time and earn (and hopefully deserve) the trust necessary to uncover the progress that prospects desire to make in their role, and the circumstances shaping that desire. The latter might include prospects’ organizational goals, responsibilities and challenges; their personal aspirations, preferences and worries; and more. In this way, high-performing sales representatives obtain the information they need to craft solutions that prospects can confidently and realistically invest in.

There was a time when primary care physicians (PCPs) might have provided such support. But unprecedented patient volumes and reporting demands, coupled with fee-for-service payment methods rewarding action over dialogue, explain why few PCPs do so today.

The encouraging news is that innovators are increasingly incorporating a new role into healthcare delivery, with the objective of providing just that kind of support. Often called a health coach, the role may also be described as a care coordinator, case manager or similar variant.

As Professor Clayton Christensen, Andrew Waldeck and I described in our recent paper, Health for hire: Unleashing patient potential to reduce chronic disease costs, an effective health coach develops a close, trusting relationship with patients that enables them to discover the progress patients seek in their lives. In the context of the right business model, this knowledge empowers a multidisciplinary team, including the coach, to design health treatments and regimes that help patients make that progress.

Importantly, just as high-performing sales representatives might configure complex, expensive products or services to suit their prospects’ needs, effective health coaches don’t expect patients to embrace standard, “one-size-fits-none” offerings. Rather, they ensure that care teams take patients’ real-world circumstances into account in the care design process, so that solutions minimize patients’ barriers to adoption and sustained engagement.

Where solutions are complex and expensive, most of us need help making good choices for ourselves, and professionals providing such help can prove invaluable resources. At their best in healthcare delivery—whether called “health coaches” or some variation on that theme—they are a rare and powerful thing.

As Senior Research Fellow for the Christensen Institute, Rebecca’s research focuses on business model innovation in healthcare delivery, including new approaches to population health management and person-centered care.