As 76 million baby boomers stampede into the healthcare system, the challenges are daunting at best. Consider this: America burns through $3 trillion a year for healthcare, yet we’re the 33rd healthiest nation in the world. Every man, woman, and child pays an average of $8,800 for that dubious result. Clearly, this is not sustainable. Can a more health-conscious generation improve that equation?
Why is it that even though we have many of the best medical facilities in the world we’re so far behind in population health outcomes? Like everything else in life, the problems stem from a combination of emotional, psychological, demographic, and practical factors.
There are some obvious factors that contribute to the astonishing waste in our healthcare system. A big part of the problem is that we’ve dramatically extended life, and the chickens are coming home to roost. The economic realities of medicalized aging reveal a disturbing lack of planning. For example, there are 1.7 million licensed nursing home beds – almost 70% of them in for-profit institutions – but only 1.4 million residents, an 18% “vacancy rate.” Hospitals also suffer from too much capacity, as a rapid increase in outpatient procedures has led to empty hospital beds in many regions. At the same time, dramatic consolidation in the hospital sector has reduced competition, and lower competition always leads to higher prices. The inefficiencies are passed on to insurers, who pass it on to the insured.
There is no one villain in the battle against rising healthcare costs. While it’s becoming conventional wisdom – and political fodder – that prescription drugs are a major culprit, the latest data available from the CDC shows prescription drug expenditures to be 9.3% of total healthcare costs, a lot of money but hardly the game-changing variable. Hospital expenditures are 32% of costs and physician and clinical expenditures another 20%. Some of the proposed solutions are painful to contemplate. A report by the Kaiser Foundation found that low deductibles or small office co-payments encourage overuse of care. Increasingly, employers and insurers are moving toward high-deductible coverage as a way to slow premium growth and require people to pay more toward the cost of care – a heavy-handed but effective solution.
On a brighter note, what about the promise of a younger generation? The 83 million Millennials – those in their late twenties and early thirties – represent one quarter of the US population, the biggest generation ever. If trends and attitudes continue on their current trajectory, Millennials will be healthier than previous generations. According to a Goldman Sachs report titled Millennials: Coming of Age, “Wellness is a daily, active pursuit. They’re exercising more, eating smarter and smoking less than previous generations.”
It’s not just that Millennials are turning away from unhealthy habits like drinking and smoking. They have a more holistic approach to health than previous generations, and they intuitively know how to use technology to reach their goals. They embrace what Dr. William Mayo, founder of the Mayo Clinic, believed 100 years ago: “The ideal of medicine is to eliminate the need for a physician.”
It’s obviously true that right now Millennials are younger and therefore healthier by definition. But lifelong habits and attitudes are formed at an early age, and that bodes well for the future. They seek to avoid doctors and medications through prevention. But perhaps Millennials’ biggest positive impact will come from being digital natives who are comfortable with technology and take every opportunity to use it to their advantage. While they distrust the medical system more than previous generations, they are more likely to trust cost-efficient innovations such as telemedicine and online consultations. And because they expect more from technology they could provide much-needed focus in its development.
The Medical Internet of Things – the vast collection of medical apps and devices that are designed to connect to healthcare IT systems – lives within a messy environment that is anything but connected. Electronic Health Records have little interoperability, hampering their usefulness. Patient Portals are under-populated with the information that is most useful to patients, and awareness that these systems even exist is low. The digital health landscape is littered with underused, poorly designed tools: There are more than 44,000 medical apps available, many of them unused. Digital health startups have proliferated as a result of healthcare’s gold rush mentality, many of them featuring proprietary, stand-alone platforms. According to Accenture, more than half of all digital health startups will fail within 2 years; in the meantime they only add to the confusion.
Our approach to how we develop medical technology is misguided. The most useful and reliable applications result from collaborations among developers, physicians, patients, and experts in health law, yet such collaborations are the exception rather than the rule. As long as we have an unfocused approach to healthcare innovation, thinking of it only as The Next Big Thing, we’ll be missing the opportunities to advance health outcomes through technical innovation.
But Millennials understand technology on a visceral level, and instead of being intimidated by its proliferation they know how to narrow their choices to those technologies that fit their needs. They understand the most basic law of usability: the best experience a person can have anywhere becomes the minimum expectation everywhere. Usability leads to utility and adoption. But one only needs to access the average patient portal to see what an uninviting, confusing digital environment looks like.
Millennials also view expanded healthcare coverage as a worthy goal – the best opportunity to keep people out of the system in the long run. Many of them understand that the Affordable Care Act is flawed and imperfect, but they also believe that the healthcare system’s quality and cost issues can be brought under control through a combination of technology, data sharing, and prevention. A 2014 Pew Research Center study found that a high percentage of Millennials believe that providing health coverage for everyone should be the government’s responsibility; the concept of creeping socialism doesn’t enter their mind. Perhaps they know that the worst form of socialism is when the uninsured have to rely on the hospital emergency room for primary care, and the rest of us end up paying the bill.
Millennials hold the key to bringing our healthcare system’s outcomes in line with what we pay for them. The combination of systemically integrated technologies and the ability to use them, wellness and prevention as a way of life, and taking personal responsibility and initiative for one’s health can ultimately save us from ourselves.