It's Behavior, Stupid-Integrated Intelligent Engagement Will Replace Current Methods of Adherence Programs

Closing Statements of a Series

To borrow from a political campaign: it all comes down to behavior.

This series of articles has focused on the growing need for effective adherence strategies; not just adherence to medication, but the undeniable recognition that our healthcare system must develop a revolutionary approach to deploy the dozens of proven health behavior change theories and models to improve the behavior of the “person.”

For decades managed care has been attempting to reduce the cost of care through contracting, utilization management, case management and disease management, all while watching a skyrocketing level of new illness; diabetes. Diabetes is all about behavior; and current counseling and prevention programs just do not work, at least at scale. We must use integrated intelligent engagement to stem this epidemic. And we must start soon.

The problems are enormous and only growing larger.

There has been an explosion of tactical approaches to this problem, but this author feels that no one of the technologies has the capability of solving our healthcare problems. As John Mattison, MD, chief medical information officer of Kaiser and Dennis Robbins, PhD, MPH, healthcare futurist and author have suggested, we need a “plecosystem” of approaches that provide “person-centric” solutions.

This author believes that only by combining a wide variety of technologies together and providing a virtual health assistant (VHA) that can understand and engage with people in full conversations can we produce the desired results.

Furthermore, VHAs will become the brain and the personality behind the plecosystem and the companies highlighted in this series well become the leaders in the near future.

We have been throwing tactical tools at this for decades. It is time to deploy a strategic solution. I challenge the large retail pharmacies—entities such as Walgreens, Rite Aid, CVS, and Walmart that have publically said they are going to revolutionize primary care—to step up and not only redesign the delivery system, but also redefine the strategy of patient-centric to person-centric.

There are only a finite number of nurse practitioners and physician assistants who can be employed. And they are simply providing the same old insufficient “dependent” approach: a professional telling a patient what to do and hoping it will happen. I liken this approach to talking a hungry dog out of a meat truck. It has not worked and it will not work.

But, a VHA is infinitely scalable, personal, customizable, omnipresent, and can provide the constant level of counseling and coaching needed to change a person’s health over time. It is not constrained by “I’ll see you in a month.” It can constantly provide guidance and nudges fulfilling the hope of the health behavior theories and models we have all grown to depend upon; but at a much more effective level.

Health plans and integrated systems likewise are looking at patient-centered medical homes to solve our problems. But given the shortage of primary care physicians, how can that be scaled? They, likewise, have the resources to deploy integrated intelligent engagement to hundreds of millions of Americans, literally overnight.

The science is proven, the technology is ready, the people are in dire need, are the evidence-based guidelines are honed. All it needs now is for a visionary to step up and deploy this approach across the tens of millions of people in US who need this approach. The market will reward the early adopters of integrated intelligent engagement!