The Big Shift: Trends and Treadmills

Thus times do shift, each thing his turn does hold;
New things succeed, as former things grow old.

Robert Herrick (1591-1674)

I awoke this day thinking of health care trends.

I searched the Net. I found two pieces on the subject.

• One was from Health Affairs (Susan Devore, Health Affairs, February 10, 2014).

Her article contains eight bits of homespun wisdom on where things were going under these subheadings.

1. Chronic Disease, Everywhere (chronic disease will be in vogue)

2. Put Me in Coach ( People will have health care coaches)

3. Health Care at Home (More will get their care at home)

4. On-the- Job Health (And at work too)

5. Changes in the Exchanges (The exchanges will be in constant flux)

6. War of the Words (Reform will remain controversial)

7. Data Liberation ( Data will become available for everybody)

8. Partners R Us ( Look for unusual partnerships between strange bedfollows – corporations, hospitals, and physicians to cut costs).


• The second piece was from a health care consultant, Steve Valentine, MBA. He told health care organizations how to adjust to changing times (Steven Valentine, “Ten Healthcare Trends to Watch, “ Svalentine @the camdengroup.com, January 2014).

Here are his 10 trends, as revealed in these ten titles.

1. Insurance exchanges will provide mixed results to providers

2. New care and payment models will continue to develop and expand

3. Consolidation of providers will continue…the big will get bigger

4. Physician shortage begins to take effect, and alignment is a priority

5. Marketing and creating a strong brand will be important

6. Transparency will continue to increase

7. Large employers will increase their partnering with providers

8. Expect continued deployment of new technology

9. Health systems and hospitals will continue to expand their continuum of care within their market

10. Labor relations will continue to be a challenge

Valentine concludes; “The transformation of healthcare is truly upon us in 2014, and we all are anxious regarding its impact. Demand for some services will increase while processes are put in place to reduce resource consumption, and provider consolidation will continue ahead, with systems assessing mergers with other systems. Given the mid-term election, the rhetoric this year will be very loud regarding “ObamaCare” with those who sing its praises and those who feel it is a disaster.”

I do not wish to parse these trends. They speak for themselves. The trends mostly concern consolidation, partnering, and new technologies.

The Big Shift

Underlying these trends is a big shift from payers and providers to consumers and patients. The underlying trends are about patient and consumer engagement. It has dawned that the key to lowering costs and improving health lies with patients not with care givers and care payers.

As my primary care physician told me: “ Your health depends on you, not on me.” He stressed my health depends on what happens before you arrive at the office and once you leave the office, not what goes on in the office.

The big shift involves shift in costs to patients, shift in behavioral responsibilities to patients, shift in choices of care to patients, shift in sites of care to the home and to the workplace, and a shift to more transparent information to patients.

In my mind, the poster child for this new attitude, this shift from health care givers to health care receivers, is exemplified by the current rage over treadmills at work and in front of computers and the TV at home.

James Levine, MD, a Mayo Clinic physician, has pioneered this treadmill concept. Why not, Doctor Levine, asks, gently walk on a desk treadmill at work and in front of your TV and computer at home, while walking at 2 MPH on a treadmill. By doing so, you can get your exercise, save time, get your work done, ward off obesity, and protect yourself against those cardiovascular diseases that plague Americans and consume most of U.S. health care spending. Persons with a sedentary lifestyle are at increased risk for heart disease, diabetes, and lower than average life expectancy.

And so, the big shift is,

Get off your office chair and home TV seat.

Stand up straight, walk on your own two feet.

Shift from the ordinary and sedentary,

To delay your visit to the cemetery.