Modern Care Dilemma: Will it be House or Welby?

I’m excited to be part of a panel of healthcare and employee benefits experts on Thursday, June 5 at 9am PST to discuss the value of Advanced Primary Care (APC) for workforce health, employee benefits ecosystems, and the bottom line.

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When I think of two fictional doctors who best exemplify what we would like healthcare to be and what healthcare actually is, I think of Marcus Welby, MD and House. For those who don’t remember or are too young to have come across Marcus Welby, he was the protagonist in the TV series, Marcus Welby, M.D., which ran from 1969 to 1976. He was a general practitioner who tried “to treat people as individuals in an age of specialized medicine and indifferent physicians.” House, in contrast, ran from 2004 to 2012, following Gregory House, an “acerbic infectious disease specialist” who was a “prickly genius” with “brutal honesty and antisocial tendencies.” Both of these physicians got results and both of these physicians were well respected by their peers. But I certainly wish more healthcare providers were like Marcus Welby.

House represents the current state of medicine: a heavy emphasis on the biomedical model of disease. In this model, we are defined by our afflictions and will be subject to the latest and greatest biomedical advancements. While the biomedical model can be extremely helpful in managing conditions that require a technical solution, it doesn’t always acknowledge that beyond the disease itself lies a human. For conditions such as an infection or a broken bone, the biomedical model may be just fine, but if you have a chronic condition like diabetes, obesity, or cancer, the disease has an impact on how you see yourself and how others see you as well. This, in turn, impacts your health, just as your behaviors and your environmental and socioeconomic situation influence your health and how you view yourself. House isn’t going to address this challenging milieu. He’s going to treat the disease and be on his way. He may be technically proficient to diagnose and treat the disease, but is he really committed to rooting out the underlying contributors to the disease itself, let alone manage your overall health and well-being?

A 2012 study showed Americans spent about $30.2 billion dollars on complementary health practices. While this was only 1.1% of total healthcare expenditures, it represented about 9% of out-of-pocket costs spent on healthcare. Of this, nearly half ($14.7 billion) went to seeing complementary providers. This is about ⅓ of what individuals spent to see conventional providers. Complementary medicine and complementary practices are not the gold standard for any condition. So why do people spend so much money on complementary care? They do it because they’re interested in improving their health and well-being, and they feel their conventional practitioners don’t share this interest. In an age of technological advancement, emphasis on relative value units (RVUs), throughput, and related efficiencies, we’re eliminating the time for empathy, relationships, and building a holistic view of health. Marcus Welby must be spinning in his fictional grave.

Since America spends far more on its healthcare than peer nations—and has far worse results—we have to ask why. Where is the disconnect? Primary Care has been shown to prevent disease and reduce illness. Investment in Primary Care also improves access to healthcare and reduces health inequity. Relative to our peer nations, America substantially underinvests in Primary Care. If we want to make America healthy (again?), we have to get serious about investing in Primary Care, and more specifically, Advanced Primary Care.

Advanced Primary Care is both a mindset and practice approach that treats not just acute and chronic conditions, but is also focused on prevention and in understanding and addressing all the factors that contribute to our health. These factors include our personal behaviors, our environment, and the socioeconomic conditions in which we live our lives. Advanced Primary Care takes an integrated approach to care, which brings together into a single care journey those providers who can look at a person holistically and meet the bulk of their needs. This means the seamless integration of Primary Care, Mental Health, Physical Medicine, Occupational Medicine, Health and Fitness Coaches, Care Navigators (people who help patients navigate the complex healthcare system), social workers, and critical clinical support staff.

While large health systems may have all these components, they’re not often physically close to one another and almost never integrated into a single Care Team. While many different providers may share an electronic health record, they’re often not actively communicating and coordinating with each other. Having all these providers in a smaller, more integrated unit reduces barriers to access and fosters communication. This allows a patient to be surrounded by a Care Team that has a relationship with them and with each other. Giving the Care Team time to interact with the patient and each other, and providing them with the tools to assess and address the needs and care gaps of patients, creates an environment where we can see the patient as a whole, not merely as a collection of diseases. This approach provides the context to focus on overall health and well-being, and can be matched with a payment model and financial incentives that will support such an approach.

Ideally, we would have a system that has the caring and compassion of Marcus Welby, the genius of House, and is supported by a comprehensive and accountable Care Team that functions as an integrated unit. This doesn’t have to be TV fiction, but a reality that more and more people get to experience firsthand. It is “Health as it Should Be.”