Will You Please Check On Him?

A recent email exchange between a client and some members of our clinical team reminded me of the open opportunity for health benefits to impact health and human flourishing. A discussion with a plan member over access to a particular medical device turned to concern over the member’s wellbeing. Our client sent an email to our team sharing some basic information and asked: “Will you please check on him?”

That request has been rolling around in my head for weeks as I’ve reflected on what it reveals and how unique is the dynamic of the situation. A huge problem in our mass-production healthcare system comes down to the ability, and perhaps desire, to “check on” any particular individual. There are numerous causes for this but the root is structural: starting with health benefit design, moving through the actual health plan and into the may buckets of healthcare broken down by CPT codes, we’ve created a dis-integrated healthcare experience. The benefit is “administrated” by rules designed to manage costs and the “care” is transactionalized by a healthcare ecosystem designed to fit a billing infrastructure managed by systems that have no capacity to care for an individual. Further complicating all of it, are the silos into which the massively complex system is divided into, making it difficult to navigate as individuals accessing health vendors and healthcare, and as companies providing benefits to their employees.

The question, “Will you please check on him?” rings loudly as a radical request in a system that seems unable and unwilling to check on anyone other than through a prior auth or collection call. Watching the email exchange, I followed along as our team did check on him. The member’s health status was assessed, he was coached through some decisions, made aware of some resources provided by his plan, and followed up with as he navigated his next steps. We did check on him, and it made a huge difference in his health and his experience in improving it. None of what we did required a CPT code or prior auth. It took some time, some clinical expertise, some understanding of the particulars of the health benefit, and some compassion.

A few days later, I was reviewing our response to a request for proposal and a major part of the problem was revealed: in a spreadsheet focused on price and rebate guarantees, administrative metrics, and discounts, there was not one question about producing health for plan members. Nothing about removing barriers to access, cost, and complexity. Nothing about improving how they experience healthcare. Nothing about lowering the cost of care by helping people use less because they’ve gotten healthier. Have we given up on the notion that we can help individuals improve their health?

Asking your healthcare partner to “check on a member” should not be a radical ask…but in our system it is. And that’s too bad. As I watched this interesting story unfold, I was reminded why we do what we do and that it is a lot more fun, and fulfilling, being on the “radical” side of focusing on member health and the flourishing that happens for each individual in situations like the one above. The member, the client, and our clinical team all flourish when they have a chance to participate in an encounter that focuses on doing the right thing.

Thank you to all those working hard to change a system that can and should do better. It’s hard work but flourishing is worth it.