Q4400

Michael Dowling, long-time CEO of 23-hospital system Northwell Health, talks about the need for providers to move to upstream medicine instead of treating disease downstream.

This speaks to the preventative rather than managing those who have a disease. It will not be a quick or easy process to change focus given the predominant FFS reimbursement system. FFS will remain a majority reimbursement payer model even as more large systems embrace value based on improved patient outcomes and shared savings with payers.

This will not change until Americans come to terms with the reality that we are the most medicated population in the world and a significant percentage of our adult population has at least one co-morbidity.

Envisioning a future health care system based on preventing disease is a worthy goal for us, yet we are still at the very beginning of this journey.

Tasking could include the following:

1)Conceptualize the ideal health care system where providers, payers, and consumers work together to prevent disease

2)Involve all stakeholders in a robust debate about wellness goals, an ideal preventative process, and the pathway to do this initiative

3)Flesh-in goals for providers, payers, and consumers

4)Identify target diseases of Upstream Medicine

5)Study the causes of each lifestyle disease and protocols used today to manage the symptoms of the disease

6)Research potential cures for those with a lifestyle disease and its likely cost versus the cost of managing the disease over time

7)Gather data from protocols now being used to cure disease

8)Identify the at-risk groups of younger adults for these lifestyle diseases

9)Identify the resources necessary to create a preventative model

10)Determine the pay-for of each study (one for Type-2 diabetes, one for heart disease, one each for each different kinds of cancer, etc.)

Related tasking could include the following:

• Identify disease historically considered part of the aging process
• Research how some are reversing the medical signs of aging through recent advances in extending telomeres and the discovery of the ‘youth molecule’
• Create studies for each new protocol by disease type
• Tease the data to determine when most pre-diabetics become Type-2 diabetics; when heart disease inflammation first is evident; when pre-obesity becomes obesity, etc.
• Identify foods that cause inflammation and lead to various diseases
• Identify the role that minerals, vitamins, and amino acids can play in determining health versus the impact of a change in diet and nutrition, exercise, attitude, and addressing the social determinants of health
• Use predictive analytics to project the net impact of lifestyle change for all Medicare recipients delineated as over 65 and those over 80
• Create an overlay for Medicare patient drug use for each diagnosis and its annual cost
• Create an algorithm to measure the potential net cost and benefit of preventing disease in younger adults who are now in their 40’s, 50’s, and early 60’s
• Determine who will benefit from new fact-driven protocols that will prevent age-related disease or malaise by the time they reach 60
• Analyze charge and payer data for those adults between the ages of 21 to 50 and 51 to 67
• Assess the role that diet and nutrition, exercise, attitude, employment, education, and social determinants of health play in wellness and the choices adults ages 30 to 65 make in their lives
• Create an algorithm to determine the statistical relationships among these factors and to identify the role that each factor plays in determining wellness and aging

This initiative should reflect the best of new research in allopathic, integrative, naturopathic, and holistic medicine. This must include the new findings on how to reverse the effects of aging and speak to new ways to boost the immune system naturally to defeat illness and disease.

In addition, research should identify specific foods, additives, and environmental toxins that affect the integrity of our food supply and their role in causing disease.

Health care can only control the downstream part of the equation right now. Consumers, the federal government, food manufacturers, and farmers each have a stake in seeing this initiative be successful.

The journey to upstream medicine will be multi-faceted, and focused on determining cause and effect in all related domains.

This in turn will drive change in consumer attitudes towards personal responsibility, the federal government’s role in health care policy, how food manufacturers harvest and prepare food, and the practices of the farming industry.

It will be a worthy initiative.

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