The model of lifetime patient relationships with healthcare providers was much in mode when I was born, when people tended more to stay in one place and use the same collection of providers, hospitals, and physicians in particular, throughout much of their lives.  Rural communities, in particular, had physicians who delivered multiple generations of babies in the same family and hospital.  This model still occasionally appears in movies, though fiction has more freedom in creating stories, and reality has changed almost completely.

While it is recognized that “it takes a village to raise a child”, we have not looked past “child development” to its logical extension of “lifetime development” with a focus on health, talent, and whatever other personal assets are needed to achieve and maintain “life excellence” in individuals, and “community excellence” in populations.  Since healthcare is my main experience base, I will restrict my discussion to what is in the way of lifetime health development, and what could be done to achieve it.

Hospitals compete strenuously for each other’s patients, while individuals change physicians at the drop of a hat — or at least of employer changes in insurance, insurers’ changes in provider networks, physician’s changes in location, etc.  In few cases did individuals ever spend their entire “patient lifetimes” with the same providers, anyway, as babies outgrew their pediatricians, women switched to an obstetrician during childbearing years, and seniors sought out geriatricians in their later years.

At the same time, the benefits of a “continuous health lifetime” are increasingly being recognized.  People are far better off if they begin with providers who supervise and support their “health development” from birth.  Healthy babies have a better chance of a healthy lifetime.  Children who are obese when young are more likely to have problems as they grow older.  Employees who lack insurance or support in maintaining their health and avoiding risks will become sick and expensive Medicare beneficiaries, if they live long enough.

While it is clear that no single provider or even system of providers can serve most individuals throughout their health lifetimes, it is equally clear that the best model for care is a healthcare system that does so.  A lifetime personal health record, sharable and transferable from provider to provider within that system will be one essential element.  But the other is a system that is focused at least as much on the health of individuals as it is on their diseases and injuries.  And we certainly do not have such a system today.

While both the American Medical Association and the American Hospital Association give rhetorical obeisance to the health of patients and communities, hospitals and physicians are almost entirely dependent on the demand and payment for sickness care in order to survive.  Machinations by CMS and commercial insurers in revising payment schemes and amounts are a constant source of stress to all providers, save for a few hundred who manage to get by on payments by patients, alone.

But when we think and speak about healthcare reform, it would be far better if we thought in terms of a model built around a “healthy lifetime”, and on “individual health development”, both focused on achieving and maintaining as high a level of health in individuals and populations as is practical.  And health is very practical, to consumers, employers, insurers and governments, particularly when contrasted to “unhealth”.  Too many reform suggestions rely on one mechanism, such as consumer-directed health plans and free competition among them, rather than a thoroughly reformed model for health that a wide range of mechanisms might support, and reforms in existing mechanisms promote.

We have the technologies to make lifetime health records possible, and to enable all health- as well as sickness-care providers access to them, when appropriate and approved by individual record owners.  We have already, and are innovating significant new options for remote monitoring of people whose risk or disease conditions need constant attention.  We also have inexpensive communications technologies that can reach individuals almost wherever they may be to motivate, remind, coach, and otherwise communicate with them, wirelessly or wired, in person, by mail or online, to make health as important a priority as is unhealth.

It is not a health care crisis we face, so much as a health crisis, and we should be using the will and willingness to invest we showed in putting a man on the moon in the 1960s to design and implement a health system fifty years later.  Existing providers can choose to remain in the sickness care business, mix health with sickness care, or move entirely into health care – there will be room for all three options.  It is simply a matter of agreeing on the idea, then on a model that will unite all stakeholders well enough to try out different designs until we find the one that works best.

Lifetime health management based on a lifetime personal health record should be enough of a model specification to make a start toward this “moon”.  It is then a matter of gathering together the resources and will needed to translate the idea into reality.  There is really little question as to the necessity of doing so.  It only waits for those who have the will, the resources, and the ability to make the translation to get started on developing individual and population health as a key foundation for a better and healthier country, and perhaps a world.  If we put as much of all three assets into health development as we have for a century in sickness care development, we should have a good chance of succeeding.