I have heard and read reports with a wide range of conclusions regarding the future of managing health, in contrast to and competition with treating sickness.  Some have suggested that the consistently unenthusiastic evaluations of disease management, the most widespread example of managing health, portend the demise of at least this narrow range of “solutions”.  Others have predicted that the “wellness” or “healthy living” market will reach the $1 trillion a year level within the next few years or decade.

Just as the original “health maintenance” and “managed care” organizations ended up focusing almost entirely on managing costs, so managing health has a major focus on reducing costs, though with a far broader range of “costs” than either HMOs or MCOs.  It includes the costs to patients in terms of health and life quality as well as longevity of life, for example.  And it includes the costs to employers and the overall economy of the absences, reduced performance at work, turnover, shortened work life, and other effects caused by “unhealth” in general.

While the “healthcare system”, and hospitals, in particular, are fond of describing the value they represent to their communities in terms of jobs and total economic impact on local economies, which naturally add up to the total costs of the system, over $2 trillion each year.  But the illegal drug industry could as easily brag about its economic impact as well, if only the money involved were used to measure it.  The real point is that the healthcare system has done extraordinarily little to promote the health, prevent and reduce disease risks, and manage patients with chronic diseases so as to reduce the crises, complications, and worsening thereof.

But there are signs that the larger health system, which includes the entire population and its health, all providers, all payers, and all other stakeholders that are affected by and affect the health of the population, are approaching a “critical mass” or “tipping point” level in terms of a far different balance of health management vs. sickness treatment.  Developments in essentially all stakeholder categories are moving in that direction, at least.

For example, “Revolution Health” has most recently partnered with Medco Health Solutions to empower consumers with a personal health record to better manage their own health and healthcare expenditures.  This adds to its investments in health spas, the RediClinic chain of retail clinics, which is the one I know of with a significant focus on “Stay Well” as well as “Get Well” services, and its own online health information memberships. [“Revolution Health and Medco to Partner on New Portal” E-Health Trend Watch July 26, 2007 (www.healthleadersmedia.com)]

Disney has joined in the effort to reduce the promotion of unhealthy behaviors by banning depictions of smoking in its movies. [“Disney Films to Ban Depiction of Smoking” MSNBC.com July 25, 2007 (www.msnbc.msn.com)]  Google and Microsoft are both competing for the e-health market, with Google focusing mainly on consumers, and Microsoft on patient/physician interaction and information therapy. [“Google vs. Microsoft e-Health in Medical Search War for Big Profits” DirectTraffic.org July 26, 2007

Positions on controlling chronic disease costs through disease management and preventing current epidemics in new cases are being taken by both liberals and conservatives.  And most of the daily increasing number of presidential candidates seem to have a position in favor of health promotion and disease prevention, as well as disease management as essential to the solution of the “healthcare cost crisis”. [T. Pugh “Curbing Chronic Diseases New Issue in Health Care Politics” KansasCity.com July 26, 2007]

Canada is taking essentially the same position, with British Columbia complaining how far it has fallen behind other provinces in its investments toward preventing, rather than waiting to treat and pay for sickness. [“An Ounce of Prevention” Straight.com (Vancouver, BC) July 26, 2007]  Employers are shifting toward “value-based approaches to employee benefit design, health plan purchases, which promotes by reducing financial barriers to employees obtaining prevention, early detection and disease management services.

Intel, Inc.’s Digital Health Group is focusing R&D efforts on finding better ways to use computer and communications technologies to enable consumers to protect and enhance their own health over a “health lifetime” as a way to promote both physical and financial independence. [S. Love “Intel in Health Care” Intel.com July 2007]  Cell phones will soon be able to store individual’s medical history for access by providers in both sickness care and health management. [“New Cellphone Projects to Save Lives with Medical History Information” World e-Report/Disease Management Alliance July 12, 2007 (www.dmalliance.org)]  Physicians are poised to join health management vendors and health insurers as providers of proactive health management services, based on the “medical home” model agreed to by primary physicians’ associations. [V. Kuraitis “Disease Management and the Medical Home Model” Disease Management & Health Outcomes 15:3 2007 135-140]

And these are but a few of the literally hundreds of examples of just about every stakeholder in the “system” poised to or already heavily involved in attacking the healthcare crisis proactively.  Some focus just on short-term gains from disease management, while others look longer term at health promotion, risk prevention and reduction.  But all are persuaded that proactive interventions that will reduce the incidence and prevalence of disease and injury, along with the crises, complications and worsening of existing chronic diseases are clearly an essential component of any serious and potentially effective solution to the crisis.  And instead of merely calling for such interventions by others, almost all stakeholders are implementing their own.