Shana
Neelu Coshal, MD
Value
based reform was the hot topic of the conference. This type of program rewards health care
providers for quality of care delivered to the patient. Psychiatry, largely, has nervous to this type
of model as behavior determines outcome, something that we do not usually see
within our control. The greatest lesson
I took away was that the solution to this problem is that what is missing on
the consumer side is trust. And trust
can be developed through co-creation of healthcare with the consumer, and
collaboration with the community. Combined
strategies for providers and consumers working in concert have shown to have
the best effects. Consumer engagement
provides real-time feedback and shapes the program over time for the
better. Mental health would benefit from
a creative design makeover to improve its overall structure by focusing on
making the provider’s life and the consumer’s life better. A new concept, “consumer work flow of life”
highlights an approach to model delivery of care that is simple, relevant, and
easy to use. I am very familiar with “provider
work flow of life”, being the provider, but I had never stopped to think about
our patients’ workflow of life and what would practically make it easier and
more enjoyable to consume care. The
average doctors visit is 2 hours, someone with a chronic illness like severe mental
illness could spend up to 10 hours a week at doctors appointments.
Resident
in Public & Community Psychiatry at MGH
PGY 5
March 1, 2019
March 1, 2019
“It’s about life, not about health.
Health is simply a tool to live your
life.”
-Dr.
Charlotte Yeh (ER physician) during Value Based Reform workshop
I had the
privilege of attending the National Health Policy Conference in Washington,
D.C. in February 2019, during a pivotal time in health care reform. Sadly, what was most apparent was the lack of
mental health parties at the table along with the persistent theme that our current
mental health system will remain abysmal without reform. There is no health without mental
health. Therefore, if the social
determinants of health i.e. the conditions in which we work, live, and age, are
responsible for 90% of all health (as opposed to our actual health care system
which only attributes 10% to overall health), then all policies are health
policies, and if all policies are health policies, then all policies are mental
health policies.
Most
people in healthcare are familiar with the aforementioned social determinants
of health, but this was the first time I was introduced to the personal
determinants of health, which include resiliency and adaptation, purpose,
optimism, and social connection. These
all ultimately contribute to how consumers cope and build assets. Fostering these characteristics and targeting
them in healthcare and societal interventions is essential. Interestingly enough, studies found
loneliness to be the greatest similarity between all frequent flyers in the
emergency room. Loneliness is the
strongest predictor of dissatisfaction with our health care system.
Currently
we are in the digital health revolution and the culture of innovation has
spawned digiceuticals, defined as technology that has clinical outcome. These technologies can be used to close
health disparities as opposed to expanding them. Artificial Intelligence should not be
programmed with human biases that would maintain these health disparities. The cell phone is showing to be an amazing
platform for behavior change.
Applications have been clinically proven by the FDA to treat substance
use, attention-deficit disorder, and emotional dysregulation. These mobile interventions have no side
effects.
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