On Our Terms: Empowering the New Health Consumer is written by corporate CEO Glen Tullman. His theorizes that we are moving into an era of health consumers, rather than patients. Considering patient comes from the Latin word meaning suffering, I’m willing to give up that aspect! However, I’m not sure about the ways On Our Terms discusses this shift.
Tullman also says that the new health consumer should now receive “people who’ve experienced what you have, have done this” suggestions à la Amazon. He takes several consumer concepts and tries to tie them to better health care for people living with chronic conditions.
For example, the new health care should work like OnStar (availability during crisis), Waze (community supplied information), Uptake (constant equipment monitoring), Amazon (product recommendations), and Lyft (increased convenience). How exactly we patients (oh, I mean consumers) are going to be monitored this closely is not discussed in detail. Nor are the privacy aspects of this supposition.
Focus on corporate costs
What is discussed in detail is the tremendous cost of treating chronic conditions, especially to companies who self-insure. Self-insurance means that the corporation pays all the health care costs of their employees (or members of the plan), in exchange for premiums, co-pays, deductibles, and co-insurance.
Sound expensive? Yes, it is, but it’s not necessarily more costly than working through a traditional insurance company. And when a company is self-insured, they often work extra hard to motivate their employees to stay as healthy as possible. Because it saves them money, and improves quality of life for employees.
This is where Tullman and his company Livongo come in. They have developed a method to monitor and assist people living with diabetes. In On Our Terms, Tullman discusses how a few different self-insured companies are using this type of service, among others, to help employees. Because it’s worked well so far, the theory is that it can be expanded to patients / consumers with many types of chronic conditions.
Be prepared. This book reads like a corporate white paper, which companies use to pitch a new product in exchange for your email address. Or more accurately, a white paper stretched to 160+ pages, using extensive repetition. The writing style is fairly dry, and full of corporate-speak. It’s not really directed at patients / consumers.
I didn’t finish this book feeling empowered. I felt talked down to, and not able to support Tullman’s thesis. But if you’re a corporate benefits manager, you might find it helpful and even exciting.
I wish the author had included more real-life stories of patients who’ve benefited from this approach. By only included one, his own son, the book never leaves the theoretical for concrete and everyday examples.
Ultimately, our health care system is about patient care. Certainly it is a broken system here in the United States. But I can’t support this solution or this book.
If you’re looking for a solid, journalistic, well-researched book on this topic, I suggest An American Sickness.
I received an Advance Reader’s Copy of this book from the publisher in exchange for this honest review. I wrote every word myself, despite the publisher sending me “useful verbiage.”
Side note, or my perspective as a patient living with several chronic conditions
I am concerned about the approach and methodology suggested in this book. Additionally, it overgeneralizes and oversimplifies, promising solutions for every chronic condition. This is all kinds of ridiculous. No one chronic condition is like another. And certainly every patient experiences their particular constellation of conditions differently.
The book is condescending towards patients, the people it purports to help. Or perhaps its first priority is the corporate benefits managers, and other people focused on cost-savings. Patients care about costs also, but still put their health first as much as possible.
Consistent monitoring, including data sharing can certainly be valuable. I already share Apple Watch data with my husband, and input migraine tracking data in an app. Sometimes I even use Facebook to check in at a location. However, I think the most effective way for this to work is with devices, especially those implanted like insulin-related monitors or pacemakers. How do we implant devices for people with seizure disorders or osteoarthritis? Where does that fall in the realm of medical ethics?
The author’s best example of how health care should change is the airlines. In the past, booking a flight meant calling travel agents or the airline. There was no other way to book a trip. Now everyone can plan their own airline travel because the flight data is made publicly available.
You had me until “publicly available.” Tullman espouses using a method that trades privacy of health data for real-time, context-aware responses from health professionals in a remote (think tele-health) setting. That’s a deal-breaker for lots of patients.
Not focused on patients
Speaking of patients, let’s talk about the most troubling generalization in the book. Tullman paints patients as non-compliant, nincompoops whose lifestyle choices are the only reason they have costly chronic conditions. He couldn’t be more wrong. The patients I know who live with chronic conditions are some of the most body-aware, self-educated, compliant, and committed folks.
Take me, for example. I was diagnosed with a life-long condition in 2007. It’s a uncommon one that medical professionals don’t have much information about, including why it picked me. We manage my symptoms, but there’s no way to predict them.
A few years later I was diagnosed with rheumatoid arthritis, another disease that isn’t a result of lifestyle choices. Thankfully, it’s a common condition with plenty of available information for clinicians and patients. It took me about a year to get a solid handle on how to manage it, and that strategy has worked in the long term.
Last year I had major surgery to correct a congenital anomaly causing me to suffer with near-constant migraines. Costly, yes. But I’ve had fantastic improvement in quality of life! Oddly enough, I’m anticipating another surgery this year. I’d receive an implanted device to manage another situation. I might indeed have data to deliver in real-time someday.
My top priority is working with caring and knowledgeable professionals. I gather the best possible data for them, and for myself. We collaborate on testing choices that also deliver information needed for decisions. Sometimes it’s a hit-or-miss situation, but I always feel engaged in the process and empowered to strive for the best solutions.
The emotional impact
This doesn’t mean it’s all sunshine and rainbows. It’s been a very hard process. Which brings me to my last comment on Tullman’s book. Living with chronic health problems is difficult emotionally. Studies show this is a typical patient experience.
Early on in the book, Tullman mentions depression as a costly chronic condition. He puts it on par with the costs of diabetes and heart disease. I couldn’t find any data to support this equivalence. I also didn’t see Tullman offering substantive solutions for people living with depression or other types of mental illness. The author doesn’t treat the diseases with sensitivity or depth of understanding. I found this especially troubling.
My conclusions, part two
Here I am on my soapbox again, I was truly hopeful that On Our Terms would offer me and other patients with chronic conditions a better solution. But translating consumer methodologies to health care is a cognitive disconnect for me. I don’t want more intrusion. I want more care, time, and cost-effectiveness. Sadly, it’s not contained in this corporation-driven perspective.