by Mike Critelli, 

Last year, Dr. Gary Welch and Colleen McGuire of Silver Fern Healthcare joined our MakeUsWell Network. Their tag line is “Human Understanding Unlocked.” Their business is focused on addressing a fundamental issue we must address if we are to have viable healthcare and health insurance systems and to have global competitiveness across a variety of fronts.

The United States throws more money at health and healthcare than any other nation in the world, and achieves horrible outcomes. We have the same pathology in our public education system as well, but this blog will just focus on the issue of health improvement.

When I was growing up, the way we thought about health was that we “got sick” through no fault of our own, either because of an infectious disease like pneumonia or a gastrointestinal condition from eating contaminated food. One of my grandmothers had diabetes and had one leg amputated below the knee, but I did not understand what caused it. At the time, we thought about diseases and illnesses as conditions that happened to us and over which we had little or no control. 

There were exceptions. We knew about alcoholism, drug addiction, and lung diseases from excessive smoking. I had uncles, aunts and cousins who had alcohol dependency or died of lung cancer. But we did not focus on obesity or the metabolic disorders to which it contributed. Hypertension, coronary artery disease, Type 2 diabetes, and cancers of our gastro-intestinal tract were not as common as they are today.

For a few decades, we thought that the answer to all these problems was education and better healthcare. If we developed a drug to treat a condition, people would take it and would be cured, especially if they understood what had made them unhealthy. If we described the treatment plan and educated patients, they would adhere and bring their condition under control.

But we learned that it did not work that way. Some people adhered to chronic disease treatment programs, but most did not. At Pitney Bowes, we believed that making chronic disease medications free of charge and delivering them directly to the homes and workplaces of our employees would dramatically increase adherence to what physicians directed them to do. 

We were wrong. Free chronic disease medications increased adherence by 3-4% and produced a compelling return on investment, as noted in a Harvard Medical School study published in 2007. This CDC article on the broader subject of medication adherence refers to that study.

But it forces us to come to grips with what gets in the way of patients doing what is best for their health, other than cost barriers. As the above-cited article notes, many factors unrelated to patient understanding or healthcare costs interfere with medication adherence and effective chronic disease management.

The question becomes: how does an individual clinician or payer of healthcare determine what is getting in the way in an individual case and execute a plan to overcome the obstacles? Dr. Welch and Ms. McGuire formed a business to use both artificial and human intelligence to provide a cost-effective solution to this problem. What is startling is that, to date, a surprising number of healthcare providers and payers have not had the curiosity or the motivation to try to solve the problem.

Medication non-adherence alone costs between $100 and $300 billion for which all of us pay in higher healthcare premiums and co-pays, according to multiple studies cited in this article from Magellan Health Insights.

If we add the cost of non-adherence to other aspects of chronic disease treatment plans, the cost exceeds $500 billion, not counting lost productivity and global competitiveness. 

On a personal level, I know individuals who seem hellbent on engaging in self-destructive behaviors because they are in denial about the consequences of their actions and are frightened to think about their mortality. Others use terms like “comfort foods” to describe what they ingest when seeking solace, as if the label will change the destructive consequences of eating unhealthy foods.

Dr. Welch and Colleen McGuire’s work is vital. By addressing these behavioral and systemic barriers, they can help Americans reduce the cost burden of healthcare premiums and improve overall health. They need support from all of us.