The Healthcare Conundrum

Over recent decades, healthcare has been at the forefront of the political agenda in the United States. Each of the two major parties have suggested that they have the solution to bringing down costs and improving the quality of care. Yet, they only debate the cost of healthcare delivery and never address the issue of quality. This is because we can quantify the cost of care, but we have a hodgepodge of metrics to try and determine quality.

The recipients of healthcare are the ones who are impacted daily by this quality confusion.  As the debate continues about who should pay for care, there continues to be a limited focus on the delivery of care. An article in the Wall Street Journal, in early December 2019, entitled “Treating Disease is No Substitute for Caring for the Ill”, focuses our attention on the real healthcare puzzle. The author of this article is Dr. Arthur Kleinman, a professor of medical anthropology and psychiatry at Harvard Medical School.  His expressed perspective is that “…the American healthcare system focuses overwhelmingly on curing acute problems. It needs to do far more to provide ongoing support for patients with chronic maladies.” The author is speaking with passion and compassion as both a highly skilled professional and also as the caregiver of his wife who was suffering with Alzheimer’s disease. Dr. Kleinman goes on to say, “Through my work as a psychiatrist, medical anthropologist and teacher, I was fairly familiar with the workings of our healthcare system, but not until I became one of the estimated 50 million Americans acting as a family caregiver did I understand the tragic inadequacies of America’s system of providing care for the chronically ill.” 

Dr. Kleinman continues, “The USA, in effect, has two health systems. One addresses disease [the science of what makes us sick] and the other addresses illness [the human experience of being sick]. Disease demands treatment, while illness calls out for care.” Our healthcare system has become expert in the intense treatment modalities required to treat disease, as defined by Dr. Kleinman.  In a great many situations, disease is treated as an inpatient event where all of the technology, telemetry and staff skill-sets are focused on gaining control of the disease. Yet, treatment of illness that is in the chronic state is predominantly not a hospital-based experience. The burden of care for a chronically ill patient falls to the patient’s support system, whether it be a mental or physical illness. Patients and their families are sent off with a series of “treatment plans” that are to serve as a roadmap for the ongoing care of the chronically ill. In many instances, the patients are being sent home with tubes still protruding from their bodies, due to the reimbursement formulas for specific disease states.  The lay caregiver has limited instructions on how to care for the patient. When the health insurers, principally Medicare, begin to wonder why there are so many rapid readmissions of discharge patients, the answer may be in the failure of the average person to understand that the transition from disease to illness presupposes an ongoing burden on the patient’s personal support system. 

As a patient moves from the disease to illness state, the pressure on the patient’s support system dramatically increases. In the disease state, when a patient is hospitalized, the patient’s family and internal support system have the resources of a highly skilled hospital team to rely upon. Once discharged, however, the entire external support system falls away and the burden becomes solely that of the patient and family, in many situations.

The mental stress placed on the family, particularly the caregivers, has been the forgotten byproduct of our present delivery-of-care model. This emotional stress, which can be defined as profound mental fatigue, takes a tremendous toll on the patient and the caregivers. I am sure that each of us reading this article can think of a family member or a friend who has sacrificed both physical and mental health to the care of a loved one. In the illness state, as defined by Dr. Kleinman, the process is ongoing 7-24-365.

While our elected leadership in Washington continues to debate insurance solutions in healthcare, we in the private sector are focused on how best to handle the urgency of a disease diagnosis with the ongoing pressures of chronic illnesses. The American healthcare system has been amazingly successful in turning many terminal diseases into long-term chronic illnesses. We now need to deal with the need for education, support networks and processes to manage these illnesses over long periods of time.

We at Curus have built a healthcare solutions company that personally guides our members and their caregivers through both the disease and the long-term chronic illness stages, once the disease is under control.  In the disease state, we navigate to the best alternative to deal with the acute issue. While in the illness state, we incorporate both ongoing physical care with mental health solutions, as needed.

In summary, technology diagnoses disease and Curus manages illness.  Curus is your assurance policy to make sure that everything is done correctly, safely and in a timely manner.  Curus fills in the healthcare gaps for our members through a comprehensive, flexible and personalized system of managing both the crisis (disease) and the chronic (illness) phases for our members.  The differentiator for Curus is in the “HOW”.