Capturing Lightning in a Bottle

A stubbornly persistent problem in our modern era has centered on the dichotomy between our increasing standard of living: wealth, comfort, technology, culture, leisure, etc. and our decreasing quality of life as measured in overall health and well-being. Headline after headline seems to affirm the struggle as we battle obesity, smoking, opioid addiction, depression, and myriad other well-being struggles even as we watch our healthcare economy balloon to staggering heights – now estimated at over $4 trillion. How is it possible that our lifespans are decreasing at the same time we are pouring such an astronomical amount of money into the black hole we call “healthcare’? We could spend hours picking at the knot described above and come no closer to loosening it. If we’re honest with ourselves, we’ve been watching it come upon us like a slow-moving train wreck inching along over decades. And that’s the problem with slow-moving train wrecks, we always think we’ve got time until it’s too late. How do you slow a $4 trillion juggernaut made up of over 300 million people? One person at a time. Of course, investors, politicians, insurance companies, big corporates, social movements, lobbyists, and most of the rest of us don’t want to hear that. What use is it to move such an ocean of issues one drop at a time? Progress we can’t see doesn’t count, right? Small movements seem ineffective. Little successes don’t appear to add up. We’ve tipped too far. Our sense is that we’ll only “fix” it with big sweeping movements: legislation, consolidation, blowing it up. We want big, top-down, levers we can pull to make it all right. But it was one drop at a time that got us here in the first place. One person. One choice. One problem. One condition. One situation. One law. The knot we’ve created was drawn, weaved, twisted, and re-twisted, over a very…long…period…of…time. But this post isn’t really about problems in the broad sweep of our healthcare system. Last week, we received data summarizing a six month period of time for a group of employees from a single employer who were enrolled in a program centered on helping them manage their diabetes. Overall medical costs for this group of people decreased 42% over the prior year – a number nearing $1 million for this employer’s health plan. But this post really isn’t about the analytics of a health plan. Most of the individuals in the group described above are like you and I. They work. They have families. They struggle. Their lives reflect choices they’ve made as well as the random events that come upon us through the course of living. They exist in various places along the long continuum we call “health.” They get tired. They make decisions based on limited resources. They wade through degrees of correct and incorrect information – correct and incorrect assumptions and understandings. The fact is that many of these patients got where they are slowly, over time, in many, many, small ways. Some ways chosen, others not. Some ways understood, others not. The trick for any of us when we find ourselves stuck in a particular place is finding, and believing in, a pathway out. If not a pathway out, how about a pathway to better? If not a pathway, how about just the next step? The thing about knots is that they often take time and persistence to unravel. Sitting with a friend earlier this week, I told him of our programs and the progress we’re seeing. “You’ve got lightning in a bottle,” he replied. That expression is meant to convey a sense of doing something extraordinarily difficult, if not impossible. It suggests the capture of something magical and powerful in a way that it might be harnessed and reused.