All In The Family
Mike once told Archie in All In The Family, “Hey Arch, would you stand up and cheer if it was me at the door? “Well that depends Meathead – on whether you was comin’ in or goin’ out?
Last I checked there’s a monthly premium for the “family” and 5 names are listed on that insurance card, but where in the world is the health plan? We often think about total cost of care in personal terms, but there’s a family cost. 47-year-old Jenny, a former swimmer, develops alcohol disorder in her early 20s. An assessment by a physician reveals significant childhood trauma and some more recent abuse, but also a larger family health crisis. No longer all that mobile, Jenny has hypertension, fibromyalgia, needs a walker, barely can get to the mailbox, takes Effexor for anxiety, Xanax, and a beta blocker Metoprolol. Her PCP is absent, giving her 90-day refills on these drugs, but doesn’t follow up. She’s now type II diabetic, approaching obesity, and suffers insomnia. But Jenny carries on - she tries to take care of her 80-year-old mom and her younger son Alex who is on the autism spectrum and deals with GERD and sleep issues, but she struggles with it all, obviously, entering him in a full-week ABA program. She cooks for her husband Ben but their health as a couple and as a family is waning. Ben is fatigued, himself starts drinking, and is missing work to help out with Alex and his mother-in-law. Their dog Suzie is no longer walking. So where's the health plan? Who to prioritize, and how? A medical at-home model emerges, focusing on the full spat of mom’s conditions, helps getting Jenny sober after in-home detox then moves to addressing other issues, reducing doses, treating her childhood trauma, getting mom more mobile. Alex now doesn’t spend all week in ABA and starts to play in a specialized soccer program and helps mom make supper. The medical team works with Alex and Jenny to address their insomnia and mom and dad re-engage in a healthier marriage, walking the dog and cheering for Alex at games. The plan takes 9 months. The estimated $500,000 in annual spend in prior years drops to just check ups. The story may be an extreme one but it’s more common than you may think and it illustrates what managing care for a family in crisis can look like. When building your model or raising your family, take note. Where’s the doctor? Are they in another state or building or center to the assessment and care—are they comin’ in as Archie said, or checked out—and are you capturing and trying to solve just one person’s condition, or have you thought about how you can solve the family’s?