Perspective:

Health care financing in the United States supports a reactive, encounter-based model in which patients are seen when they become ill, typically during hospitalizations and at outpatient visits. That care model falls short not just because it is expensive and often fails to proactively improve health, but also because so much of health is explained by individual behaviors. Our patients spend 5,000 waking hours each year engaged in other things, including deciding whether to take medications or follow other medical advice, and increasing attention is now being paid to those 5,000 hours. Three recent developments suggest that automated hovering may offer promise. First are initial efforts at payment mechanisms that support more accountability for health outcomes including nonreimbursement for preventable readmissions and bundling of payments around the goals of care rather than encounters. The second development is deeper understanding of behavioral economics and the reality that although most people want better health, the desires, distractions, and urgencies of the moment often get in the way of pursuing what’s in their own long-term self-interest. The third development is the expanded reach of both sophisticated and simple technologies (i.e., cell phones, wireless devices, and the Internet) that can help health experts connect to people during their everyday lives. There are both clinical and research opportunities in pursuing an approach for hovering that is just as rigorous as our approach to other areas of medicine. However, careful iterative testing is essential because these new forms of patient engagement, whatever shape they take, will be central to improving population health in the future.