The Colorado Health Symposium

Symposium U: America the Divided: Social Responsibility vs. Social Determinates

Heather Robinette has a BS in communications, and is pursuing a master's degree in health services administration. She has worked in several hospitals in the Denver metro area to help implement electronic health records and is an inpatient clinical documentation trainer at University of Colorado Hospital.

It doesn't take much to see that America is divided in its views regarding health care reform, health disparities and social determinates of health. It is a topic that deeply divides our nation's political parties. How do we bridge this divide and come together to begin the process of much needed change?

The first step is to understand the divide. This is exactly what Elizabeth Carger, senior manager, Public Policy and Social Marketing at Olson Zaltman Associates, set out to accomplish. Carger uses research to help clients understand how their target groups think and feel about a given topic at an unconscious level and provides recommendations on how to use this knowledge to shape communications.

Carger and her firm were commissioned to do a study for the Robert Wood Johnson Foundation to understand the deeper frames of each political group. The study involved Capitol Hill staffers on both sides of the political fence. The question at hand: How do you feel about Americans having different levels of health across populations?

The study yielded major themes in the way each party viewed health disparities. Carger describes these fundamental views as frames. Let's take a look at some of the frames that were illuminated from the results of the study.

The study found that the Democratic Party viewed health care as a system, and that the system was broken. They felt that poor levels of health emerge from an interrelated system of social, cultural, economic and biological factors. This is not the fundamental frame on the Republican side. Another Democratic view highlighted by the study is of health care as a container; in which there are barriers in place that isolate certain socioeconomic groups. Democrats also had major feelings of social imbalance and inequality in their views of health care. It is this last point of imbalance that inflames the party the most.

The study revealed that Republicans view health care not as a system but as a journey. They feel that people travel on an individual journey to health; and that poor health arises from choosing bad paths, and the inability to overcome obstacles. They feel that society as a whole is on a larger health journey through time. The major difference between the two parties is on their views of balance or imbalance. Republicans understand equality to mean an undesirable lowering of some individual's health status in order to raise others to a uniform level of health.

By understanding the divide and the fundamental values of each group; we can start to build a communication strategy to bridge the divide and communicate better across all social issues.

Symposium U: Tips for talking about health

Angie Wing is a BA candidate in scientific media design, with a minor in biology at the University of Colorado, Denver. She is passionate about psychology, medicine and design, and is interested in the connections between science and art.

How do we engage and inform people on health issues? Ann Christiano, a professor at the College of Journalism and Communications at the University of Florida, attempted to answer that question during today's plenary discussion, "The 'Me' Factor: Making Health the Default Choice."

Christiano initiated her presentation talking about how her collaboration with the previous speaker, Elizabeth Carger, made her realize that America is a deeply divided country on matters regarding health care. The two worked together on a report for the Robert Wood Johnson Foundation that examined health language that resonates across the political spectrum.

With the goal of getting others to pay attention, Christiano developed eight imperatives for conveying the right message and connecting with people:

1. Stop saying what you do and instead talk about why you do it. People in health professions too often explain the specifics of their work in great detail. What if people talked about why they are doing what they are doing? Christiano said the ensuing conversations would inspire passion and interests.

2. Be strategically empathetic with the people you are trying to engage. Remember to put yourself in your audience's shoes and find a story they can connect with.

3. Communicate in pictures. Images are great metaphors. Visuals can transform endless data into a concept or a random human case study into a person.

4. Use a full palette of emotions. Avoid projecting negative feelings and use positive ones to engage others. Humor is an excellent tool in delivering messages about serious subjects.

5. Stop hinting and tell people what you really want to do. Know enough to not put a "call this number for more information" phase on any of your communications efforts.

6. Tell stories like you mean it. Good storytelling makes new ideas possible. Personal stories turn into strong emotions, which then encourage people to seek more information.

7. Each person you communicate with is a part of a larger social circle. Facebook and Twitter are true visual representations of this phenomenon.

8. Don't worry if your audience isn't as passionate about your issue as you are. There are always people with a variety of interests and passions, just focus on clear communication.

Finally, as a "free bonus tip," Christiano urged health professionals to "share their privilege." We are here because we are focused on change, believing and not giving up. Inspire others to do the same.

Symposium U: "I'm tired of paying for everyone else's stupidity"

Cortney Babica has a BS in biology with minors in astrophysics and chemistry, and plans to apply for medical school in the fall. She works as a radiology assistant at Swedish Medical Center, and is training to become a patient care technician in the Progressive Care Unit.

The theme of this year's symposium, "bridging the divide" has been energetically and positively referenced throughout each presentation, with a warm regard for embracing our disparities and taking steps in the right direction toward health equity. By recognizing, respecting and celebrating our differences, we become closer to achieving a common goal encircled around affordable, accessible and quality health care for all. But when I fired up my computer and glanced at Dr. Sandeep Jauhar's first PowerPoint slide, I did a double take and noted his choice of title: "I'm Tired of Paying for Everyone Else's Stupidity."

Jauhar, a cardiologist and author of "Intern: A Doctor's Initiation," went on to explain his title as a common reaction that a lot of Americans displayed after the health care reform bill was passed in 2010. Why should we have to pay higher taxes and insurance premiums for people that bring their health problems upon themselves through unhealthy habits? Most Americans, Jauhar continued, who emphasize personal responsibility, have questioned this notion of "picking up the tab" for others' health problems because most believe that people should take the reins in maintaining their own health.

These bad habits are contributing to poor overall health, and Jauhar hit upon the examples of smoking, which costs the American economy $200 billion per year, and obesity, which averages 300,000 deaths per year.

So how do we attack this problem of poor lifestyle choice and unhealthy behavior in terms of health insurance? The majority of Americans, Jauhar says, believe that those with unhealthy habits should be punished in the form of increased premiums or reduced benefits. But Jauhar refuted this strategy, providing examples in which many concluded to be discriminatory behavior: lifestyle choices can be explained for a plethora of illnesses. Also, Jauhar brought up the idea that if people are not required to pay for the consequences of their actions, they are found to be more likely to engage in risky behavior. Jauhar explained this notion with an illustrative example of gorging at a cheap smorgasbord, which we can all relate to...

At any rate, the take home message Jauhar was getting to was this – we need a different insurance model. Traditional insurance has the capacity to create a moral hazard. If given the opportunity, people will spend more and demand more health care, when it is free.

Should we "pick up the tab" for the uninsured or those who may be abusing their health by partaking in unhealthy habits? Where does one draw the line for when personal responsibility kicks into play and when the context of people's lives – their socioeconomic status, gender, education, genetics etc... explains their health disparities?

Symposium U: A Design for Behavior Change — Small x Many = Big

Ellie Allan is pursuing a doctorate of physical therapy at Regis University. She lives in Frisco, CO and is interested in global health care systems and the role of personal responsibility in healthy choices and preventable disease.

"'Health' is an invitation without a party," said Chris Waugh, director and co-founder of the Food & Beverage practice for the design firm IDEO. And I'm thinking, "What?!?!?!" I thought health was the party. I run in circles for fun. I eat quinoa and drink chia seeds with a smile." But in a time when 22 percent of Coloradans are obese, achieving health clearly isn't a party for everyone.

As a budding physical therapist, I thought that everyone wanted to be healthy just to be healthy. I learned today, however, that engaging individuals and challenging them to embrace the constraints in their environment will facilitate a better outcome than telling them that exercise is "good" and expecting them to change.

When Keystone's staff offered to help participants meet the pedometer challenge goal of walking a collective 1.2 million steps throughout the conference, Waugh said they set a good example of being creative within limitations. During a busy three days of prepping and serving, staff members aren't going to have time to take a lunch break and go for a run. However, they can wear pedometers and challenge each other to take more steps during their shift. As a group, Symposium participants and Keystone staff ended up walking 2.6 million steps in two days. That's a lot of steps.

Its small accomplishments like these that can change behaviors and empower individuals to take ownership of their health. Health care providers and policymakers often think that we can impact the health of others with facts and statistics – but extrinsic motivation only achieves so much. People who develop their own form of intrinsic motivation towards eating healthy and exercise are the ones who can really celebrate.

Symposium U: Wes Moore's empathy factor

Christine Tagliaferri Rael is a PhD candidate in health and behavioral science at the University of Colorado, Denver. She is interested in exploring ways to expand affordable care to low-income and hard to reach individuals living in rural Colorado. She teaches HIV/AIDS, hepatitis C and STI prevention classes to incarcerated Colorado adults, as well as helping to provide free testing, and raising community awareness.

Public health research is steadily transitioning toward a mixed-methods model. Though the connection between empirical research and Wes Moore's presentation highlighting the importance of education, expectations and advocacy for at-risk youth does not appear to have a direct correlation, it provides a concrete example of how the larger field of health can benefit from qualitative methods. Moore talked extensively about interpreting information in two important ways: First, through contextualization and second, through the reduction of "otherization." In the following paragraphs, I will talk about how these points can be understood in ways that are meaningful for the larger population's health.

Moore discussed the importance of placing individual life experiences within a context that is relatable to a wider audience. This idea implies that a greater emphasis should be given to collecting qualitative data within the health care setting. For instance, providers could ask consumers open-ended questions about the non-clinical aspects of their lives to help frame individual health decision-making. Having access to a more holistic patient profile allows providers to identify their patients' strengths and weaknesses to help them better address challenges and barriers to behavior change.

Secondly, Moore identified "othering" as an important tool for advancing collective health. Specifically, othering means to explicitly examine our interconnectedness with people who appear to be drastically different from ourselves. Understanding our similarities, fosters empathy on the part of both providers and non-clinical individuals, leading to better care. We can gather information about these similarities by engaging qualitative methods such as focus groups, interviews and participant observation. With this knowledge, we can develop appropriate interventions to more effectively improve empathy in health care and community settings.

The engagement of the mixed-methods approach in a research context allows for improvement in care on both broad and deep levels. Moore effectively showed how we can facilitate this in a way that is engaging, thought-provoking and tangible. Emerging public health literature corroborates his assertions: Increased consumer satisfaction with patient-provider interactions leads to better treatment adherence among a litany of other positive outcomes. In closing, I felt Moore's presentation highlighted the importance of using a variety of research techniques, as well as tapping into the knowledge of cross-disciplinary professionals to address the complex issues in our changing health care system.

Symposium Today: July 27, 2012

Editor's note: Throughout the Colorado Health Symposium, July 25-27, we provided a daily summary of news and insights through the Symposium Today blog posting.

Quote of the day:

"The fact that it's easier for a child to get a gun than health care is a fundamental problem." — Wes Moore, author of "The Other Wes Moore"

Moore energizes Symposium crowd
"You can't have an honest conversation about [national] debts and deficits unless you can have a conversation about health issues," said Wes Moore, author of the best-seller, "The Other Wes Moore" and Friday's keynote speaker. Moore's book examines many questions about personal responsibility, accountability, circumstance and choice, recurring themes of the 2012 Colorado Health Symposium. During the keynote, Moore eloquently correlated his experience with the challenges in health and health care discussed throughout the three-day conference. His remarks earned a standing ovation from the audience of about 400 people.

After spending his childhood years in a drug-ridden Baltimore neighborhood, Moore's family moved to the South Bronx shortly after his father's death. Following a brush with the law, his mother enrolled him in a military academy. Later, he became a college football Hall of Famer, Rhodes Scholar, decorated Army combat veteran and business leader. Meanwhile, another Wes Moore, who grew up in the same part of town under similar circumstances, ended up a convicted felon serving a life sentence for murder.

Intrigued by their divergent paths, Moore wrote his imprisoned counterpart a note. A month later, he received a response. "The letter I received was one of the most interesting and articulate letters I've ever received and it raised more questions ... The more I learned about this tragedy, the more I realized we had a lot of similarities and not just the same names," he said. Moore explored their differing outcomes in his novel which resonated with readers and led to a number of televised profiles.

Among the many points he made regarding health, Moore challenged the assertion that environment determines one's eventual success or failure in life. "We're not products of our environments, I think we're products of our expectations ... The expectations others have of you will eventually become the expectations you have for yourselves," he said. "If we look at a kid and the community they're from and say they're probably not going to make it, then kids have a funny way of making that happen, because we are a nation of self-fulfilling prophecies."

Regarding health, he maintained that communities need to hold themselves to higher expectations as well. "We can't have neighborhoods where it's acceptable to have a McDonalds as the only food outlet." Other issues Moore addressed included guns as a public health issue in light of the Aurora movie theater massacre. "The fact that it's easier for a child to get a gun than health care is a fundamental problem," he said. "This country has to better address gun laws ... I'm not talking about banning guns, but we need to be more careful about who can get weapons."

Health and the "me factor"
Dovetailing nicely with Wes Moore's rousing keynote, Friday's plenary discussion focused on personal responsibility and health. Moderated by Elizabeth Carger, a market researcher with Olson Zaltman Associates, the discussion dwelled on how to engage reluctant masses and those with opposing views on health and health care.

With "bridging the divides" a recurrent theme throughout the 2012 Symposium, Carger talked about the political divides impeding health policy. Carger was a project researcher of "A New Way to Talk About the Social Determinants of Health." Produced for the Robert Wood Johnson Foundation, the study shares how to develop more compelling, effective and persuasive messages that resonate across the political spectrum.

"Democrats believe the system is broken and that any one factor is not going to fix it," she said. On the other hand, Republicans tend to believe that "poor health comes from choosing bad paths and the inability to overcome obstacles." In short, Democrats believe the imbalance in health is unjust while Republicans believe that as long as there are differences in income there will be differences in health. Democrats believe equality should be the goal, while Republicans believe equality is an unrealistic and unfair goal. Democrats want to level the playing field, while Republicans would like to raise the playing field. "You have to sell your message to Republicans," Carger said. "In order to do that, it's critical to scrub the word 'equity' out of your language." A glossary of other terms to avoid is included in the study.

Ann E. Christiano, a professor of public-interest communications who also worked on the aforementioned study, offered eight tips for getting people to pay attention and make health a priority. They are: 1) Stop saying what you do. Focus on why you do it. 2) Become strategically empathetic. 3) Communicate in pictures. 4) Use the full palette of emotion. 5) Stop hinting. Tell people what you want them to do. 6) Tell stories like you mean it. 7) Remember that each person you communicate with is part of a larger social network. 8) Don't worry about whether your audience is as passionate about your issue as you are. Demanding moral conviction from everyone in your audience can be limiting. As a bonus tip, Christiano advised those in the conference room to "share their privilege." "You believe the issues you are taking on are surmountable," she said. "Understanding that change is possible can be the first and biggest step for everyone."

Sandeep Jauhar, MD, PhD, gave the Symposium audience some insights on attitudes about how personal responsibility (or lack thereof) drives up insurance premiums when people smoke, drink in excess or become obese. In doing so, he examined the statement, "I'm tired of paying for somebody else's stupidity," and why it resonates with so many Americans. "Americans don't want to pick up the tab for other people's personal habits," said Jauhar, author of the book, "Intern: A Doctor's Initiation." "We believe in personal responsibility." He noted that the call for "personal responsibility" in managing health transcends political lines. "We need to make people responsible in their own health, otherwise we increase risks," Jauhar said. He pointed out that smoking costs the American health care system $200 billion a year and obesity will soon become the No. 1 cause of death with 300,000 American deaths annually. Jauhar also highlighted some notable findings regarding personal responsibility and insurance coverage. Among them: A health insurance experiment from RAND Corp. that showed people spend more on health care when they have no-deductible health insurance policies. "When health care is perceived as free, patients will generally use more of it," he said. In West Virginia, an experiment reduced Medicaid benefits for recipients who didn't participate in a wellness program. Jauhar regarded that experiment as a "failure" since only 15 percent of the recipients took part and the program did not deter non-healthy behavior. What the program did not take into account were "real life barriers" to compliance such as lack of transportation or child care.

Concluding the discussion, Chris Waugh, director and co-founder of IDEO's Food & Beverage practice, talked about how to make health more interesting and engaging. Waugh works with businesses to design innovative approaches to move conversation to action. Much of the time, that can be done by taking the word "health" out of the equation. He offered an example of worksite cooking classes hosted by IDEO. "If you start by saying you should learn to cook healthy food because it's good for you, that's a terrible invitation," he said. "'Health' is an invitation without a party." On the other hand, an employer that offers free cooking classes that emphasize that cooking makes one attractive to romantic prospects gets more participation and better results. As for making health a bigger priority among kids, Waugh suggested reframing physical activity as play over exercise. "We have to make exercise more functional," he said, noting that "walkability" is becoming a more important factor in real estate purchases than square footage.

Biographies of today's plenary speakers at the Colorado Health Symposium are available online.

Symposium odds and ends
Friday's session closed with a bang as Anne Warhover, president and CEO of the Colorado Health Foundation announced that the Colorado Health Insurance Cooperative Inc. (CO-OP) will receive a $69 million loan from the U.S. Department of Health and Human Services to begin work on a statewide nonprofit health insurance CO-OP. Read more about it in this news release ... The Symposium's first pedometer challenge was a rousing success. Provided with a pedometer upon arrival, Symposium attendees worked collectively toward the challenge of taking 1.2 million steps (representing the number of Coloradan children). Warhover threw participants a curve ball when she doubled the goal on the second day. With help from Keystone's banquet staff, participants surpassed the goal, closing the event with 2.6 million steps. For meeting the goal, the Foundation will donate $25,000 to Feeding Colorado, an association of five Feeding America food banks.

Catch up with the Symposium online
For those who missed some or the entire Symposium, plenary sessions (and Wednesday's interactive debate) are available via Ustream.

You also can keep up through other social media channels including blogs, and frequent postings on Facebook and Twitter. Look out for announcements on our Health Symposium Twitter stream using the #12CHS hashtag.

Next up: The 2013 Colorado Health Symposium
Mark your calendars for the 2013 Colorado Health Symposium, Aug. 7-9, 2013 in Keystone, Colo. See you there!

Symposium U: Where is the sense of community in modern-day America?

Kari Thomasgard has been a critical care nurse at Denver Health for over 5 years and is pursuing an MS in Family Practice at Regis University. She is passionate about working with underserved and disadvantaged populations, and hopes to provide more preventative and holistic care.

Bright-eyed and bushy -tailed, Len Nichols, PhD, better known as "The Preacher," opened up the Symposium's second day with some extremely thought-provoking questions.

Nichols, who is director for Health Policy Research and Ethics at George Mason University, focused on health disparities based on geographic location. He asked the audience, "Why don't we love our neighbors as ourselves? Why are there such disparities in health based on where one lives?"

Nichols reminded listeners that there is really nothing to laugh about when it comes to such disparities, because they're not fair. It's not fair that some people get a head start and never look back to lend a hand. Health disparities are PREVENTABLE differences in the burden of disease. America may have come a long way in regards to some things such as the abolishment of slavery and equal rights for women, but we have lost track of what really matters – each other.

Being an eternal optimist, I force myself to always look on the bright side. Nichols states, "Bad behavior is based on fear." I agree. Ideally, all human beings are good, right? People don't want to kill, steal, cheat, lie, abandon, etc., because it doesn't feel good. People make bad or evil decisions because they are scared. The reality of the pursuit of happiness in America is so grim because we are all out for ourselves. Isn't one of the first lessons in childhood learning to share? Plus, on a simple level, lending a hand feels good.

Finally, as I soaked up all of the knowledge and insight Nichols offered, I asked myself, "If we all took care of one another, what would happen to those disparities?" Maybe we should give it a shot. 

Discovery Session – The Colorado Health Benefit Exchange: A roadmap to accessible and affordable coverage

Laura Gerard is a program officer for Health Coverage at the Colorado Health Foundation.

This session on the Colorado Health Benefit Exchange (COHBE) provided an overview of progress on Exchange implementation and explored different perspectives on how the Exchange can and should work to increase access to adequate and affordable health coverage for Coloradans.

Session facilitator Dr. Len Nichols, director of George Mason University's Center for Health Policy Research and Ethics, introduced the panel with contextual remarks on how Colorado compares with the rest of the country. By passing legislation (Senate Bill 200 signed into law July 2011), Colorado is out front in creating a state exchange.

Patty Fontneau, executive director of the COHBE, explained that a health benefit exchange is a place where individuals and small employers can go to get insurance. Technically it is a marketplace. You can shop and compare plans that have the same benefits. The Exchange will be like Travelocity, Expedia or Amazon but will have health insurance as the product instead of flights or books. The Exchange goal is to increase access and affordability of choice while focusing on the unique needs of our state. COHBE is governed by a board as well as a legislative review committee. Currently, they are working to build a service and technology platform and will start testing early next year. They are also in the process of developing a series of policies that are discussed at board meetings. Coverage will begin in 2014. Go to www.getcoveredco.org to get involved as COHBE welcomes all input.

Dede de Percin, executive director of the Colorado Consumer Health Initiative, explained how her organization works to bring a united consumer voice to health insurance decisions made in Colorado. The goal of the Affordable Care Act (ACA) is to make sure everyone can get care they need when they need it, and the Exchange is a key component. It is also an incredibly complicated mechanism. Many factors need to be considered such as income, Medicaid eligibility and individual affordability. It's essential that communities of color are involved in COHBE development as there will be a disproportionate number of minorities enrolling in COHBE.

Dr. Steve DelCastillo, president of the Multicultural Leadership Center, works on behalf of Latinos to improve health. He demonstrated the complexities of health disparities with a slide that simply read "once" and said there are two ways to read it (Spanish and English). Once means "11" in Spanish and "once" in English. What if this word was written on a prescription? Dr. DelCastillo explained how obesity and diabetes are growing problems in the Latino community. Access to diabetes screening is a health access issue facing the Latino community as many Latinos are undiagnosed. The Exchange will greatly impact Latinos as the 2011 Colorado Health Access Survey (CHAS) finds that the Latino population makes up 13% of the uninsured pool.

Steve ErkenBrack, president and CEO of Rocky Mountain Health Plans, brings three different perspectives to the Exchange – he was a member of the 208 Commission, he brings a health plan viewpoint and he is from Grand Junction, a community where care coordination has really evolved. ErkenBrack said that until you have a system of coverage, you can't address cost. We need to expand coverage, lower cost AND make it appealing to consumers.

To end on a great comment from Mr. ErkenBrack – the Exchange is not this year's Patronus (you may need to be a Harry Potter fan to know what this is) but is the right approach to affordable and accessible care for all Coloradoans.

Symposium U: Symbols of hope for health

Hannah Newman has a BS in psychology and is pursuing a master’s degree in public health in environmental and occupational health at the Colorado School of Public Health. Her experience working as a crisis and suicide counselor in her home state of Louisiana inspired her to study public health and work to improve quality and access to health care.

Dr. Michael O. Minor is best known as the Mississippi Delta preacher who banned fried chicken in his church. Believe it or not, that's not even his most amazing accomplishment. Minor is a faith-based health and wellness advocate who reaches communities at the local, regional and national level. He currently serves as the national director of the Health and Human Services Partnership with the National Baptist Convention, and has collaborated with First Lady Michelle Obama in her Let's Move! campaign.

Minor suggests the answer to America's problems isn't found in Washington, D.C., but in communities themselves. This is the reason places of worship are so important – they serve as strong symbols of hope and change in the community.

This was not the only reference to symbolism. He alluded to the holy trinity of wellness. An emphasis needs to be placed on the holistic view of health, paying equal attention to the mind, body and soul. Often times, we fixate on treating the body and ignore the other two equally important aspects.

Minor suggests that improvement begins with making ourselves whole, so that we can then form partnerships and help others. After listening to his inspiring talk, it is clear that his church has played an important role in facilitating this process. It has moved beyond traditional boundaries, providing resources for the entire community and reaching members of the congregation all the time, not just on Sundays.

I had the pleasure of speaking with Minor after his presentation, and he told me the most important take-home message for my readers: Hope is the driving factor within a person who strives for improvement. If we have hope, the other aspects of our lives will begin to fall together because it gives us a desire to get better. If we have a reliance on a higher power, that hope will live within us.

It's also important to remember that change does not happen overnight; it's the incremental steps we take each day that lead to change. This message could not be more important to a fast-paced society that is accustomed to immediate gratification.

Discovery Session: Why the next generation of health professionals will move in packs

Lauren Cook is senior director of social media and digital strategy at GroundFloor Media, a Denver-based communications agency. In her role, she advises clients across all industries on a variety online campaigns and strategies including online brand perception and promotion, social media crisis, digital technologies, and influencer relations.

It's been proven that teams can solve complex problems much better than individuals can. There's examples of team success everywhere – just take a look at beehives, flocks of birds and schools of fish. While it took some time, the health care industry is slowly learning what nature has known all along – that thinking in groups is clearly more effective, efficient and successful.

This was the topic at this afternoon's panel, "The Workforce Future Is Now: Team-Based Care," where the audience and session participants held an interactive discussion on the opportunities and challenges with team-based primary care.

Facilitator Mark Earnest explained how primary care can historically be likened to the lone wolf concept with the provider working in a silo, absent of collaboration. But the industry is evolving and embracing collective intelligence as a vehicle to offer integrative health care in which the patient is a critical part of the team.

Now in clinics in rural towns like Lamar, Colorado and larger cities in California, teams of patient advocates, nurses, physicians, behaviorists and so on are forming multi-discipline teams that treat and diagnose patients in a less hierarchical and more synergistic model. Panelists Liliana Garcia, Colleen Ihnken and Jason Williams all described their experiences working in a care team model, sharing story after story of successful case studies where efficiently functioning teams were able to provide better, more affordable care – often to patients who didn't even have health insurance.

The session was best exemplified by the story of a teenage girl who walked into an integrative clinic to get her teeth cleaned. During her initial screening process, it was uncovered that the young woman was having suicidal tendencies because of problems at home with her mother. Through the team-based model, the young woman left the clinic with a better understanding of how to communicate with her family through strategies she learned through the clinic behaviorist. She also left with clean teeth and a longer-term plan for her mental health.

The team-based care model is now being taught to students across the country, but the next challenge is teaching these grads to go out into a world where this collaborative model might not pre-exist. As an audience member shared before the session ended, "Doctors got all the way to medical school because they didn't work in teams. We need to teach them to work and communicate too." Clearly, the work has just begun.

Have you experienced team-based health care? What do you see are the challenges with this model?