We predict self-care will become the new principal source of care. People living with diverse chronic conditions spend more time on self-management than with their providers. The increasing burden of chronic disease and costs coupled with value-based payments and innovative care models will generate a shift away from expensive specialized care toward high-value self-care facilitated by information technology, social support, and clinical expertise. This predicted shift in the value stream carries with it risks and uncertainties but will likely prevail as society seeks to confer “agency” by enabling people to make decisions and engage effectively in care coproduction.
The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Drs Nelson and Meyer); Harvard Business School, Cambridge, Massachusetts and The Kings Fund, London, United Kingdom (Dr Bohmer).
Correspondence: Eugene C. Nelson, DSc, MPH, Dartmouth-Hitchcock Medical Center, 35 Centerra Pkwy, Ste 300, Lebanon, NH 03766 (firstname.lastname@example.org).
The authors acknowledge the general support that has been provided by The Dartmouth Institute for Health Policy and Clinical Practice and the Dartmouth-Hitchcock Health System.
The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.