George Halvorson’s Perfect Health Care Plan
George C. Halvorson is chairman and chief executive officer of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, headquartered in Oakland, California. Kaiser Permanente is the nation’s largest nonprofit health plan and hospital system, serving more than 8.6 million members and generating $40 billion in annual revenue.
George Halvorson serves on the Institute of Medicine Task Force on Evidence Based Care and the Commonwealth Commission for a High Performing Health System. He serves on the American Hospital Association’s Advisory Committee on Health Care Reform. He chairs the World Economic Conference Health Governors for 2009 and chairs the International Federation of Health Plans. He has received the Modern Healthcare/Health Information and Management Systems Society CEO IT Achievement Award. The Workgroup for Electronic Data Interchange also awarded him the 2009 Louis Sullivan Award for leadership and achievements in advancing health care quality.
Halvorson has written several health care reform books, including the newly released Health Care Will Not Reform Itself: A User’s Guide to Refocusing and Reforming American Health Care. He also wrote Health Care Reform Now!, Health Care Co-ops in Uganda, Strong Medicine, and Epidemic of Care as guidebooks for health care reform.
Halvorson served as an advisor to the governments of Uganda, Great Britain, Jamaica, and Russia on issues of health policy and financing. His strong commitment to diversity and inter-ethnic healing has led him to his current writing project, a new book about racial prejudice around the world.
Prior to joining Kaiser Permanente, Halvorson was president and chief executive officer of HealthPartners, headquartered in Minneapolis. With more than 30 years of health care management experience, he has also held several senior management positions with Blue Cross and Blue Shield of Minnesota.
Question: What are the elements of a perfect system?
George Halvorson: A perfect system is patient-focused. It's not built around the caregivers, it's not built around opportunities, it's not built around revenue streams, it's built around the patients. The perfect system focuses on the patient. And the perfect system has all of the information about each patient so that knowledgeable caregivers working with the patient can figure out the optimal care pattern for that patient is. And if you're a healthy person and pre-diabetic, the right plan for you is to avoid diabetes. If you have diabetes and you've got co-morbidity, the right plan for you is a plan that links your caregivers and manages the complications. And everybody has different perfect outcome, everybody should have care plan. Everyone should have somebody working with them, a care team, a support team working with them to optimize their care. The perfect system can do that.
In an imperfect system, patients stumble into the Emergency Room, that’s unconnected to anything else they do, they get care for their asthma in one place and get care for their kidney failure in another place-- completed unrelated care. An imperfect system is built around the individual provider business sites and not around care. The perfect system has a data flow, has information going to the patients, has patients able to make informed choices. So, when you’ve got one hospital that has a death rate for heart disease of three or four times the next hospital over, patients should know that. There should be an informed set of choices for patients. There are huge differences in oncology outcomes. If you have stage 3 cancer, you’re likelihood of living six months is significantly different depending on the oncologist you chose. Nobody knows that. If you have a mammogram read, the accuracy of the mammogram varies significantly based on the reader. Some readers have twice as many mammograms getting to stage 3 and death as other readers. And nobody knows that. People don’t know that. So, people assume, “I had a mammogram and are protected.” The perfect system would keep track of mammogram success rates, cancer survival rates, bone surgery success rates. If you sort through the process – heart surgery success rates. And make that information part of the data flow that patients can use.
So, you need the right data, you need the right incentives, you need patient-focused care plans and you put all that together and combine that with the current medical science and there’s a great opportunity to do some really wonderful things for people.
What we have instead is a silent system. At Kaiser Permanente, because we are vertically integrated, can do a lot of this work now and we are doing it. The rest of the world isn’t vertically integrated, so it’s harder to do a lot of those pieces. But what the rest of the world can do is virtual integration. If you can’t be vertically integrated, you can still create integration links using the computer, care registries, data flows, and create care plans for patients and then provide feedback to that from other sources, like the claims processing system.
If you go to the doctor and you have a claim filed on our behalf by the doctor, there’s the diagnosis, there’s the treatment, there’s the cost of care, there’s the person who did it, the timeframes. Most of the information that’s in a medical record is in the claim. It’s not timely, the accuracy level is a little lower, it’s not real time, but it’s there. And so, if you’re having asthma attacks, multiple asthma attacks will show up on both of the electronic medical record and the claims database. And right now, the electronic medical record can use it to make an improvement of care. The claims database is wasted. That data is not being used and it could be used and should be used. So, part of the American Health Care Reform agenda should be to create access to that database and require everybody who pays for care in America to use that database and focus on issues like asthma care to make sure every asthmatic basically ends up with at least a computer tracking their care and some kind of a care plan that will improve asthma care.
Question: Should we pursue realignment where care providers and insurers combine?
George Halvorson: It makes huge sense to have as much alignment as you can possibly get between the revenue stream and the care delivery. We need to reward the best providers for being the best providers. Some processes are into very individual, like knee surgery, topically involve the knee surgeon and the patient and doesn’t involve quite a few other areas, although there are therapists involved in the recovery. Other conditions like diabetes take an entire team of caregivers. And so you need team coordination, team dataflow, team reward system. The very best payers ought to reward a partner with teams of caregivers for the chronic conditions and then create a marketplace that rewards the best performance by the individual performers. And if you did both of those things, you would have better knee surgery, and better diabetic care. And if the insurance company stands back from that whole process and isn’t part of it relative to the benefit package or dataflow, information flow, channeling patients to the best providers, I think that does the patients a disservice because the teamwork should be there and that partnership should be there.
So the ideal model going forward is a linked model. And also there are quite a few vertically integrated care systems in America that ought to be thinking about stepping up to the plate and taking prepayments, much like Kaiser. And I think as we go forward, depending on how healthcare reform shakes out, that could happen.
Question: What are the solutions that will be ideal for the long term and not just stop gap measures?
George Halvorson: I think there is an understanding on the part of President Obama and some of the key Senate leaders, and some of the key House leaders that the care delivery system is not organized optimally right now and that we ought to be working toward a better model. And I think there is an appreciation of team care, and I think there is an appreciation of data flows, datasets, data tracking, informed patient choice. I think all of that is in the air, but it’s not sufficiently in the bills. And so we’ve had discussions, conversations, hearings about those kinds of issues, and then when the bills finally got written, some of those pieces didn’t get incorporated. Even when Senator Backus did his hearing the other day, or his press conference, and he talked about how he would like to see healthcare organized in the future, one of the things he cited was us, Mayo, Cleveland Clinic, Geysinger, some of the other care systems, and said it would be good for America to reorganize and to move down those paths.
I think though that the way America can get there is not by trying to reorganize the system from that perspective. It’s by saying, we need to fix a couple of things in this country. We need to have half as many kids with asthma attacks. We need to figure out how to put all of the pieces in place to get there. And if we set a goal like that, diagnose every kid, make sure that every kid has a treatment plan, make sure there is a database, make sure you’re tracking what happens to every kid, when you put all of those pieces in place they lend themselves to a system because you can’t achieve those things unless you have tools, data, information, somebody accountable. And if we set a few goals for the country and then work backward from the goals to the plan and take that very seriously and have reward systems based on achieving those plans, I think what will happen then is there will be a natural gravitation of caregivers into more tightly organized and coordinated care teams. But that’s not going to happen until there is a reason to do it.
A caregiver is not going to reorganize just for the theory of it, or because somebody gave a nice speech and it sounded good, or because Mayo has a great brand, or we have a great brand. They’re going to do it because doing it makes it more likely that they will cut the number of heart failure attacks in half. And if they do that, and if they band together to do that and they are rewarded for doing that, that model will work. So, I think we’ve got to get there; goal first, rewards, tools, and then I think there will be an aggregation that will come out of it, but it will be an aggregation that results from the goal, not one that creates the outcome.
And if you look at any other business, if you look at any – if you go to a factory, there are no factories in the world that will build a tool and throw the tool randomly into the factory and hopes that somebody picks it up and uses it in some smart way. Every factory says, this is a product we want, we want to produce this hubcap, we want this hubcap to have a 99.9% degree of variability. To do that, what are the tools have to be. And then they work backward from the hubcap to the tool kit. Healthcare is the only thing that throws a new wrench in and says, “I hope somebody in there uses it and somehow in the end the hubcap is better.” It doesn’t work. So we have to start. We have to start with the hubcap, we have to start with the outcome, we have to cut the number of congestive heart failure patients, or the number of asthma attacks and then build the toolkit from that and then the benefit package, that Blue Cross pays has to reward those outcomes. Because if they ignore the outcomes, or do as we do now and actually reward perverse outcomes, care delivery will not change.
Topic: Easing the transition to another model
George Halvorson: Healthcare in this country responds very quickly to incentives. So, if you created a care environment where the care teams who cut the number of asthma attacks in half win; get more money, get more patients benefit. If you create a situation where the care teams that have half as many kidney failures win, everybody will gravitate to that model. Healthcare providers are very, very smart. You don’t get through medical school or hospital administration school without being very smart. So, everybody very carefully studies the compensation system and understands exactly what is rewarded and what’s not. And if you try to force people on just for the sake of putting them into teams and there is no reward involved and there is no positive outcome, people won't go to teams. But if you create a reward system that rewards the result of teams then people will figure 15 very creative ways to the form teams. And so it has to be in the results. You've got to build the architecture as every other market does a product that is sold.
Now think about cell phones. The cell phone market is based on the product that’s sold. You will not sell a cell phone today of the kind that we used three or four years ago in the market because that's not what people want to buy today. And so the cell phone market is constantly changing, constantly improving because they are rewarded by the change. They're not changing because they like to change—they’re changing because they trying to get to that next market share than because there is a win for them by coming up with a better phone, engineering a better phone. There is no win in healthcare right now coming up with a better outcome. There is none. There's actually a loss. And so you've got to change that; that has to change. Healthcare people are just as smart as cell phone engineers. So if you change that then the entire system will follow that and that's what the change has to happen. And it's got to be in rewarding a different set of outcomes and then people will organize differently and put toolkits in place to get to those outcomes.
Recorded on: September 21, 2009
The CEO of Kaiser Permanente thinks the ideal health care plan would be built around the patient. What we have now is a silent system, he says.
Get smarter, faster. Subscribe to our daily newsletter.
How would the ability to genetically customize children change society? Sci-fi author Eugene Clark explores the future on our horizon in Volume I of the "Genetic Pressure" series.
- A new sci-fi book series called "Genetic Pressure" explores the scientific and moral implications of a world with a burgeoning designer baby industry.
- It's currently illegal to implant genetically edited human embryos in most nations, but designer babies may someday become widespread.
- While gene-editing technology could help humans eliminate genetic diseases, some in the scientific community fear it may also usher in a new era of eugenics.
Tribalism and discrimination<p>One question the "Genetic Pressure" series explores: What would tribalism and discrimination look like in a world with designer babies? As designer babies grow up, they could be noticeably different from other people, potentially being smarter, more attractive and healthier. This could breed resentment between the groups—as it does in the series.</p><p>"[Designer babies] slowly find that 'everyone else,' and even their own parents, becomes less and less tolerable," author Eugene Clark told Big Think. "Meanwhile, everyone else slowly feels threatened by the designer babies."</p><p>For example, one character in the series who was born a designer baby faces discrimination and harassment from "normal people"—they call her "soulless" and say she was "made in a factory," a "consumer product." </p><p>Would such divisions emerge in the real world? The answer may depend on who's able to afford designer baby services. If it's only the ultra-wealthy, then it's easy to imagine how being a designer baby could be seen by society as a kind of hyper-privilege, which designer babies would have to reckon with. </p><p>Even if people from all socioeconomic backgrounds can someday afford designer babies, people born designer babies may struggle with tough existential questions: Can they ever take full credit for things they achieve, or were they born with an unfair advantage? To what extent should they spend their lives helping the less fortunate? </p>
Sexuality dilemmas<p>Sexuality presents another set of thorny questions. If a designer baby industry someday allows people to optimize humans for attractiveness, designer babies could grow up to find themselves surrounded by ultra-attractive people. That may not sound like a big problem.</p><p>But consider that, if designer babies someday become the standard way to have children, there'd necessarily be a years-long gap in which only some people are having designer babies. Meanwhile, the rest of society would be having children the old-fashioned way. So, in terms of attractiveness, society could see increasingly apparent disparities in physical appearances between the two groups. "Normal people" could begin to seem increasingly ugly.</p><p>But ultra-attractive people who were born designer babies could face problems, too. One could be the loss of body image. </p><p>When designer babies grow up in the "Genetic Pressure" series, men look like all the other men, and women look like all the other women. This homogeneity of physical appearance occurs because parents of designer babies start following trends, all choosing similar traits for their children: tall, athletic build, olive skin, etc. </p><p>Sure, facial traits remain relatively unique, but everyone's more or less equally attractive. And this causes strange changes to sexual preferences.</p><p>"In a society of sexual equals, they start looking for other differentiators," he said, noting that violet-colored eyes become a rare trait that genetically engineered humans find especially attractive in the series.</p><p>But what about sexual relationships between genetically engineered humans and "normal" people? In the "Genetic Pressure" series, many "normal" people want to have kids with (or at least have sex with) genetically engineered humans. But a minority of engineered humans oppose breeding with "normal" people, and this leads to an ideology that considers engineered humans to be racially supreme. </p>
Regulating designer babies<p>On a policy level, there are many open questions about how governments might legislate a world with designer babies. But it's not totally new territory, considering the West's dark history of eugenics experiments.</p><p>In the 20th century, the U.S. conducted multiple eugenics programs, including immigration restrictions based on genetic inferiority and forced sterilizations. In 1927, for example, the Supreme Court ruled that forcibly sterilizing the mentally handicapped didn't violate the Constitution. Supreme Court Justice Oliver Wendall Holmes wrote, "… three generations of imbeciles are enough." </p><p>After the Holocaust, eugenics programs became increasingly taboo and regulated in the U.S. (though some states continued forced sterilizations <a href="https://www.uvm.edu/~lkaelber/eugenics/" target="_blank">into the 1970s</a>). In recent years, some policymakers and scientists have expressed concerns about how gene-editing technologies could reanimate the eugenics nightmares of the 20th century. </p><p>Currently, the U.S. doesn't explicitly ban human germline genetic editing on the federal level, but a combination of laws effectively render it <a href="https://academic.oup.com/jlb/advance-article/doi/10.1093/jlb/lsaa006/5841599#204481018" target="_blank" rel="noopener noreferrer">illegal to implant a genetically modified embryo</a>. Part of the reason is that scientists still aren't sure of the unintended consequences of new gene-editing technologies. </p><p>But there are also concerns that these technologies could usher in a new era of eugenics. After all, the function of a designer baby industry, like the one in the "Genetic Pressure" series, wouldn't necessarily be limited to eliminating genetic diseases; it could also work to increase the occurrence of "desirable" traits. </p><p>If the industry did that, it'd effectively signal that the <em>opposites of those traits are undesirable. </em>As the International Bioethics Committee <a href="https://academic.oup.com/jlb/advance-article/doi/10.1093/jlb/lsaa006/5841599#204481018" target="_blank" rel="noopener noreferrer">wrote</a>, this would "jeopardize the inherent and therefore equal dignity of all human beings and renew eugenics, disguised as the fulfillment of the wish for a better, improved life."</p><p><em>"Genetic Pressure Volume I: Baby Steps"</em><em> by Eugene Clark is <a href="http://bigth.ink/38VhJn3" target="_blank">available now.</a></em></p>
Answering the question of who you are is not an easy task. Let's unpack what culture, philosophy, and neuroscience have to say.
- Who am I? It's a question that humans have grappled with since the dawn of time, and most of us are no closer to an answer.
- Trying to pin down what makes you you depends on which school of thought you prescribe to. Some argue that the self is an illusion, while others believe that finding one's "true self" is about sincerity and authenticity.
- In this video, author Gish Jen, Harvard professor Michael Puett, psychotherapist Mark Epstein, and neuroscientist Sam Harris discuss three layers of the self, looking through the lens of culture, philosophy, and neuroscience.
The newly discovered galaxies are 62x bigger than the Milky Way.
- Two recently discovered radio galaxies are among the largest objects in the cosmos.
- The discovery implies that radio galaxies are more common than previously thought.
- The discovery was made while creating a radio map of the sky with a small part of a new radio array.
An extremely active galaxy<p> <br> </p><p>Radio galaxies are galaxies with extremely active central regions, known as nuclei, which shine incredibly brightly in some part of the electromagnetic spectrum. They are known for emitting large jets of ionized matter into intergalactic space at speeds approaching that of light. They are related to quasars and blazars. It is thought that supermassive black holes are the energy source that make these galaxies shine so brightly. </p><p>What makes these two galaxies (known as MGTC J095959.63+024608.6 and MGTC J100016.84+015133.0) so interesting is their size. Only 831 similar, "giant radio galaxies" are known to exist. As study co-author Dr. Matthew Prescott explains, these are particularly large even for <a href="https://www.forbes.com/sites/jamiecartereurope/2021/01/18/we-just-found-two-mysterious-galaxies-62-times-bigger-than-our-milky-way-say-scientists/?sh=76edf29c2892" target="_blank" rel="noopener noreferrer">giants</a>:</p><p>"These two galaxies are special because they are amongst the largest giants known, and in the top 10 percent of all giant radio galaxies. They are more than two mega-parsecs across, which is around 6.5 million light-years or about 62 times the size of the Milky Way. Yet they are fainter than others of the same size."</p><p>The smaller of the two is just over two megaparsecs across, roughly six and a half million light-years. The larger is almost another half megaparsec larger than <a href="http://www.sci-news.com/astronomy/giant-radio-galaxies-09266.html" target="_blank">that</a>. <br></p><p>Exactly how these things get to be so massive remains a mystery. Some have proposed that they are ejecting matter into unusually empty space, allowing for the jet to expand further, though some evidence contradicts this. The most commonly suggested idea is that they are simply much, much older than the previously observed radio galaxies, allowing more time for expansion to occur.</p>
How does this change our understanding of the universe?<p> While exciting and impressive on their own, the findings also suggest that there are very many more of these giant galaxies than previously supposed. If you were going off the previous estimates for how typical these galaxies are, then the odds of finding these two would be 1 in 2.7×10<sup>6. </sup>This suggests that there must be more, given that the alternative is that the scientists were impossibly lucky. </p><p> In the study, the researchers also apply this reasoning to smaller versions of these galaxies, saying:</p><p> "While our analysis has considered only enormous (>2 Mpc) objects, if radio galaxies must grow to reach this size, then we may expect to similarly uncover in our data previously undetected GRGs with smaller sizes."</p><p> Exactly how common radio galaxies and turn out to be remains to be seen. Still, it will undoubtedly be an exciting time for radio astronomy as new telescopes are turned skywards to search for them.</p>
How did they find them?<iframe width="730" height="430" src="https://www.youtube.com/embed/c1ZW3nVfe5A" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> The new galaxies were discovered by the amusingly named <a href="https://www.sarao.ac.za/gallery/meerkat/" target="_blank" rel="noopener noreferrer">MeerKAT</a> radio telescope in South Africa during the creation of a new radio map of the sky. The MeerKAT is the first of what will soon be the <a href="https://en.wikipedia.org/wiki/Square_Kilometre_Array" target="_blank" rel="noopener noreferrer">Square Kilometre Array</a> of telescopes, which will span several countries in the southern hemisphere and make even more impressive discoveries in radio astronomy possible. </p>
The father of all giant sea bugs was recently discovered off the coast of Java.
- A new species of isopod with a resemblance to a certain Sith lord was just discovered.
- It is the first known giant isopod from the Indian Ocean.
- The finding extends the list of giant isopods even further.
The ocean depths are home to many creatures that some consider to be unnatural.<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzU2NzY4My9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYxNTUwMzg0NX0.BTK3zVeXxoduyvXfsvp4QH40_9POsrgca_W5CQpjVtw/img.png?width=980" id="b6fb0" class="rm-shortcode" data-rm-shortcode-id="2739ec50d9f9a3bd0058f937b6d447ac" data-rm-shortcode-name="rebelmouse-image" data-width="1512" data-height="2224" />
What benefit does this find have for science? And is it as evil as it looks?<div class="rm-shortcode" data-media_id="7XqcvwWp" data-player_id="FvQKszTI" data-rm-shortcode-id="8506fcd195866131efb93525ae42dec4"> <div id="botr_7XqcvwWp_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/7XqcvwWp-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/7XqcvwWp-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/7XqcvwWp-FvQKszTI.js"></script> </div> <p>The discovery of a new species is always a cause for celebration in zoology. That this is the discovery of an animal that inhabits the deeps of the sea, one of the least explored areas humans can get to, is the icing on the cake.</p><p>Helen Wong of the National University of Singapore, who co-authored the species' description, explained the importance of the discovery:</p><p>"The identification of this new species is an indication of just how little we know about the oceans. There is certainly more for us to explore in terms of biodiversity in the deep sea of our region." </p><p>The animal's visual similarity to Darth Vader is a result of its compound eyes and the curious shape of its <a href="https://lkcnhm.nus.edu.sg/research/sjades2018/" target="_blank" rel="noopener noreferrer dofollow" style="">head</a>. However, given the location of its discovery, the bottom of the remote seas, it may be associated with all manner of horrifically evil Elder Things and <a href="https://en.wikipedia.org/wiki/Cthulhu" target="_blank" rel="dofollow">Great Old Ones</a>. <em></em></p>
Daydreaming can be a pleasant pastime, but people who suffer from maladaptive daydreamers are trapped by their fantasies.
Maladaptive daydreaming<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTUwMjgyMy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0OTUxNzc3Nn0.yVIUGnZl6VnJhfevESkBpb1TEvwKrHcLtobwNJV55HI/img.jpg?width=1245&coordinates=0%2C63%2C0%2C63&height=700" id="713cf" class="rm-shortcode" data-rm-shortcode-id="e2d24a66284b3aa58ad16b66c135dc9d" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
One maladaptive dreamer spent hours a day dreaming he was a powerful man who could solve the world's problems.
(Photo: Pixabay)<p>Daydreaming is an indulgence of the mind and imagination, one provided courtesy of the <a href="https://www.sciencedirect.com/topics/neuroscience/default-mode-network#:~:text=The%20default%20mode%20network%20(DMN,and%20Exercise%20Psychology%20Research%2C%202016" target="_blank">default mode network</a>, a network of interacting brain regions that is active even when the conscious mind is not. But like so many of life's indulgences—wine, steak dinners, video games, and even <a href="https://www.healthline.com/health-news/why-too-much-exercise-can-be-bad-042514" target="_blank">exercise</a>—too much daydreaming can be harmful to our well-being. When daydreaming crosses that threshold, it can be considered maladaptive.</p><p>This disorder was first identified by <a href="https://haifa.academia.edu/EliSomer" target="_blank">Eli Somer</a>, a professor of clinical psychology at the University of Haifa, School of Social Work, in <a href="https://link.springer.com/article/10.1023/A:1020597026919" target="_blank" rel="noopener noreferrer">a 2002 paper</a>. That paper looked to six patients in a trauma center whose daydreaming habits replaced human interactions or interfered with their standard life functions, such as going to school or holding down a job. </p><p>Since then, other case studies have looked at <a href="https://www.healthline.com/health/mental-health/maladaptive-daydreaming#:~:text=Maladaptive%20daydreaming%20is%20a%20psychiatric,life%20events%20trigger%20day%20dreams." target="_blank" rel="noopener noreferrer">maladaptive daydreamers</a> and compiled a list of potential symptoms. These include vivid, richly-detailed daydreams; abnormally long daydreaming sessions; daydreams triggered by real-life events; daydreaming sessions that interrupt sleep; and repetitive motions or whisperings while daydreaming. On average, one study reported, maladaptive daydreamers spend <a href="https://bigthink.com/bps-research-digest/people-with-maladaptive-daydreaming-spend-an-average-of-four-hours-a-day-lost-in-their-imagination" target="_self">four hours a day</a> housed in their imaginations.</p><p>"This is not like rehearsing a conversation that you might have with a boss," <a href="https://www.cnn.com/2016/12/30/health/maladaptive-daydreaming-feature/index.html" target="_blank" rel="noopener noreferrer">Somer told CNN</a>. "This is fanciful, weaving of stories. It produces an intense sense of presence."</p><p>While such symptoms are common, though not comprehensive or guaranteed, how maladaptive daydreams manifest are naturally individual to the dreamers. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426361/" target="_blank" rel="noopener noreferrer">In one case study</a>, researchers analyzed the diary of a man codenamed "Peter." Peter described investing as many as 14 hours a day online. The news and images he happened upon would trigger related fantasies. For example, he may envision himself as a multimillionaire genius who could prevent bad news from occurring or self-insert himself into the power fantasies of superhero movies or police procedurals for hours at a time.</p><p>"When I felt this pain as a child, I started imagining how things could be different. I created stories which never happened. To suppress that pain I would hug my pillow or quilt, thinking I was being comforted by someone else," Peter wrote.</p><p>In an interview with CNN, Cordellia Rose described her maladaptive daydreaming like a drug and noted that her daydreams developed into intricate storylines that could last for years. These stories proved so distracted that she was unable to complete everyday tasks such as driving lessons.</p><p>"You get hooked on it, because it can be like an action movie in your head that's so gripping that you cannot turn off," Rose told CNN. "This [condition] needs to be public, because these are people suffering, and badly."</p><p>To be clear, maladaptive dreaming is not a <a href="https://www.webmd.com/schizophrenia/guide/what-is-psychosis#1" target="_blank" rel="noopener noreferrer">psychotic disorder</a> like schizophrenia. Daydreamers such as Peter and Rose are aware that their fantasies are as unreal as they may be unrealistic. Because of this, many maladaptive dreamers understand the difficulties they face and the real-life losses they have endured for the sake of their fantasies. </p>