This is a follow-up to a previous blog, titled “What About Patient Accountability?”
My previous blog provoked some good conversations regarding a multitude of considerations and challenges for driving more patient accountability in healthcare delivery and insurance. Let’s now advance the discussion from “if” and “why” to “how.”
If we want to increase accountability, then we must start with a means of measurement. And, to create a measurement system to help drive patient accountability and promote healthy behavior, the standardization and broad adoption of “health scores” for individuals in our healthcare system shouldn’t be too difficult. Surely, the medical community can agree upon some basic numbers to reflect the health of individuals and help guide lifestyle adjustments.
Providers and payers alike have been advocating for patients to routinely attend annual wellness visits with their primary care physicians. The adoption of new care delivery and reimbursement models, such as Accountable Care Organizations and Medical Homes, will further increase the focus and importance of regular visits with primary care physicians. (Hopefully, the reimbursement transformation will also help reduce the significant compensation disparity between family practice and specialties.)
Perhaps these annual visits can become mandatory check-ups for individuals, allowing providers and payers to more closely monitor their health with ongoing, relative measurements that impact their healthcare insurance costs. And, in the case of Medicaid and Medicare recipients, these measurements could have implications on possible penalties or eligibility for non-essential benefits.
Each visit could include a screening to measure the following numbers, concluding with a personalized care plan that is printed and/or delivered electronically to clearly educate the individual on their condition with simple lifestyle (diet, exercise, disease management, etc.) suggestions for health improvement – that will ultimately help them avoid financial penalties or earn rewards.
The first step to increasing patient accountability must be increased access to information and education. Thanks to on-board computers and modern dashboards with measurements for mileage, fuel and fluid levels, engine temperature, brake linings and even fuel efficiency, most car owners know more about the health and performance of their vehicles than they do about their own body.
Each individual’s total “health number” (and resulting personalized care plan) could be derived from a vital checklist that includes the following measures and objectives:
1) Blood Pressure: Less than 120/80 mmHg
2) Blood Sugar: A fasting blood-sugar level of 99mg/dL or less
3) Cholesterol: Total cholesterol under 200 mg/dL with LDL cholesterol under 100 mg/dL
4) HDL (Good) Cholesterol: More than 50mg/dL
5) Triglycerides: Less than 150 mg/dL
6) Thyroid: A thyroid-stimulating hormone level under 4.0 mIU/L
7) Body Mass Index: Between 18.5 and 24.9
8) Physical Activity: Between 30 and 60 minutes per day
In most cases, the improvement of these measures will require losing weight, quitting smoking, consuming less alcohol, and exercising more regularly. Undoubtedly, improving these behaviors across the population will help significantly reduce the volume of chronic disease which will ultimately improve lives and reduce healthcare costs.
Just as we all have credit scores, perhaps someday soon we will also have “health scores” that carry similar implications and offer similarly clear pathways for improvement…