Healthcare folks are getting their ducks in a row pretty quickly, I think. ACOs, Medicare Advantage Plans, even Medicaid ACOs are popping up at an ever-increasing rate. “Risk” is the universal term that permeates the landscape in healthcare today: More organizations are betting that taking “risk” will prove to be profitable and good for their patients. Fee-For-Service will be “out” and Risk will be “in”.
To support “Risk”, we are moving toward a world where outcomes and clinical measures are the defining entities. Many brilliant people with more years in healthcare than they care to admit are coming to terms with exactly what an organization should do to (1) take better care of its patients and (2) stay profitable. But still, something is missing… something for which we haven’t yet found an answer.
That “something” is the American patient. The patient is our last bastion of concern. Why? Look around you. The average US citizen is doing a lousy job of taking care of their bodies. The obesity rate is running at an all time high, leading to lethargic citizens who are ignoring their medical issues until it’s too late. Diabetes is on the increase at an unbelievable rate and a lot of Americans are very “ho-hum” about it because there’s a pill they can take to make things better. There’s always a pill. A recent CDC survey of obese children found that 48% of obese boys and 36% of obese girls believe their weight is “about right.” Of the children who were merely overweight, 81% of boys and 71% of girls also judged their weight to be “about right”. About right? Whaaaat? These kids are obese and overweight for crying out loud and will probably be diabetic in a few years, but they think their weight is about right?
The average US patient is out of touch with their health issues. They are unaccountable in the grandest terms. And guess what happens next? We foot the bill for the disastrous acute and chronic illness problems that THEY get themselves into. This is one of the key reasons Medicare and Medicaid are in such horrible shape right now. Go ahead, blame the insurance companies, blame the government, blame the doctors – but look closely: It’s really the patient who is to blame when you drill down and take an honest look at the problem.
If we can get patients, regardless of their insurance status, to be accountable for their health, we can help fix healthcare. At least that’s my theory. And since I’m the King, I can implement the plan to get healthcare back on a fiscally sound track.
But…How do we become an accountable nation from a “health” standpoint?
Easy. We adopt a “Health Score” that is reportable by every US citizen. This score has the same undertones as a “Credit Score” which is so familiar to everyone who wants to buy a house or lease a car. Credit Scores were imposed by the credit agencies years ago as a way of standardizing our risk as citizens who were about to go the bank and borrow money. The higher your score, the better your risk and the lower your interest rates that you paid. If your score was lousy (meaning you disregarded your fiscal habits) you paid more at the bank to get a loan. It’s a seamless system that EVERYONE has bought into, from banks to corporations to consumers.
Nobody argues that your credit score is reflective of how good you have been managing your credit. And nobody argues that someone with a lousy credit score should pay MORE for a loan than someone with a great credit score. We have bought into Credit Scores completely. So why can’t we do the same thing with Health Scores?
We can, and here’s how it would work.
Everyone starts out with an average Health Score of 500. From there you can go up or down based upon how well you manage your health.
Here are some examples:
• Your Body Mass Index falls higher than 30: subtract 25 points. If it goes up to 35, subtract 75 points.
• Your Body Mass Index falls higher than 30 but you are taking weight loss classes: add back 10 points.
• You are taking nutrition classes: add back 10 points.
• You are taking healthy cooking classes: add back 5 points.
• You use tobacco products: subtract 25 points.
• You use tobacco products but are taking smoking cessation classes: add back 10 points.
• You are Type 2 diabetic: subtract 75 points.
• You are diabetic and get your HbA1c monitored regularly: add 15 points.
• You are diabetic and keep your HbA1c less than 7%: add 15 points.
• You are diabetic and get regular foot and eye exams: add 15 points.
• Your total cholesterol is greater than 180: subtract 25 points.
• Your total cholesterol is greater than 200: subtract 35 points.
• Your total cholesterol is greater than 200 but you are taking cholesterol-lowering medication: add back 15 points.
• You take an aspirin dose daily: add 10 points.
• You exercise for 30 minutes 3 times per week: add 25 points.
• You are over 65 years old and have handrails installed in your bathrooms: add 10 points.
Well, you get the idea. Certainly these rating standards would be developed by clinical experts adept at such things. And also as certain, the ratings will evolve over time, as all new programs do. But the important thing is to establish a system and apply it to every person who needs or wants insurance, whether it is Medicare, Medicaid or commercial.
Ultimately, patients would have their insurance premiums controlled by their “Health Score.” Also, patients with high Health Scores would get preferential time in the waiting room to see a doctor. Think of it like a bonus system: If you work hard to keep your Health Score high – you are rewarded with gold-level healthcare from your doctor or clinic. If you do a lousy job keeping your Health Score maintained – you get to pay more for your healthcare and you might have to wait an extra hour or two to be seen.
Once the “Health Scores” are in place and the US population begins to accept them as they have done with “Credit Scores”, you will see a new accountability emerging in this country:
1. People will begin to think about their diet and stay away from unhealthy meals in favor of healthier alternatives. Instead of gorging at their favorite “Golden Whatever” restaurant and taking in 3,000 calories at a whack, people will start cooking at home or finding healthier meals to consume.
2. People will begin to think long and hard about losing weight, quitting smoking, stopping excessive alcohol consumption.
3. People with chronic illnesses will take their illnesses seriously and become their own best gatekeepers.
4. People will start taking walks, riding their bikes, playing sports – moving and burning calories.
The positive effects?
Doctors will rejoice, babies will smile and dogs will howl at the moon. And the cost of healthcare will go down precipitously as American patients finally become “accountable” for their health issues. Then, in perfect harmony, the programs implemented such as “accountable care”, “care coordination” and “risk management” will be coupled with “accountable patients”, and the United States will finally begin to reverse its sharp decline of health in its citizenry and just as suddenly will see a decline in the healthcare spend. Healthcare in the United States will be fixed..or, er…better. And “better” may just be the thing that saves Medicare and Medicaid from imminent implosion.
It’s how I would fix healthcare if I were King of the United States.