Until everyone becomes responsible for his or her own health, we are going to have people sitting around on the sofa, watching Maury, eating bon bons, 36 hours per day and being 100 pounds overweight with Type 2 diabetes. The only way to stop this behavior is to educate the patient about what they should be doing, the consequences of not doing it and they are facing death and dismemberment by not doing it. Worse than that, they make my insurance go up and I'm a carrot eating gym rat
I had ready Dr. DeSalvo's comments at my buddy Brian Ahier's blog article here and passed it up as another "We have to do these things" without any clue as to how to get them done. A wise man once said "execution is everything, ideas are a dime a dozen." A stupid mouse once said "Let's tie a bell on the cat so it can't sneak up on us." Great idea, no execution. I have never seen, nor heard of, a cat with a bell around its neck, either.
So what do we do? First, we have to educate the patient. In most cases, the individual has the means to avoid chronic disease through diet and exercise. We just have to teach them how to do it. Then we have to hit them where they live: the wallet. Adults who show no increase in weight, waist/height ratio, lipid panel, HbA1c or fasting glucose get discounts on his or her insurance. That discount might literally be the amount they collectively saved the group by being healthy. We here at Sentia have the ability to generate reports that detail population health in seconds. That discount would be significant. If your numbers go up (or down in the case of HDL Cholesterol or 'good cholesterol') you pay more for insurance. Period. Your bad decisions will no longer negatively affect the cost of my health insurance.
How do you educate the patient, though? We can't make fun of the cat bell people and then not trot out a real solution, so here it is: Automatically generate patient education for every measured criteria that the patient is out of range on detailing how to fix it . That is exactly what we do here at Sentia. (See an example of patient education here for a sample patient. You might have to zoom in.) Every year at most, three months for patients with critical problems, an Individual Health Assessment (see it here and notice that our patient's body age is 37 while his chronological age is 12. Exaggeration for effect.) can be done and a report detailing the results put in the patients hands along with the ability to log in to the EMR that his or her doctor uses, and look at what the real measurements are, see X-rays, see symptoms and diagnoses and yes read about how to affect the above criteria with diet and exercise. Even better, we can tell if the patient has read the prescribed education and with evidence based care see if they are following the recommendations. Those who aren't pay more for their insurance, maybe almost as much as they are paying their old, rickety, self-important, money grubbing, do nothing insurance now. For the carrot eating gym rats, health insurance will be far, FAR less expensive. Pay for performance? You bet.
Thanks for the heads up Dr. DeSalvo. We have been doing precisely that since 2009.
Real Solutions
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