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Connected Health and Patient-Provider Accountability

May 3, 2010

The last post on holding citizens accountable really struck a chord.  I’m delighted to see so much passionate debate about this important issue.

So, let me start here by reiterating, clearly, my position.  For those individuals who are the unfortunate recipients of bad luck or bad genes (yes, addiction is part of this) our health care system should be there for you to provide high quality care.  That is what insurance is about.  However, I am steadfast in my belief that we as a society must hold each other accountable for healthy behaviors.

Of course this is not as simple as I’ve made it sound. There are shades of gray. Many of the comments from my last post articulated some of these nuances.  But, in general, we will not see reductions in health care costs as long as we tolerate unhealthy behaviors and encourage businesses to flood the market with unhealthy products (such as high fat/high sugar foods).

Here is some further thinking on this matter.

I suggest we take the lessons learned from 30+ years of anti-smoking campaigns and apply them to promoting dietary prevention of chronic conditions, such as high blood pressure.  This would go a long way to solving the problem way before folks could be burdened with avoidable, resource-absorbing and costly chronic diagnoses.

Lets continue to follow the anti-smoking story. We’ve gotten smoking incidence down to 20% of the population.  It required intense and sustained public health education, but also other techniques like good old fashioned peer pressure and even to some extent ostracizing smokers.  The latest news on this front is that certain employers either will not hire you if you smoke or require you to pay a higher health insurance premium. In short, we have applied motivational tools and accoutability to reduce the number of people smoking to one in five.  Can we do the same for obesity? Hypertension? High cholesterol?

Not if our only strategy is holding doctors accountable for changing patient behavior.  Doctors don’t have the training to do this properly and, often, they lack the interest.

Here’s an idea.  Hold doctors accountable for as nearly flawless-as-possible care for those folks who have unfortunate health outcomes (bad genes, accidents, etc.). We’ve already started down this road with the increased emphasis on system improvements and patient safety. But, for the prevention of chronic illnesses, hold consumers accountable for a healthier lifestyle.

Employers have been trying hard to do this for years via wellness programs, disease management initiatives and the like.  Sometimes health plans are doing it on behalf of their employer customers.  However, there has been essentially no collaboration with providers on this, largely because providers have turned a deaf ear. They are happier and rewarded for taking care of everything as if it was an accident and you were a victim.

Health plans have the opportunity to take the high road.  Bring providers and employers together. Hold providers accountable for patient safety and system level care. Hold employees accoutable for staying as healthy as possible. Can it be done collaboratively?

One of the strongest persuassive voices in your life is your doctor’s voice.  Imagine if she was directly involved with an employee wellness program, recommended your participation, got detailed reports of your progress and was part of a virtual coaching team to keep you on track.

We have many of the technology-based tools in place to make this happen and, in several instances, we are already seeing excellent results. But, we are a long way from a national public education and prevention program the likes of the anti-smoking campaign I talked about earlier.

How do we get there? I would love to hear your thoughts.

5 Comments leave one →
  1. Kamran Tavangar permalink
    May 3, 2010 1:13 pm

    Traditionally, holding people accountable for their own healthy behavior hasn’t been “fun”: you’re supposed to do it because it’s good for you. I think that people need to win something or be recognized in some way for their efforts. Just telling them “it’s good for you” doesn’t seem to work.

    Here’s a germ of an idea: some sort of a game where you win something (e.g Red Sox tickets) for doing something healthy. The money pool for the program would need to be created through collaborative efforts through insurance companies, hospitals etc. Then there’s a whole PR campaign touting the benefits etc of doing those healthy things and the winner is prominently displayed and recognized. People love a good competition!

    • May 3, 2010 1:15 pm

      I think you are on target, Kamran. for some folks competition and gaming is an important motivator.

  2. May 10, 2010 8:47 am

    Thanks for sharing. Your thoughts are right on target!
    Implementing this approach can be expedited by ensuring that communication, care, reporting & incentives are aligned and transparent. This effort can start where there is already alignment at the local level between patients, providers, employers, insurers & other key constituents.

    I agree that the technology is not the problem, quite the contrary it is part of the solution. A specific approach to ensure that change is promoted would be for the government (or some other constituent with deep pockets) to fund a contest where the best (quality & value) & most innovative solutions would win a prize (similar to the US public education “Race to the Top” program). Inertia in the US Healthcare industry stems from the lack of certainty of how change will effect profitability/income. These ‘prizes’ would ease the transition. Aggressively sharing best & next practices would help too.

    Keep up the great posts!

  3. Sandra Peters permalink
    May 14, 2010 11:29 pm

    Hi Dr. Kvedar,

    I’ve thoroughly enjoyed reading your posts! I think employees are extremely price sensitive. I believe that employers should charge employees that exhibit poor and expensive lifestyle behaviors more for their insurance – they will likely cost more. I say work with the National Business Groups and the local business coalitions, count me in!

    Sandra Peters

    • May 15, 2010 2:59 pm

      There is beauty in simplicity here. I fear, however, that the simplicity would be overshadowed by the complexity of implementation (think about what labor unions would do with that, for instance).

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