I took a quick look at some data from the Thomson Reuters 2010 PULSE Healthcare Survey about screenings by age compared to recommendations. Here’s what it showed (in summary):

BUT, this has huge implications.  If we’re trying to get people engaged in their care at a pre-disease point (i.e., pre-diabetic) or trying to engage them earlier in their chronic kidney care continuum, this matters.  They’re likely to ignore the outreach about wellness and disease management if they don’t think it applies to them.  I guess it’s like thinking that you’ll win the lottery.  Or thinking that the last dose of chemotherapy (even though you’re about to die) might just save you.

But, if you dig into the data, you do see some differences by age and by income (per Thomson Reuters 2010 PULSE Healthcare Survey):

• 35.5% of those making >$100K think of themselves in excellent health versus 11.1% of those making less than $25K.
• Only 1.1% of those making >$100K think of themselves in poor health versus 14.3% of those making <$25K.

(While we know that there are healthcare discrepencies tied to income, this wouldn’t explain this great of a gap in self-perception.)

• 61.7% of those <35 perceive themselves to be in very good or excellent health versus 40.7% of those >65 (but a lot of that could be explained away since they are much more likely to have symptomatic diseases at that age)

(comments in parenthesis are my perspective not from the study)

While it has long been called juvenile diabetes, the reality is that of the 30,000 new cases diagnosed each year, about ½ of them are in adults. The key question is whether you could screen for this. There is now a blood test which is being used at Type 1 Diabetes TrialNet (18 research centers conducting clinical trials) which can help physicians identify the onset of the disease as early as 10 years before symptoms.

Right now, people that qualify can get the test for free, but I think this brings into play the larger question. When is it appropriate and cost effective to screen people about future diseases? In today’s US healthcare model, the “churn” of membership often downplays the long-term public value of prevention. Unless you know a member will be with you in the future when these costs come to be, should you bear the costs of the test today?

A few stats from yesterday’s WSJ on this:

• 3 million Americans have Type 1 diabetes (compared to 22M who have Type 2)
• 80 people a day in the US that are diagnosed with Type 1 diabetes
• 3% annual increase in the Type 1 diabetes cases world-wide under the age of 14
• 11-14 is the peak age for Type 1 diagnoses

So, the key question is how do you know if you’re at risk…

The primary factor that was identified in the article was whether you have a family member with the disease. If yes, you’re 15x more likely to have Type 1 diabetes than the general population. Perhaps as part of an HRA (health risk assessment), we should be asking about Type 1 diabetes in the family and screening those that say yes. Or, we could look at medical or pharmacy claims and reach out to family members about being screened.

“To change behavior, mobile health applications need to go beyond self- tracking, providing tips or access to an online community. Such applications need to address disconnects between long-term intentions and moment-to-moment choices. The most effective tools will creatively instantiate well-evidenced behavior-change principles with data mining, social networking, location awareness, and other capabilities of mobile technologies.”

- Margaret Morris PhD, Senior Researcher, Intel

The idea is to improve patient engagement and outcomes by using games and the idea of competing, earning rewards, and solving challenges to improve health.  I think this is especially relevant with all the chronic diseases and obesity challenges in kids, but there are gamers of all ages.  Certainly, Wii and other technologies that respond to movement and integrate into social media help enable this.

Keas is certainly one company whose name I’ve heard a few times in this space for healthcare.  But, I think lots of people are talking about this and trying to figure it out.  A simple Google search pulls up lots of discussion on the topic.

With the upcoming Facebook IPO and their success working with Zynga on gaming, it makes me wonder if they’ll make any movement in this space.  They’ve generally stayed out of the healthcare space other than exercise and diet, but with their recent effort around organ donation, one could speculate about what they could do with all the money they’re raising.

Gabe Zichermann, the author of Game-Based Marketing, speaks of balancing the fun and frivolity of gamification with the task of making life easier for cancer patients. He says, “I don’t presume to think that we can make having cancer into a purely fun experience. But, we have data to show that when we give cancer patients gamified experiences to help them manage their drug prescriptions and manage chemotherapy, they improve their emotional state and also their adherence to their protocol.”

“AMD is a disease that affects the macula, the pencil eraser-size part of the retina where precise vision forms, resulting in the loss of central vision and making everyday activities like reading and driving much harder.” (Employee Benefit News, 4/15/12)

Some of the other data from the EBN article include:

• Women are likely to be affected than males
• Whites are more likely to be affected than other ethnic groups
• The warning signs include:
  • Blurred vision
  • Straight lines appearing wavy

The article also has an interesting series of statistics from Human Capital Management Resources about how often eye doctors were the first to detect a disease:

• 20% for diabetes
• 30% for hypertension
• 65% for high cholesterol

The article stresses the need for employers to understand the value of a vision care program especially as people get into their 50s and 60s. I certainly hear lots of people stressing eye care around diabetes, but it makes me think this question and action item should be included in more disease management and case management programs both as part of the assessment and the care plan.

We all know rates were getting cut in Medicare so this shifted some of that pain to make companies focus on what matters in terms of quality and outcomes.

Now, the GAO has put out a report that questions whether the expansion of the Star program to include 3 Star plans was a good idea.  (see Gorman’s comments here)  I think this is a fair question.  Should we reward mediocrity?  I think there are ways to do this.

1. You could pay 3 and 3.5 star programs but only if they show improvement year-over-year.
2. You could lower the payments or only reimburse them for investments made (i.e., no profit).
3. You could do it for one year then move the line up to 3.5 stars and then move it to 4 stars to give plans some time to implement, learn, and improve.

Right now, very few plans earn 5 stars, but dropping it to include 3-star plans makes almost 90% of plans get bonuses.  Maybe this is a case for some time of GE program where the top 10% get the biggest bonus; the bottom 10% have to stop offering a program; and the remaining funds get divided up based on some time of rating system.

The key here is not to throw the baby out with the bathwater.  The framework is good.  It’s taking time to understand the program, implement changes, and see an impact.  But, let’s not reward people that can’t continue to innovate and improve and do it in a way that rewards members based on outcomes and satisfaction.