Wednesday, July 28, 2010

The Well Being Index: The Problem Gets Bigger

The Disease Management Care Blog doesn't necessarily agree with Newt Gingrich's politics, but it has learned to appreciate the insights of former professors armed with the lessons of history. Case in point has been Newt's habit of repeatedly a quoting President Eisenhower's answer to the seemingly unsolvable:

"Whenever see a problem I can't solve, I always make it bigger"

In preparation for a speaking gig at an upcoming international conference, the DMCB has been struggling with its own big problem: boiling the business case of disease management down to an easily grasped elevator pitch. "Mitigating the pooled risk of insured populations defined by the presence of chronic illness" doesn't quite make it. Saying that "health insurers are happy to pay for special services for high risk persons because the expense is lower than the cost of what would otherwise happen" is better, but even that's still too complicated. When brokers, human resources and physicians are around, the wheels really come off because terms like "premiums," "claims expense," "cost," "charges," "revenue," "outcomes," "reconciliation," "return on investment," "engagement," "contact rates" and "value" fly around thicker than hospital administrators on a newly covered Medicare code. Toss in caveats, like "trend," "non-chronics," "confidence intervals" and "program costs" and it's little wonder why skepticism and confusion abounds.

Enter Healthways and their "Well Being Index." Rather than mess with the thorny problem of educating non-mathematician customers about the subtle dimensions of the actuarial sciences and convincing them that there's value somewhere in those numbers, Healthways made the problem larger. Knowing that customers ultimately expect disease management, prevention and wellness programs to make persons, well.... healthier, the measurement solution presented itself. What followed was the decision to partner with Gallup to create a survey that simply asked about health from the consumer/end-users' point of view. All that was left was to settle on the various sub-domains (Life Evaluation, Emotional Health, Physical Health, Healthy Behaviors, Work Environment and Basic Access) and use them to understandably assess outcomes that actually mean something for their customers.

While the business concept is intriguing enough, it remains to be seen how this will serve Healthways over the long run. Kick it up a notch, though, and consider whether the concept of "well being" could turn out to be a key metric in our nation's ongoing search for health reform. Healthways would certainly like that, but that's not the point. The point is that maybe the Obama Administration and Congress should think about the Eisenhower quote when they're thinking about the next meaningful steps in health - not health "insurance" - reform.

We'll see.

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