Imagine if your health plan was …

Suspend your understanding of your relationship with your health insurance company as it stands today and imagine something different with me…Imagine

Imagine your health plan is a wellness “club”. In addition to providing insurance to help cover the cost of being sick, you opt in to the plan’s Wellness Club – a community with tools, expertise and social engagement opportunities to enable members to work together in order to live healthy and happy lives. Imagine choosing to join a health plan not because it was the better of 2 bad choices provided by your employer but because your friends and neighbors were members and you saw that they were getting together on weekends and having fun and working together towards the bigger goal of reducing our national defecit and increasing our national productivity.

We have a problem.

As a society, we are currently working together to prematurely kill ourselves and bankrupt the nation as a result of the lifestyle choices we make. Research by Duke’s Ralph R. Keeney published in the paper “Personal Decisions Are the Leading Cause of Death” concludes that about half of the deaths in this nation are considered premature and nearly 80% of those premature deaths are the result of obesity and smoking. Healthcare consumes nearly 18% of the entire GDP and is the largest component of government deficit spending and debt. And here’s the kicker, more than 70% of the dollars spent on healthcare in this country are attributed to preventable chronic disease. Yes, the healthcare system is completely screwed up and needs to be fixed, but 70% of the dollars spent in that screwed up system don’t have to be. We are doing this to ourselves – we can’t blame it on big hospitals, big insurance companies or the government.

And make no mistake about it, we are working together, as a community, to be this sick.  This is not about the fat guy next to you on the plane. We are social beings, we don’t live in this world as individuals, we do what we do together. Just before you got on that plane it was somehow socially acceptable to stand in a long line at the airport and wait patiently for the opportunity to devour a Big Mac, fries and Coke. The longer the line, the more socially acceptable it is to stand in it, that is just the way we are wired, we do it together. But really, how is it logical that one can stand in that line without feeling like a total idiot. If you think about it, the fast food we wait in line for is pretty much just an addictive combination of fat, sugar and salt that puts us on the path to diabetes and heart disease. Factor in lost productivity and the economic consequences of poor health and the line between our daily choices and the ongoing success of our great nation is actually quite easy to draw. It is up to us – you and me and him and her – together.

A wellness movement.

Individually we seem to be proudly willing to sacrifice our own future health for today’s pleasures. I am all too tired of hearing: “I’m going to die sooner or later, I might as well go with a smile on my face”. It seems glaringly obvious to me that doctors are failing to scare people into making healthy living choices, so it seems we need to somehow change our habits as a community, for the good of the whole. Trying to get people to change their habits for their own long-term good clearly doesn’t work but given the opportunity, people will work towards something that is bigger than themselves.

To paraphrase Charles Duhigg from his book “The Power of Habit”: A movement starts because of the social habits of friends and close acquaintances, it grows because of the habits of communities and the weak ties that hold neighborhoods and clans together, and it endures because participants learn new habits that create a fresh sense of identity and a feeling of ownership.

We need a wellness movement.

Movements require communities of people – people who come together to participate in achieving something larger than themselves.  If we work on it together, we can help each other create new habits and establish new self-identities towards the common goal of being a more productive nation and decreasing our debt (all with the nasty side-effect of individually living longer and healthier lives, but keep that to yourself).

So, where is this community going to come from, who is going to lead and organize it?

Dream with me… it goes something like this:

On my health plan’s web site I opt in to the Well Club. It is going to cost me $150 per year out of my own pocket to be a member but I will easily get double that in value if I participate fully. Participation means that I take advantage of discounts on gym memberships, fitness and wellness devices, I use my earned activity points to apply to co-pays for insurance claims, etc, etc.

As part of signing up I sign a pledge that I will engage in the Club’s activities and events and I will leverage the tools available  in order to do my part towards the Club goal of lowering the total dollars spent on health care for all members. I’m not just signing up to get some discounts, I’m pledging to do my part to make a difference. I’m paying for the opportunity to participate, to make that pledge, and I’ll be reminded of it frequently.

As mentioned, there are many ways to participate in the Club. A few default participation options are preselected – allowing me to opt out or just keep the defaults. I look over some of the choices and in addition to the defaults, I decide to join a local team of Club members who live near me and meet in-person on a regular basis to walk together. I’d like to meet some new friends in the neighborhood anyway. I stick with the default to commit to drinking 8 glasses of water every day and tracking my progress and the I also choose to purchase one of the subsidized activity tracking devices (Fitbit or Jawbone Up or ??) and connect it to the Club mobile and web apps so everyone on the team can see each others progress towards their personal goals. As part of tracking my activity, I also commit to tracking my weight and blood pressure and agree to allow this data to be made available to my primary care physician in a summary form twice a year.

The local team I choose to join (they call themselves the “Dead Presidents” – after the street names in this part of town) regularly does these “Walk Quests” that last 14 days. A Walk Quest is an example of a gamified wellness tool provided by the Well Club. In a Walk Quest, each team member participating commits to walking a stretch-goal number of total steps during the two weeks – resulting in one single total goal for the team. It’s fun, we use the app to stay in contact with each other during the Quest, encouraging everyone to stay on track and do their part and sometimes helping out by walking extra steps when a team member is stuck at home with a sore back for a couple of days. As we complete Quests, we get to publish the results and that gives us some serious bragging rights in comparison to other team’s efforts.

The Club has a meeting place not too far from where I live with an auditorium and a bunch of smaller meeting rooms. I can go there and attend talks on nutrition, exercise, diabetes management, the list goes on and on. The talks are also recorded and available online. They show a movie outside in the summer on Saturday evenings – the movies are old and a bit lame, but it’s a great chance to put on my Dead Presidents t-shirt and meet other Club members not on our local team. The t-shirts were a reward that all team members earned for completing 4 Walk Quests in the past 6 months.

In one of the talks I attended I learned that lowering healthcare costs isn’t just about learning to live a healthier life. I can also help lower the Club total by talking to my doctor about switching to a generic version of a drug I take and driving a bit out of my way to get some lab work done. It turns out that the lab near my house actually costs my health plan 3 times more than the one across town – for the exact same test. It’s a $20 copay for me either way, but I want to do my part to see that grand total number for the Club continue to come down in comparison to regional averages.

On the Club web site I can actually log in and see the total of my exact health care expenditures for the year – including the portion paid by the health plan and the portion paid by me out of pocket. I can see how my total expenditure is trending over time and I can compare this to average numbers of other people like me – that really helps me see how I am contributing to the goal of lowering healthcare costs in this country.

The Club has a handy discount card that gets me discounts around town, I use it to shave a few bucks off my monthly gym membership and there are a few vendors at the local farmers market who give me a deal with it. My wife is always reminding me to use my Club card at various businesses around town but I’m not much of a discount seeking guy, I joined to get my Up and become a member of the Dead Presidents.

Regardless of whether it pays for itself or not, I’m having fun, and this thing is spreading across the nation, all major insurance companies are doing it and our team is in the top 30% in the nation on sticking to our goals and lowering our expected future healthcare costs and BEEP BEEEEEEEP… BEEP BEEEEEEEP …..  BEEP BEEEEEEEP

Wake up… you’ve been dreaming too long, let’s get back to the real world.

Can a health plan do this?

You may be thinking that this sounds similar to various employer wellness programs. But unfortunately, employer wellness programs are not seemingly helping. RAND just completed a congressionally mandated analysis that concluded (per Reuters) that “programs that try to get employees to become healthier and reduce medical costs have only a modest effect”.

It may sound similar, but I’m not talking here about a wellness program for your long term benefit, or even for your employers benefit – I’m talking about a movement for the sake of the ongoing leadership position of our nation in the world.  I’m talking about a movement, a new national identity. (I know, we woke up from that dream, but I’m going to keep dreaming.)

Doctors are clearly not the answer – they fix us when we are sick – they don’t start movements. And by law doctors are restricted to helping one person at a time and keeping it private so they have no idea how to go about using the weak ties of an existing community to create a wellness movement. And <cynic alert>they have a perverse incentive for you to stay sick </cynic alert>.

So who is left, the government? (I hope you’re laughing right along with me right now.)

First, I’ll suggest a fundamental reason why this may not work, just to get the bad news out of the way and let the day dream continue: Health plans today are health insurance companies; that’s pretty much it. They serve a very specific market-based function – the transfer of money from insured members premiums (usually via their employers) to medical providers for the reimbursement of medical care. In this role insurance companies have to make cold, hard business decisions that affect the lives of their members. The relationship between health plan members and the health plan is thus a very strict market-based relationship. But this concept of a health “club” implies and requires a strong social component. Dan Ariely, in his book “Predictably Irrational” indicates that research has proven how hard it is to mix market norms with social norms (don’t ever leave $30 on your mother-in-law’s dining room table as a way to thank her for having you over for dinner!)  Is it possible to be an insurace company and a health club? I’m not sure, maybe the tendencies of human behavior won’t allow it – we’re going to have to ask Dan.

But it seems to me that health plans have a financial interst in lowering the amount of money spent on health care, they may be the only ones that do. And as it stands today, everybody hates health insurance companies, so this could be a chance to establish a new kind of a brand with members, a new relationship with the ultimate user of the system – the members.

And when it comes to our health, nobody knows more about you and me than our health plans do. They know every prescription you actually take; they have every diagnosis, every procedure, every trip to the ER; they have lab results; they know it all – way more than any one of your doctors. Health plans are the only ones who know how much you are actually spending on health care.

Up until now, they have just kept all of this “big” data locked up in a secret vault. They don’t use it to help establish a better relationship with the very person the data represents –  you! Instead, they are seemingly willing to sit back and be labeled the evil business man in the healthcare equation.

If not health plans, then who? Imagine, it isn’t hard to do (sorry, but I had to).

About Mark Feinholz

Software developer, architect, technical product manager. Inspired by technology to help us live happier and healthier lives.
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  1. Pingback: Employer-provided Health Insurance Is Stupid | mark feinholz – software, healthcare & stuff

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