Category Archives: Vitality

Press Release: Healthcare X PRIZE release Initial Prize Design for Public Comment

As I mentioned yesterday, I have been actively involved in the development of the Initial Prize Design for a potential Healthcare X PRIZE. Today I was able to attend a star studded event as described below and have enjoyed the early buzz and feedback thus far.
Looking forward to your comments and ongoing interest as we refine the Prize over the coming months. The Press Release:

WASHINGTON (April 14, 2009) — The X PRIZE Foundation, a nonprofit organization that drives innovation through large incentive competitions, in collaboration with the WellPoint Foundation, one of the nation’s largest private foundations, and WellPoint, Inc. (NYSE: WLP), the nation’s largest health benefits company in terms of medical membership, announced today the initial competition design for a $10M+ Healthcare X PRIZE.

The Grand Challenge for this Healthcare X PRIZE will be to create an optimal health paradigm that empowers and engages individuals and communities in a way that dramatically improves health value. Following today’s announcement, the public is invited to comment on the approach and provide feedback to ensure that the competition results in affordable, high-quality health care for all communities. An overview of the initial prize design and guidelines are available for public comment at www.xprize.org/wellpoint.

The initial X PRIZE design was announced jointly by Dr. Peter H. Diamandis, chairman and CEO, The X PRIZE Foundation and Angela Braly, president and CEO, WellPoint, Inc. They were joined by the Hon. Bill Bradley, former U.S. Senator, and managing director, Allen & Company LLC, and the Hon. Newt Gingrich, former Speaker of the House and Founder, Center for Health Transformation, for a health care discussion moderated by Susan Dentzer, editor in chief, Health Affairs.

“President Obama has called for bold new ideas to revitalize our health care system. We are answering that call by developing an innovative incentive prize that optimizes the health of all Americans and significantly increases the value from every health dollar,” said Dr. Diamandis. “This is not the situation today and we need to change it. Ultimately, you get what you incentivize. If we can refocus our health care system on helping individuals optimize health, and reward providers who improve outcomes, the implications over the next decade will be profound.”

“I’m very pleased to be part of this developing X PRIZE competition,” said Sen. Bradley, “This prize will bring together people from different elements of the health care system and get them collaborating to devise a new system that will produce the highest quality health care for the greatest number of people at the lowest possible cost. The greatest key is tapping into the American people; if you’ve got a great idea, put it forward.”

The collaboration between The X PRIZE Foundation, WellPoint, Inc. and the WellPoint Foundation to design a $10M+ Healthcare X PRIZE was announced in October 2008. Since then, hundreds of comments from the public and leaders across the health care industry have been collected from The X PRIZE Foundation Web site to create the initial design announced today.

“From across the health spectrum physicians, consumers, entrepreneurs, technology experts, government officials and others have already contributed their time and expertise to developing a meaningful prize design,” said Angela Braly. “Now we ask the public and interested stakeholders to take a look at our initial design and share ideas on how we can use a Healthcare X PRIZE to create a dramatic improvement in the health of our families and communities while simultaneously improving affordability.”

The X PRIZE Foundation’s health care prize development team and WellPoint collaborated with prominent health care providers, thought-leaders, academic and political advisors from across the nation to identify key components for a health care focused incentivized competition. Key advisors include: Dr. Glenn Steele, CEO, Geisinger Health System; Dr. Jim Weinstein, director, Dartmouth Institute for Health Policy and Clinical Practice; Dr. Carol Diamond, managing director, Markle Foundation; Mark Litow, principal and consulting actuary, Milliman; Dr. Dean Ornish, president, Preventive Medicine Research Institute; Michael E. Porter, professor, Harvard Business School; Hon. Bill Bradley, former U.S. Senator; and Hon. Newt Gingrich, former Speaker of the House and Founder, Center for Health Transformation.

The proposed $10M+ Healthcare X PRIZE is designed to improve health value by more than 50 percent in a community during a three year trial. A competition around value measures and compares health outcomes against the total cost of care for a community. Health outcomes would be measured by a “community health index,” which combines functional health (e.g., reduced sick days, improved ability to climb stairs) and clinical events (e.g., visit to ER, rehospitalization). Total cost would include direct costs incurred across health benefits, payroll (sick and disability pay), coupled with out-of-pocket health care.

“We have a challenge of how we pay for things. In many ways, we over pay for acute care and we underpay for preventative care and wellness,” said Speaker Gingrich. “This approach allows for significant improvements that would lead to better health outcomes, which would lead to longer, more active lives and do so at lower costs.”

Under the proposed competition framework, teams would have 18 months to conceive, model, and submit plans to create a new paradigm that can impact the health status of individual participants as well as the overall health status of communities. A later pilot phase will be used to demonstrate that the models can successfully be applied on a small scale. To select finalists, the competitive field will be narrowed to approximately the top five performers as judged by an objective process currently under development. During the competition stage, the five finalists will be matched to a test community of 10,000 individuals and compared against a control group during a three year real-world trial. WellPoint, together with its affiliated health plans, has committed to collect appropriate data and collaborate with employers and providers to set up the test communities, subject to validation by an independent third party. The competing team’s ability to change incentives is expected to drive improved behaviors across consumers and providers.

“We appreciate the tremendous support and advice we’ve received from the health community as we’ve shaped this effort,” said Dr. Vijay Goel, director of Prize Development, The X PRIZE Foundation. “By engaging individuals through the creation of a personal vitality score to help them understand their health options, and then measuring the impact of their choices at the community health level, we can create new approaches to achieve optimal health in a convenient, proactive, and effective way. We see the Healthcare X PRIZE effort as a public-private collaboration that makes affordable health care for working families a sustainable reality.”

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The Vitality Index: The Return of the Health Care FICO Score

Vitality (vī-tăl’ĭ-tē)

  1. The capacity to live, grow, or develop.
  2. Physical or intellectual vigor; energy.
  3. The characteristic, principle, or force that distinguishes living things from nonliving things.

I am finding it hard to use financial analogies these days to explain health care concepts given recent events. It’s analogous to the feeling you get when you accidentally use the word “maverick”. But despite the meltdown, I still find the Health / Wealth construct to be very powerful way of effectively communicating emerging health care reform ideas.

One of those worthy health/wealth constructs is the concept of a Health Care FICO score. I originally proposed this back in September 21, 2007 to some mild interest but mostly concern regarding its potential misuse. My efforts to define the Health Care FICO Score concept were unfortunately put forth right about the time another company was trying to develop a new model for rating health care debt differently than traditional debt (I believe that poor idea and confusing concept has appropriately died).

To rehash, I believe their needs to be a singular score, or more appropriately an index, that provides an indication of my health status. It cannot just be one measure, or provide one perspective, but a comprehensive scoring of all the important aspects of my health (health status, behaviors, satisfaction, risks, etc). An “index score” also means that it is weighted in order to normalize for race, genetics, geographies, or other factors. This sounds complicated, and I agree that it might be, but I also believe these complexities can be abstracted out into a little black box managed by statisticians, researchers, and academics as a best effort to create the health index. I don’t think people really care, or even understand, how we arrive at a financial FICO score, but they certainly care what their number is and what it means to their financial health.

The financial FICO score could, and probably should, be considered an “asset” that requires management, protection, and efforts to improve it. The FICO score is universally understood to be a surrogate measure of the level of risk one assumes in lending money to the individual. Lenders use the FICO score to determine if they want to “invest” in a relationship with the individual that is mutually beneficial. Depending on the FICO score, lenders may alter the terms up or down depending on their tolerance for risk and reward. These differential rates are the hallmark of the system and allow for natural risk selection based on behavior, choices, and past performance. It works reasonably well because we all can understand and in general agree what the FICO score means. It is not perfect, and there are problems (and occasional abuses), but in general it is effective.

I don’t see why my health asset should be any different. I think knowing my Health Care FICO score would be very valuable to me personally, would be valuable to my physician, and should be used to help create differentiation in the services I choose to invest in my health. The Health Care FICO score should be a roll up of many different measures that are indicators of my health – both traditional quality metrics as well as new vitality metrics that measures ideas such as satisfaction, nutritional status, wellness/fitness, functional status, etc. In fact, we should not just consider health the absence of disease but rather we should consider health something that we are actively pursuing. Therefore if disease subtracts from my health (or a normalized health index of 100), perhaps someone with diabetes scores an 65. However, when appropriately managed (checking glucose 3X per day, HbA1c <7.0, annual optho exam, etc), perhaps they can shoot up to an 85. However, when they become an activated patient (average sugar 120, active nutrition, exercise program), perhaps their score normalizes back to “Health Baseline” of 100.

On the other hand, a healthy individual (traditionally defined by the absence of disease), is not necessarily a ‘healthy” person. Perhaps they are the pre-diabetic, overweight, underexercised, poor nutrtion individual who is just a time bomb. The Health Care FICO score should be able to adjust for increased levels of “vitality” – active health promotion efforts wherein the individual can be rewarded for health choices and behaviors. Therefore this person can raise their Health Care FICO to 120 with getting BMI in line and cholesterol down but move to 140 as they demonstrate their vitality – active fitness programs, nutritional intake, and online community participation.

This range of scoring could be used in multiple ways, most good but clearly some bad. The key to this concept would be to come to some agreement on what metrics matter, what activities actually produce the results we want, and validate the rules/data collection so that we can actually create a reliable score. There wouldn’t need to be just one aggregated scoring system either – in the FICO world we have three companies who provide this service – and the information is used to triangulate risk assessment (each company has slightly different ways in which calculate the score).

The notion of a Vitality Index can be powerful, but it is fraught with complexity and challenge. I believe the value of having this single, agreeable index could unlock the next wave of payment, performance, and value transformation required to move our health care to a 21st century system of care.

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Filed under Consumerism, Transparency, Value, Vitality