Wednesday, March 18, 2009

Individual Vitality Score: Why Health Care Needs a FICO Equivalent

Dr. Shreeve posts some interesting comments relative to the challenge and the necessity to measure health care impact at both the patient and community levels.

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,>

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.

Tuesday, March 17, 2009

Scott Shreeve, MD to join the Health X PRIZE in pursuit of Revolutionary Breakthroughs

Noted open source and heath 2.0 advocate to join Health X PRIZE team in health system reform effort

Scott Shreeve, MD announces his participation in the Health Care X PRIZE development process in a blog post on March 2, 2009. Using the metaphor of the original moonshot, Scott described his reasons to join the effort:

I have always dreamed big, and sought impossible challenges, and for this reason I am excited to announce my association with the X PRIZE Foundation as a Senior Health Advisor. This very discrete project (through June 2009) is solely focused on defining a Health Care X PRIZE that can leverage a well described competition as the catalyst for transformative change. Over the coming months, I will be meeting with corporate executives, policy experts, government officials, thought leaders, patient advocates, and others interested in engaging in this work to to define the “health care moonshot”. The X PRIZE framework has specific competition constraints, a unique investment multiplier effect, and holds the promise of organizing many of the best and brightest reform efforts currently underway in our country. I look forward to working with Dr. Peter Diamandis and Robert Weiss on this very exciting project.

I will also look forward to speaking with many of you, sharing our findings and research as we proceed, and engaging the broad health community and ultimately our entire country to join in the inspirational effort to transform our health care system. Please feel free to contact me directly with your interest, your X PRIZE ideas, or to discuss how you can help be a part of the “Health Care Moonshot”.


We look forward to having Scott join the team as we seek revolutionary breakthroughs using the unique X PRIZE Competition framework.

Monday, March 16, 2009

WellPoint Innovation Team to lead Health X PRIZE Collaboration

Chad Pomeroy and Pam Rogers to keep Wellpoint at the edge of innovation and health care reform through investment in X PRIZE process

Wellpoint has made a concerted effort over the last several years to stay at the edge of health care innovation. Beginning with their acquisition of Lumenos in 2005, Wellpoint has made a series of investment in health care consumerism. In addition to these acquisitions, Wellpoint has also conducted a series of Innovation Conferences wherein they recruit the best and brightest health care startups to showcase their solutions with the winner getting an opportunity to implement within Wellpoint's network. These efforts are part of an overall innovation strategy by Wellpoint that included the creation of a distinct Innovation business unit.

Heading up that unit is Chad Pomeroy, who came to Wellpoint as part of the Lumenos transaction. Chad has been a long time leader in health care consumerism and empowering patients with information, tools, and technology that allows them to more fully engage in their health. In fact, Chad is an industry recognized leader in consumer driven health plan design and developed a unique claims payment system designed specifically for HRA/HSA's. At Wellpoint, he has led the innovation efforts and his team has demonstrated a capacity to create, test and bring new ideas to market quickly. This has helped WellPoint maintain a leadership position within the rapidly evolving health plan industry. Chad was the primary driver of engaging with the X PRIZE to push this unique innovation model forward.

Chad is assisted in the Health X PRIZE development effort by Pam Rogers, who is the Executive Direct of Consumer Innovation for Wellpoint. Pam has been with Wellpoint (originally Anthem BCBS) since 1993 and served in a variety of leadership roles in product development and client implementation. During her tenure she has led cross-cutting projects in many disciplines, including business development, operational performance improvement, quality assurance and data warehouse management. She has a personal interest and professional focus on health care finances and was responsible for implementing Wellpoint's HRA / HSA products across the enterprise. She has a passion for leading edge innovation and is a great operational complement to Chad's leadership.

Beside the obvious $10M PRIZE purse that has already been donated, Wellpoint has organizationally committed to funding the PRIZE process, development, interim awards, and contest management. This commitment includes wide ranging access to Wellpoint internal resources including other members of the innovation team, product development, analytics and measurement, actuarial staff, and marketing and public relations. Perhaps most valuable, Wellpoint has committed to providing its membership base as potential pilots for the top five solutions to emerge from the contest for actual implementation. This will dramatically impact the speed of adoption of a potentially breakthrough solution.

Its been impressive to see the largest health benefits company step forward and commit to the X PRIZE framework as a new model of innovation worthy of this level of commitment. I believe they see, or perhaps more appropriately believe at this stage, that revolutionary breakthroughs are possible through well designed competitions that can inspire, can give hope, and deliver results. Looking forward to this effort making a dramatic impact on our health system.

Sunday, March 15, 2009

Vijay Goel, MD to lead Health Care X PRIZE Development Process

Vijay Goel, MD to lead effort to work with national thought leaders to develop Healthcare X PRIZE.

Vijay Goel, MD recently announced in late January that he was joining the X PRIZE Foundation as the Director of Prize Development over the health prize. Vijay has a long history of innovation and entrepreneurship, most recently focused on new models to engage and empower consumers by helping them to "shop" for healthcare services and appointments.

In Vijay's own words:

As some of you know, I've taken a new role with the X PRIZE Foundation...they offered me an amazing role in designing a X PRIZE for healthcare-- finding the market failure in the health sector that can best be solved by a competition for a $10M+ prize.

The mission is amazing...define a competition to showcase competitors that will definitively improve quality while reducing costs. The execution will be challenging-- defining the appropriate scope of this particular prize where teams can clearly understand the start and finish lines and a clear winner can emerge.

At present, we're looking to define the best space to start, so please let me know if you would like to share your insights on addressable issues that would make for a good competition.

Here's to healthy innovation in healthcare as we kick off 2009!

Looking forward to having Vijay lead the team effort to develop the Health X PRIZE.

Thursday, March 12, 2009

X PRIZE Foundation teams with WellPoint and WellPoint Foundation to create Health X PRIZE

First industry-specific X PRIZE in health care or insurance would be at least $10 million WellPoint plans to test finalists’ proposals in real-world situations in company’s state plans

INDIANAPOLIS – October 15, 2008WellPoint, Inc. (NYSE: WLP), the nation’s largest health insurance company in terms of medical membership; the WellPoint Foundation, one of the largest corporate foundations in the United States; and the X PRIZE Foundation, the nation’s pre-eminent philanthropic organization focused on innovation through competition, today announced a landmark collaboration to develop a $10 million or more competition designed to generate new ways to address the nation’s serious health care system challenges.

“WellPoint and its Foundation recognize the challenges facing our health care system are substantial, which is why it’s critical for health benefits companies, health care providers, government leaders, and consumers to work together to identify real-world solutions that will create the most benefit for all Americans,” said Angela F. Braly, president and CEO of WellPoint and member of the WellPoint Foundation board of directors.

Braly added that although WellPoint has made great progress in health care innovation through solutions that address transparency, affordability, access and care quality, “we’ve chosen to partner with the X PRIZE Foundation and solicit the best ideas from all parties because we believe that the stakes are too high and the opportunity too great to not do everything we can with any and all willing partners that may identify the next great solution in health care.”

As part of this groundbreaking collaboration, WellPoint and the X PRIZE Foundation will solicit participation from employers, health care providers, consumers, government partners and any other interested parties to develop competition guidelines that reflect the health care industry’s most pressing challenges. In addition, WellPoint has committed to test the selected finalists’ entries in its state markets, in order to test their ability to result in viable, creative and achievable health care system changes. Transparency will be emphasized throughout the process, from development of the prize to the conclusion of the competition. All results will be shared publicly, with the knowledge gained considered non-proprietary.

An X PRIZE competition awards a minimum of $10 million to the first team to achieve a specific goal set by the X PRIZE Foundation. Rather than awarding money to honor past achievements or directly funding research, an X PRIZE incites innovation by tapping into the competitive and entrepreneurial spirit of individuals and teams to revolutionize industries for the benefit of humanity.

“We believe significant innovation is achieved when companies and individuals are motivated by the chance to compete among their peers to design and implement groundbreaking solutions to the significant challenges facing us,” said Dr. Peter H. Diamandis, X PRIZE Foundation chairman and CEO. “After launching competitions for sub-orbital flight, lunar exploration, rapid human genome sequencing and a 100 mpg car, we have decided to tackle a new, immense challenge: America’s health care system. WellPoint and the WellPoint Foundation are the right partners for this venture and we are excited by the prospect of more companies joining our team.”

This unique approach to tackling the nation’s health care system’s challenges drew praise from the business community. “We should look for every opportunity to drive down inefficiencies, to try new things, and to pilot different initiatives and not be afraid to restructure them or retool them as we go along,” said Virginia Proestakes, health benefits program leader for GE. “I think the time is right for innovation and bright, new, imaginative ideas, which is why a health care X PRIZE is so important to us at GE.”

Public policy leaders agreed that this approach could yield substantial results. Former Speaker of the U.S. House and founder of the Center for Health Transformation, Newt Gingrich, said that the proposed approach is “going to generate a whole new generation of conversation. And you’re going to have thousands of people talking among themselves about the fact that the X PRIZE Foundation and the WellPoint companies have come together to fundamentally rethink the financing and payment of health care. That is such a profound application of the prize concept to social public policy that I think it’s a terrific breakthrough.”

“I am pleased to be a part of this WellPoint/X PRIZE health care competition,” said former U.S. Senator Bill Bradley. “I see it as a way for maximizing the involvement of the American people in two of the thorniest problems in health care – payments and delivery. The result of this could positively impact the direction of health care reform in the next decades.”

Key health care leaders also endorsed the proposed competition. “People who become nurses, medical technicians, doctors and pharmacists are in this area of work for one primary reason: it feels good to make people better,” said NewYork-Presbyterian Hospital President and CEO Dr. Herbert Pardes. “If you then pull them together and say ‘can we find ways of giving people better treatment, more patient-focused care and save the nation some money in doing it,’ then they’re going to feel terrific, everybody will be better for it, and the competition authors can take enormous credit for stimulating a very productive movement and idea.”

Another leading health care expert, Westchester Medical Group President Dr. Simeon Schwartz, agreed that such a competition could lead to dramatic improvements. “The only way that we will achieve fundamental change in the health care system is to reach a consensus for meaningful change largely supported by the public. We need to refocus the public on the redesign of our delivery system and on improving the value in health care. I believe that the prize can generate the interest necessary to do just that.”

At this time, WellPoint, the WellPoint Foundation and the X PRIZE Foundation are announcing their intention to collaborate to develop a prize; the actual award amount, competition rules and guidelines are expected to be finalized in early 2009. The X PRIZE Foundation, along with noted experts in the field, will independently lead the competition. WellPoint has agreed to test the viability of selected solutions in its markets.

To learn more about the competition, see what key opinion leaders are saying about it, and to participate in the development of the prize, please visit www.xprize.org/wellpoint.

About WellPoint, Inc.

WellPoint, Inc. is the largest health benefits company in terms of medical membership in the United States. WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at www.wellpoint.com.
About the WellPoint Foundation

About the WellPoint Foundation, Inc.

The WellPoint Foundation, Inc. is a private, non-profit organization wholly funded by WellPoint, Inc. Through charitable contributions and programs, the Foundation promotes WellPoint’s inherent commitment to enhance the health and well-being of individuals and families in communities that WellPoint’s affiliate health plans serve. With combined assets of $200 million, the Foundation focuses its funding on strategic initiatives that address and provide innovative solutions to reduce the number of uninsured as well as organizations that promote the Healthy Generations Program, a multi-generational initiative that targets specific disease states and medical conditions. These disease states and medical conditions include: prenatal care in the first trimester, low birth weight babies, cardiac morbidity rates, long term activities that decrease obesity and increase physical activity, diabetes prevalence in adult populations, adult pneumococcal and influenza vaccinations and smoking cessation. The Foundation also coordinates the company’s annual associate giving campaign and provides a 50 percent match of associates’ campaign pledges. To learn more about the WellPoint Foundation please visit www.wellpointfoundation.org.

About the X PRIZE Foundation

The X PRIZE Foundation is an educational nonprofit prize institute whose mission is to create radical breakthroughs for the benefit of humanity. In 2004, the Foundation captured the world’s attention when the Burt Rutan-led team, backed by Microsoft co-founder Paul Allen, built and flew the world’s first private spaceship to win the $10 million Ansari X PRIZE for suborbital spaceflight. The Foundation has since launched the $10 million Archon X PRIZE for Genomics, the $30 million Google Lunar X PRIZE, and the $10 million Progressive Insurance Automotive X PRIZE. The Foundation and its partner BT Global Services are creating prizes in Space and Ocean Exploration, Life Sciences, Energy & Environment, Education and Global Development. The Foundation is widely recognized as the leading model for fostering innovation through competition.

For more information, please visit www.xprize.org.