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.