Healthcare Only Affects Outcomes by 20%

Figure 1 - Courtesy of UCLA Health

Introduction

In a widely circulated study done by the County Health Rankings and authored by Carlyn M Hood , Keith P Gennuso , Geoffrey R Swain , Bridget B Catlin, the authors “suggest that approximately 40% of modifiable determinants of health are due to social and economic factors, 30% due to health behaviors, 20% due to clinical care, and 10% due to physical environmental factors.”  We spent 4.4 trillion dollars, 17.3% of the gross domestic product and barely moved the needle?  Today we will discuss why this is and what can be done about it.

The Problem

The only people who have “skin in the game” are the patient and the insurance company.  Big business and the quest for ever increasing profit has forced the doctor to just a few minutes per year per patient.  This means that the doctor doesn’t and can’t have the time to sit and explain to the patient why it is they should behave a certain, healthy way.  The patient is the ultimate arbiter of his or her own health, but “eat right and exercise” is so vague that it usually falls on deaf ears. Insurance companies are only interested in status quo, making money and quite literally don’t have time or energy to educate patients.  It is not their responsibility.  

Patient Behaviors

If only 20% of the “determinants of health” are in medicine, what about the other 80%?  Social and economic factors are the largest determinates.  If more people could afford health care that would basically be a zero sum and be the same as everyone else.  The 30% cited for health behaviors, like smoking, are completely avoidable.  The 10% for physical and environmental factors are also avoidable since genetic factors are ignored for this study.  With a reduction in cost and an education of what to do and what not do, why and what the consequences are, we should be able to mitigate or eliminate the 80% quoted in the study by reducing cost and modifying unhealthy behavior.  

Big Insurance

At its core, a health insurance company is just a bank.  This bank takes your money and holds on to it in the event that you have a health problem, then they pay for your care.  If that is the case, then all the things they do that AREN’T ‘write a check to your doctor’ is wasted time, effort and money.  Your money.  If you aren’t healthy, they don’t care.  They will add the cost of your bad decisions to the demographic you inhabit and charge everyone more.  
If we look at health insurance a slightly different way, we may see that the insurance company has an interest in keeping you healthy.  We will discuss how to execute this at some length below.  If you are healthy, you should consume fewer healthcare resources.  This is the big disconnect with health insurance.  Couple the greed and incompetence of the health insurance companies with the lack of education in the public and you have a recipe for the highest healthcare costs on the planet.  

If the doctor can’t affect these outcomes, due to time and budgetary constraints, and the patient can’t because they just don’t know what they don’t know, then that leaves big insurance.  If the insurance companies came up with a way to prescribe education based on your test results, then they could affect the behavior and influence the outcomes positively.  We all know this isn’t going to happen.  Bankers only care about money and they have no interest in upsetting the apple cart and trying something new.

The Solution

What we need then is an entity that can get all this done, that can automate all these processes and not only supply the necessary education to the patient, but put some teeth in it by taking lab results into account and pricing policies accordingly.  

A New Kind of Insurance Company

What we are describing here is a completely new way to look at the insurance problem.  Keeping patients healthy through education reduces costs for everyone.  The insurance company knows what your lab results are because it pays for them.  It wouldn’t be difficult then to compare your results with normal and not only alert you about the differences, but create a plan to get you back to normal.  That’s exactly (part of) what we have done here at Sentia Health.  

The Idea and the Execution

If we are going to make a new kind of insurance company, we may as well make a new kind of insurance.  If this new company wrote and provided an electronic medical record and gave it to the practitioners free of charge, then we could avoid the cost of medical coding.  This saves the practices money and ultimately the patient money.  If we gave the patient access to his or her medical records, we could avoid phone calls and correspondence.  The patient could simply log in and look at his or her results.   If we integrated something like Krames online patient education (and we have) based on the test results and procedures performed, then we could ensure that the patient receives the education they need to stay healthy along with pre- and post-procedure instructions.  If we then had a way to track (and we do) what education the patient has seen, we could offer discounts for simply reading the education.  If we then tracked the lab results of the patient year over year, or checkup to checkup, then we could see the actual results of the education.  We could then offer discounts for not getting worse year over year.  Yes, we are all going to get worse as we age, but this is a known quantity.  

So, for eliminating everything that isn’t ‘write the practice a check,’ we will eliminate 50+% of the cost of health insurance.  Eliminating medical coding, the purchase of a medical records system and all the ancillary things that can be automated should save the average practitioner about $73,000 per year. Informing the patient, and tracking his or her progress will have a larger benefit than the entire medical industry if this study is to be believed.  We believe it, medicine is currently about treating disease.  Conventional wisdom, while sometimes misguided, is probably completely reliable with “an ounce of prevention is worth a pound of cure.”

The 80% of the health outcomes not addressed by the current healthcare system boil down to cost and behavior.  We have addressed cost by showing a 50+% reduction in price, and behavior by educating the patient on what is wrong with them, how to address and mitigate it, and rewarding measured progress toward health.

Conclusion

Today, we have shown a way to improve the health of every man woman and child in the United States buy multiples more than the entirety of the healthcare system.  By educating the populous of the effects of their decisions and automating processes and eliminating waste, we can cut at least half out of the cost of health insurance.

We have built a comprehensive health information system to keep the patient healthy and on the right track with the ability to incentivize healthy living.  Implementing this system should be fairly simple and will completely revolutionize the way healthcare is paid for, saving countless lives.  We have shown a way to use this system to make the best healthcare system in the world also the most efficacious and the most affordable.