Adam Bosworth, Keas Founder and CEO
This country has a devastating task just paying for our current health care system. We are spending about $2.4 Trillion dollars each year which, if you assume that only about 100MM people have any sort of serious issue at all, resolves to a cost of $24,000 per person. Worse, it is on track to grow to $3.4 Trillion in just 5 years. Indeed, Wellpoint, a major insurer, recently tried to raise their rates for insurance 39% in a single year in a time of almost no inflation. What is well known is that much of this cost, certainly more than half, can be greatly reduced if people actually take care of their health, take their medicines, exercise appropriately, eat with some care, avoid stupid things like smoking, and get the right check ups at the right times.
All of this is called “patient engagement.” And it isn’t working.
Eating habits and exercise habits are worse. Many medicines are only used 30-40% of the time by people for whom they are prescribed and appropriate routine examinations which could nip things in the bud don’t happen when they should. We’re going broke paying for this.
Why isn’t it working?
When you get right down to it, it isn’t working because no one is paid to keep people healthy. Indeed, the current “health care system” is largely paid more if people stay sick. So there is little money flowing into programs to help people stay healthy. Since relatively little money is flowing, there aren’t particularly good or engaging tools to help people manage their health. Consumers out there aren’t that motivated because they don’t have real skin in the game and it is work now for benefits later. By contrast, in automobile insurance most people have learned to avoid getting too many speeding tickets or driving drunk because they DO have skin in the game. At the same time the industry has developed better tools to teach people good driving habits.
There is a simple solution for this. Learn from automobile insurance. We spend $2,400 Billion dollars a year treating sickness. There are about 100MM Americans who either have a chronic condition or who are overweight and heading that way or both. Provide the same trade the automobile industry does. Take 1% of the money we spend on getting sick and use it to actually improve health. How? Provide material incentives to those who are making steady headway in the metrics that matter, cholesterol, blood pressure, BMI, getting their checkups at the right times, smoking less or not at all. Don’t pay for “plans”. Pay people for results and progress. And pay the people who advise them, ideally their Primary Care Physicians, if, and only if, these patients actually make material progress.
As a straw man proposal, let’s pay $600 each year for material improvement, $100 to the person actually making the required improvements and $100 to their physician/coach. Conversely, let’s charge ALL at risk patients who aren’t making progress an additional $400 / year (income adjusted) as a mandatory health insurance fee. Now, let’s assume that at any given time 40MM people make steady progress and it takes them 4 years to reach the point where they should be. In reality, fewer will do this, but use this number just to cost out this idea. We will pay out $24 Billion a year or 1% of what we’re currently spending. 60MM people won’t do it and from them we collect $24 Billion. That’s skin in the game. If you’re making improvement you’re $1,000 richer than if you aren’t. Those are real incentives. And it will fund the training and online tools required to help people meet the goals for material improvement that actually pay out for them.
One more thing is required. People MUST have access to an electronic copy of their health data, especially their test results (e.g. cholesterol, HDL, LDL, Hemoglobin A1C, Blood Pressure). People can’t improve what they don’t know and engagement strategies cannot help them to hit targets for measurable improvement without knowing their current data. Online tools need the data electronically. Just as an online retirement calculator needs some data, so do these tools.
Give people both access to their data and skin in the game and watch the change. There is over $1,000,000,000,000.00 each year at stake in decreased costs if this works. And innumerable lost lives and suffering. That’s what we have to lose.
About Adam Bosworth
Adam Bosworth is a technology leader and innovator who was instrumental in building numerous technology products, including Google Health, Microsoft Access, Microsoft Internet Explorer, and BEA WebLogic Integration and Workshop.
After facing serious family challenges with the health care system, Adam decided to transition from 25 years of building databases and software to apply this knowledge and pursue his passion for helping people become healthy and well. He founded Keas in 2008 to bring together the latest technology, medical information, and wellness programs to inspire, motivate, and reward consumers to better manage their own health care and live healthier lives.
Prior to starting Keas, Adam was vice president of engineering at Google, Inc., and was instrumental in the development of Google Calendar and Spreadsheets. He then headed Google Health, a personal health information centralization service.
