Just back from the energizing Health 2.0 event , reading your post re. Hcare FICO . Actually , a similar service does exist in The Netherlands – as a semi government health agency ( Institute for Prevention and Early Diagnosis ) pilot , with some VC co funding .The original objective was to carve out the high risk population and make screening much more effective and efficient at an early stage . The program is highly successfull – not suffering from some of the negative side effects Archana refers to in her comment to your post .

Through web questionaires and simple lab tests ( urine,stool,blood in a do it yourself at home kit sent to a lab a la DNA direct ) , the subscriber gets a personal health ( risk ) profile , updated yearly , on a personal and encrypted web page . It is called the ” Prevention Compass” – including other than your web page a card to entitle for an array of various incentives/discounts with 3rd parties in the wellness and lifestyle business . Other than the trivial tracker stuff for weight etc , the web page does include extensive recommendation how to go about changing behaviour , anf if the risk profile so indicate , refers to a ”checkpoint” next where you live with GoogleMaps to meet with a provider face to face .
At the time of that checkpoint visit , a lungfunction test and EKG are performed – becoming part of the profile .

The information is shielded from the govt ,employers and insurance companies – in fact , some employers and/or payers will compensate in full or partially the annual subscription fee .

I suggested to Matthew to include in the upcoming 2008 Health 2.0 event some best practices from outside USA – this might be a good candidate . Unfortunately , the URL of this service is in Dutch – but then , you may have people around who can decipher that .

http://www.preventiekompas.nl/index.htm

regards

Jos Bakker
Senior Director, Global Strategic Mkt & Business Dev’t
Healthcare Informatics, Philips Medical Systems

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Since leaving the conference I’ve been thinking about the concept and believe this might be a catalyst to create change (disruption)to the traditional model of Dyson’s calcified health care. However, any change has to incorporate an overhaul of the current reimbursement system focused on “per click” rather than preventative care. I would like to see a world where we reward (reimburse) physicians at the end of each year for raising the FICO scores of his/her patients.

I’m also uncertain how we address the mass of Americans who are old, poor and unhealthy (physically and genetically). Under your concept their FICO score would make their premiums skyrocket and as a result they would likely fall into the uninsured category. Changing health (y) behavior is a monumental chore and often only works when the individual is faced with a crisis. Also what do we do with employers who only want to hire high FICOs and pay for their insurance. Do we create a social net to cover the uninsured, elderly population? I would also stress that any concept along these lines has to focus on the younger generations (kids). Here in West Virginia there has been a study that shows that directing efforts to change the patterns of adults doesn’t work — but if you get the kids on board then the parents will come along. (Think seat belts as an example – adult never wore a seat belt but when your kid in the back starts saying dad why don’t you have your seat belt on — dad buckles up. What if that concept applied to healthy eating and exercise).

More thinking going on in my brain – but only time to write this short comment for now. Look forward to continuing to carrying on the conversation.

FICO score, Genome, DNA direct and the likes provide negative reinforcement to the average patient, who is already aware that he/she is failing in many more of these scores like BMI, Lipid panel, Hemoglobin A1C etc. To bring the change is so overwhelming for a patient that he gives up and spirals down to poor health.

In this Health2.0 generation we need to approach this with a disruption. Empowering patients with self care attitude and developing a happiness index as a score. This might ease out the stress of ’stress management’. This needs to parallel the example of healthy unconditional parenting where bribes or time-outs have a limited role and making the ‘right decision’ itself is the incentive.

So before we bring out these FICO scores to the table please think what really works for you.

Archana Dubey, MD
blog.healdeal.com