I have a good friend, Andrew Sykes, who is a well-respected wellness actuary. I’d say he is one of the sharpest guys in healthcare I have met and he is an advisor for our company. We spend a lot of time talking about the consumerization of healthcare and how personalization is an imperative to align the right interventions to the right people at the right time. The prevailing wisdom has been to first assess a person, figure out a bit more about them, and then propose something they should do. The problem with the traditional assessment is that it is fraught with error. Andrew Sykes wrote an article a few years back articulating why he believes this is the case and I wanted to share the high points.
What is a health risk assessment? A health assessment typically consists of about 5-10 pages of questions that cover topics around exercise, eating, alcohol, biometrics, and more. Many of you have probably filled one out (when you are going to get $100+ from your employer most likely). Here are the problems with traditional assessments according to Andrew Sykes:
1. Health assessments paint a biased picture of the population. Most people that fill out health assessments are healthier than average so the data is skewed. It is more worthwhile to just assume that your population maps to the general population of healthcare prevalence (why wouldn’t they?) and focus the attention (and incentive dollars) on programs.
2. We have really poor memories. I can’t even remember what I did yesterday so when the assessment asks questions about my physical activity or my nutrition I am likely going to recollect myself in a much better state (oh, of course I work out 5 days/week). We have hindsight bias and wishful memories.
3. We know we’re being observed. We know the assessment is going to be collected and reviewed by someone, somewhere. As a result, we alter our behavior because we are being observed. And we know what the right answer should be so we’re inclined to overestimate our health too. There is a term for this called the Hawthorne Effect. Asking fewer questions with more frequency in a less intrusive way can glean more accurate information.
4. We are programmed to misreport. As humans we are already biased to misreport because anything less than “getting a good grade” is failure. As a result, we tell “white lies” on health assessments that we skim through in as little time as possible. When the reports come back that we’re actually healthier than we really are, it only exacerbates the problem.
5. Health assessments focus too much on risk factors, not health habits. Health assessments ask questions to smoke out high risk individuals for intervention but that’s not how health assessments are marketed. They are marketed to promote positive health drivers. Improving health isn’t about merely being “not sick” but rather helping make someone their best selves. If a health assessment is actually going to be useful, its content should be squarely focused on improving health drivers like exercise, nutrition and sleep.
6. Health assessments actually drive up healthcare costs. Health assessments give people a “free pass” to go visit their physician and get prescription medications which drive up healthcare costs. Most people do not learn about the results from their health assessment and fundamentally change their behavior. By going to the doctor with some new information, individuals can work to “treat” their health risks rather than reverse them with a change in lifestyle.
The traditional health assessment is dead. Let’s stop spending money on it as soon as possible. It’s not enough to say that it’s a good year over year benchmark because people aren’t truthful and healthcare is not getting improved because of the assessment. There is a better way. Learning about individuals is a process, not a 5-10 page questionnaire. It is a process that directly accompanies engagement in actions and programs designed to improve health, not just treat the health risk.
Posted on November 9, 2015 02:30 PMComments: