Health Score: Transition from Healthcare to Health
BACKGROUND: The military medical model has previously been focused on healthcare: Relative Value Units (RVU), provider productivity, and business plans, with little regard to the actual health outcomes/status of a population. As Patient Centered Medical Home was implemented, pay for performance incentives focused attention on HEDIS metrics alone to include diabetes, cancer prevention exams, and asthma. Introduced in fall 2011, the Adjusted Clinical Grouping scores provided a more comprehensive and objective tool to measure expected use of MTF and network resources. While the ACG scores are useful to administrative management of health care resources, they do not engage the patient in a proactive way to take initiative to manage their own health care. Health Care Integrators and Primary Care Teams, consistently reacting to HEDIS metrics, plead and nag their patients to complete health screenings and essential self-care.
TRENDS: A quick internet search shows several websites in development of a personalized health score, to include factors such as smoking, blood pressure, nicotine use, cholesterol level, sleep, exercise and diet. The fact that such websites are in development, indicates increased consumer demand for more information regarding health status. Capitalizing on the need for more consumers to become aware of their personal health status and the current evolution of the Electronic Health Record, it would be advantageous to lay a foundation for collecting data points relevant to a health score. Furthermore, the implementation of a personalized health score, available to each DoD beneficiary, as well as collectively available to health care teams and administration will advance our society into the future of an objective/outcomes based health care model. (Transition from Health Care to Health)
FUTURE STATE: The proposed Health Score is comprised of a mix of self-reported and facility collected data points to include smoking, body mass index (BMI), blood pressure, cholesterol levels, diabetes, mental health, aerobic exercise and diet. In addition, the score can be affected negatively by failure to complete preventative exams (such as screening exams for colon, cervical and breast cancers) as well as failure to complete immunizations (flu shots and shingles vaccines).
IMPLEMENTATION: Data points currently collected in routine screenings include systolic blood pressure, low density lipoprotein, and hemoglobin A1C. This initiative requires the creation of data collection (drop down menus) in the Tri Service Work Flow (TSWF) for tobacco status (if applicable, smoking quit date), completion of the mental health screening assessment & score, reported aerobic activity level and reported diet (servings of fruits and vegetables). Once these data point collection fields are available, and then recommend pilot testing to determine the reliability and validity of a health score tool.
RESULTS: True patient centric care provides the patient with a tangible measure of their health status and specific information on how to improve it. This will inherently improve Experience of Care for our patients. The objective measure of a comprehensive Population Health score gives commanders and staff a standardized goal across the MHS: to improve the Health of their enrolled population instead of chasing RVU’s. Readiness improves as patients have direct access to their health care status and patients, through increased awareness, find personal incentives to improve their health. Finally, Per Capita Cost improves as all MHS MTFs are focused on a cost reduction model based on improving overall health.