The day before yesterday we discussed the "How tos" of health insurance. We are talking about nuts and bolts of how to effect healthcare reform from insurance to individual behavior modification. Yesterday, we talked about value based healthcare, or paying doctors who are effective at keeping people healthy, not just seeing more patients, doing more tests, and performing more procedures. Today, we are going to discuss how to actually engage the patients and educate them in such a way that will cause them to act in a way that promotes health.

Obviously, simply scaring people by saying "you are going to die" is not so effective or we wouldn't still have people who smoke. We come at it a little differently, from a three pronged approach. The first is history and lifestyle questions. We let the patient tell us things like how many cavities they've had filled or how often they eat out, or how many 'touches' they get in a day. These are things that they don't normally think about and some they wouldn't even know could be a problem. The second plank of our approach is, of course, hard science. Respiration, heart rate, lipid panel, height and weight, glucose and/or A1c along with several others. These show the patient specific measurements that his or her behavior is affecting. We rank each of these measurements as normal, watch, or critical, with watch and critical highlighted in yellow or red. The third part of our approach is to combine all this data into one easy to understand number representing the patient's "Body Age" based on the Uth Sørensen VO2 uptake equation and modified with the patient's answers to the lifestyle questions. When the patient naturally compares his or her chronological age with the body age and comes up lacking, they get the message that "you've burned x number more years than you've lived," or as I prefer, "hard living puts you in an early grave."

So that's all well and good, but we haven't done a thing to modify behavior, and that was the original premise. For the lifestyle questions, we think that simply making the patient aware is enough. If you don't brush your teeth, you increase your risk for a heart attack (remember us making reference to that question and you wondering what that had to do with the price of tea in China? Now you know.). Improving BMI, blood lipid levels and other hard measurements is a little more complicated. What we do is prescribe patient education that shows exactly what the patient's measurement was what the aceptable levels are, how the former relates to the latter, and how to bring that measurement back into the normal range. Sure, most of the advice prescribed is "eat better and exercise more" but it't also WHAT to eat HOW MUCH to eat and HOW and HOW MUCH to exercise.

Back to the thesis: how does this affect the health of the patient? If they don't do the reading, and we can tell, it won't affect anything. If they don't modify the behavior, and we can tell, it won't affect anything. We end up going back to the old saw that you will learn to love to hate: The new breed of insurance company described on our front page. This insurance company will offer discounts to people who maintain a healthy lifestyle. In precisely the same way we incentivized doctors yesterday, we will incentivize patients today, with cold, hard cash. If you as a patient increase your health, as measured with our hard science, or maintain your health, you get discounts. If your health gets worse, you don't get discounts and we hit you square in the wallet. The more you go off course, the more you pay. Before any of you bleeding hearts start wailing "not fair" remember YOUR insurance premiums are predicated on everyone's behavior, good bad or indifferent. Today, literally, they smoke and sit on the couch eating bonbons and watching Maury 36 hours a day and you pay for their bad behavior.

Again, all of this happens automatically with no human intervention, the way we have been talking about this new breed of insurance company since we began. There is no judgement, there is simply the consequence of your actions. This is absolutely fair as well. We aren't asking everyone to be Mr. Universe, just don't get any worse and we are showing you what to correct and how to correct it as well. This will yield: