'

Health costs should work like a bathtub

Make the model for health care costs a bathtub, with water, and we can all live better for less.

Mark Kajdos, CEO, Pragmate.comI have been more than a little skeptical here about what seem like contradictory claims for health reform in the U.S.

The idea that we can save money and get better outcomes while retaining the present system and investing in health IT seem self-contradictory.

In some ways they are.

Answers came this week, at the Emory-Georgia Tech Predictive Health Symposium in Atlanta.

These concepts are, in fact, related:

  • The key to better outcomes is coaching.
  • Coaching is possible through data. If you know your personal health data and have power to share it, more people can coach you.
  • Reimbursement systems now work against coaching, and must be changed for coaching to become accepted practice.

The whole Gordian Knot must be cut at once. You can't unleash a new method for delivering health care unless you can build a functioning business model for it.

Dr. Ralph Snyderman noted in his talk that attempts to institute coaching through hospitals have largely failed because coaching cuts costs. "Every dollar saved is a dollar out of someone's pocket," he observed.

While sitting in the stands between sessions Mark Kajdos of Pragmate (above), who is trying to build a coaching philosophy into healthcare, drew for me a chart that explained it all.

It looks like a bathtub. It's familiar to any car owner or manager of a nuclear power plant. It shows costs over time. High when a car or plant is new, and when it's wearing out, lowest in mid-life.

That's not the model for our current health care system. It's more like a ski jump in reverse -- a bit high at the start, then falling, then rising sharply until we die.

Health coaching is valuable at all stages of life. As Emory pediatrics chair Barbara Stoll noted, adolescents often lose insurance, and coaching from a pediatrician, just as they most need it, facing a world of temptation alone.

William Rouse of Georgia Tech called this the "rule of 20," and says he learned it from a music executive. What you listen to at 20 is what you will listen to at 60.

The same is also true for how you live.

Predictive Health Institute director Ken Brigham, who opened the proceedings on Monday, promised in his brief talk that this year's symposium would be more practical, less theoretical, than in past years. Health reform is coming, and has to, he said.

The key to making it work, then, is to unleash data, enable coaching, and give every adult regular wellness visits to keep chronic conditions from happening as long as possible.

Make the model for health care costs a bathtub, with water, and we can all live better for less.