How I Cut the National Debt: Tools Pharma and Health Care Could Use

Posted: August 30, 2010 in Web Favorites
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I’m not an economist or fiscal policy expert. Just your average citizen. But I’ve achieved fiscal responsibility for the US through 2018. On my own. Without even touching a calculator. All I needed was 20 minutes and this nifty simulator from some really smart folks at The Committee for a Responsible Federal Budget (CRFB).

Of course, it wasn’t as easy as most campaign slogans make it seem. I had to learn about nearly every line item (courtesy of the handy info button next to each one), and make hard choices about which programs to cut, which to keep and how to pay for them. But as I wielded my sharpened digital pencil, the simulator did all the heavy lifting—crunching numbers and keeping tabs on my spending and income. The process also taught me a lot. I now have a much better understanding of the complexities and trade-offs involved than I could ever have gotten from watching C-Span 24/7 or reading every page of the official US Budget documents.

What’s this got to do with health care? Don’t worry. The point of this post is not about slashing Medicare entitlements or repealing health care reform. It’s about the simulator tool itself. I can only imagine the complexity of assumptions, calculations, spreadsheets and algorithms that the bipartisan CRFB had to analyze and compile to make their simulator work. But the science and expertise is hidden behind an interface that’s engagingly simple. All I had to worry about was making decisions about what was important to me. Therein lies a crucial lesson for those of us who want to connect with health care consumers.

Why can’t we make learning about and making important health care decisions just as easy?

Let’s just stick with numbers. Like the federal budget, health care is rife with a mind-boggling blizzard of figures—blood pressure, glucose levels, calorie counts, A1Cs, to name a few—just as incomprehensible to us average Joes and Joelles as the budget deficit. But unlike the deficit, we are personally responsible for managing “our” numbers. And we haven’t a clue where to start. That’s why I’d like to see more consumer health care tools like the budget simulator. Mask the science behind an engagingly simple interface that makes the numbers real, personal and pertinent.

Years ago I demonstrated this by having an interactive game prototype developed for the management of hypertension. “Aim for 120/80” was modeled after a football field, with blood pressure (BP) values in place of yardage markers. To get into the end zone (120/80), you had to make choices like losing weight or exercising more. The distances each choice moved you toward your goal were based on the best available data at the time, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure—which is such a mouthful, even for experts, it’s commonly called JNC7. (JNC8 is due out next year.)

A football game teaches patients steps they can take to reach their BP goal.

The objective was to:

  • Visualize something that was invisible (hypertension);
  • Demonstrate the positive effects of the simple steps I can take to reach my BP goal;
  • But most of all, make sense of the numbers. Make them personal. Make them relevant. Make them work for me.

Alas, “Aim for 120/80” never got beyond the prototype stage. What’s really disturbing is how little else has been done since then to help make personal health care decisions easier for consumers. But I have stumbled across some notable examples.

Roche ACCU-CHEK Connect program is a good start

Diabetes management is a prime example of the disconnect between patients and overwhelming numbers. The founder and director of Taking Control of Your Diabetes (TCOYD) Dr. Stephen Edelman knows all too well is that the most significant thing patients associate with their glucose numbers is feelings of frustration, guilt and failure. He always strikes a chord with patient audiences when he talks about “making up the numbers” on their blood sugar diaries. If you don’t understand the numbers and how to manage them, why even bother to test and record them? You might as well just make them up—or record only the “good” numbers—to keep your doctor happy.

The ACCU-CHECK Connect program from Roche attempts to change that mindset and simplify the glucose numbers game. While not computerized, their “Testing in Pairs” and “360” tools help people with diabetes make the connection between blood sugar numbers and the things they do. The concept behind “Testing in Pairs” is particularly appealing: focus on just one set of numbers, say before and after breakfast, and see how small changes in your routine from one day to the next change your test results. Not surprisingly, the tools were developed based on input from diabetes bloggers and broadcasters, like Riva Greenberg. According to her, the number one recommendation the diabetes social media community made to Roche was “Keep It Real – Display the real experience of diabetes, the real blood sugar numbers we get, and teach patients what to do with them.”

I think we need more pharma companies and healthcare providers who listen to patients. So there can be more tools that teach patients what to do and how to do it. That’s patient empowerment at its best.

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