Healthcare Reform & Frequent Flyers

By Mehul Sheth D.O.

I find it fascinating when elegant solutions transcend their original purpose.

For example, Dr. Atul Gawande writes about applying a checklist to medicine. In the world of flying, the checklist is used to help reduce the number of errors. The thinking is simple-for every eventuality in the cockpit there is a flow diagram, based on best practices, to resolve the issue. They range from the mundane-taking off-to the scary-aircraft stall. Mostly because of this process airlines have taken leaps and bounds and are considered the safest mode of transportation. Dr. Gawande writes a great exposition in The Checklist Manifesto on how the same theory done prior to each surgical procedure can help eliminate simple mistakes in the OR.

As I thought about this I realized that the airline industry has yet more to teach us. As an inner city primary care pediatrician I was dragged in two directions. On the one side was the ideal of providing health care to everyone regardless of income. On the other was the lack of interest interposed with the gross misuse of the system. We have the world’s greatest healthcare infrastructure, but the utilization has been horrific. I blame much of this on a disconnect between the cost of healthcare and the value of healthcare. What I mean is that most folks, until recently, didn’t see the cost of their doctor’s visits. They paid a premium every month regardless of their utilization of the system. The value became clear if they had a cardiac bypass or other procedures, but the value of primary care was hard to gauge. In the end the more that those procedures cost, the more that they valued their healthcare.

The medical atmosphere is clear now-we need to prevent disease in order to bring down costs. The cost of our system is dragging down the country as a whole. The only question is how do you put value back into primary care medicine? By playing games! As a regular traveler, I have learned the rules of an important game-the frequent flyer program. Overall it’s pretty simple-based on your usage of a particular airline, you attain status that grant you perks. It’s simple, but folks are crazy about their status.

Translate this principle to the medical world. The more you participate in preventative care, the more “perks” you get out of the system. Everyone gets basic healthcare, but above that you could have three tiers, let’s call them silver, gold and platinum. The rules to attain the different levels need to be simple. An annual physical exam gets you to silver level. Completing all your screening tests gets you to gold. Striving for and/or achieving certain known risk factor reducers, such as not smoking and maintain a healthy weight, gets you to platinum. The tiers would relate to how much of medical costs are covered. Silver covers 50%, Gold covers 75% and Platinum 100%. In addition, the level of coverage also increases, until the top level allows you the “executive” health care plan that includes things such are personal trainers, massage therapists and other “elite” benefits. You could also bring in theories from other successful games such as Foursquare. Different accomplishments grant you badges that you can show off to other players with pride.

Although this is being done on a lower level with wellness plans and certain insurance companies reducing premiums based on screening lab test completed, the tie between the input into the system doesn’t match the output. In our frequent patient game doing things that make you healthy will grant you perks that will keep you healthy. It’s a simple concept, but anyone who flies regularly knows that it’s a powerful motivator!

About: Mehul Sheth DO is a physician executive with Allscripts and career coach. He's accessable via his LinkedIn profile and his blog at http://techpedsdoc.wordpress.com

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