The Zagat Guide to HealthCare — And More Thoughts on Scoring

If Health 2.0 is about anything, it’s about making health care more “commercial.” So what about some kind of Consumer Reports-type guide for choosing health plans and doctors? Well, get this: the folks behind the Zagat Survey, that famous slim burgundy restaurant ratings booklet, are making a move into health care with a new online system for rating doctors in one of the nation’s largest health insurers, WellPoint.Zagats_guide

USA Today reports that instead of Zagat’s four dining categories — food, décor, service and cost — members will rate doctors on Trust, Communication, Availability and Office Environment. They’ll give doctors a numerical score up to 30 points, and can post comments freely. The program will be available to more than a million Wellpoint members by the end of March, and eventually to all 35 million of its members nationwide.

This is a pretty bold move for Wellpoint, when you consider how much people like to bitch online. I wonder how they will police comments from disgruntled members, which can easily besmirch physicians’ reputations?

But then again, as my buddy Matthew over at The Health Care Blog (co-founder of the recent Health 2.0 Conference) reports, there’s likely to be quite a bit of cynicism about using the system at all. “After all, why should anyone use a health plan site to rate doctors rather than an independent one, and for that matter is Wellpoint going to let its customers rate it (the health plan itself?)”

Also, there’s already been quite some skepticism over the fact that patients aren’t being asked to rate costs or quality or even medical expertise here — only some parameters of how comfortable they feel with a particular doctor — so Wellpoint and Zagat may be missing the essential point.

It seems to be clear, Matthew notes, that some sort of consumer ratings system for health care offerings is coming fast. “And plans might as well get into the game somehow, although given the lack of trust they have in the market, my guess is that an independent ratings company is more likely to succeed. And there are lots of those around. Perhaps the question is whether it’ll be a guide known best for restaurants like Yelp, a general health care site which allows ratings like Revolution or Vimo, or whether a specialist one that just rates doctors like RateMDs, CareSeek, or Health World Web.”

No matter who leads the pack, what we’ll end up with will be something like a health care version of Amazon customer product ratings: Did these boots fit well? Would you recommend them to other people? Not completely devoid of value, but certainly not revolutionizing the way you interact with your health care plan.

A much more impactful type of scoring is hopefully on its way in the form of a personal FICO Score for your health care. The idea is to take the concept of a financial FICO score, and apply it to your overall health risks and medical standing. The better your health, the higher your score, and it would be your doctor’s/health plan’s job to help you raise that score. If they don’t, that would be good grounds to find another doctor or health plan. Under this model, doctors and insurers would be directly accountable for the care they give, and patients would do a lot of shopping around. Obviously, for a system like this to really work, your Health FICO Score would have to be evaluated independently of your health plan. Now we’re talking something really new and different!

I like the way surfer/MD/healthcare pundit Scott Shreeve puts it: “While many people talk about the concept of a healthcare tipping point, I believe we can go faster by looking at the ‘crossover’ between industries to learn and apply what is already known in other industries to the health care problem.”

Additional thoughts on scoring your health plan or your health itself, Guys? Or do you already consider your A1c to be your default Health FICO Score with diabetes?

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13 Responses

  1. kassie
    kassie October 30, 2007 at 8:03 am | | Reply

    I have access to one plan. There are 2 endocrinologists within 55 miles of me, and I can’t stand one of them. And I realize that I’m lucky to have a health care plan and endos within 100 miles.

    I think for a lot of people the concept of shopping around is a luxury, not unlike choosing fancy restaurants in big cities.

  2. joan
    joan October 30, 2007 at 8:54 am | | Reply

    I actually feel like I have a great plan through my employer (which is a hospital). Costs me $20 a month for my premium, $10 for $10 copay for visits with my internist/family physician and $30 copay for specialist visits. My needles and strips are covered 100% (no copay) and a new benefit for next year is that all “generic” blood pressure, cholesterol and diabetes medications are covered 100% without a copay. Of course, insulin is never generic but at least that is my only med that I have a copay for. My endo (who actually spent 30 minutes talking with me on my last visit because he asked me how I was and I said I was frustrated with my diabetes). I have no complaints!
    Joan

  3. Jim
    Jim October 30, 2007 at 12:58 pm | | Reply

    I do have some reservations about any online scoring system to rate doctors.If a doctor gives you news you don’t like does that make you give him a bad score? With some people it might. Also what is good for one person may not be acceptable to another. There are just too many variables involved.

    There needs be a definitive criteria in which to rate doctors. Leaving it up to the general public may not be the best way to do it. But then again I could be wrong.

  4. Kevin
    Kevin October 30, 2007 at 2:36 pm | | Reply

    We should do the same thing for health care bloggers but obviously using different categories. What categories would make sense? Accuracy, Entertainment, Relevance, Clarity… Are there more or different ones?

  5. Dave
    Dave October 30, 2007 at 2:52 pm | | Reply

    Actually, it is comfort that drives malpractice suits, or the absence of it. Comfort is the most important aspect of a medical care provider.

    Quality is a matter of how does one know. Cost is one, again, of how does one know, particularly when insurance pays for it, and insurance controls who we can see.

  6. Jana
    Jana October 30, 2007 at 5:22 pm | | Reply

    “Not completely devoid of value, but certainly not revolutionizing the way you interact with your health care plan.”

    Maybe not, but it sure would be useful when you’re moving! I’m still covered under my mother’s insurance plan, no matter where I live, and I’ve moved twice in the past couple of years and had to get new endos each time. Every time it was like picking a name out of a hat (although I checked RateMDs.com etc., there just aren’t very many docs on there). I’ve gotten really lucky the most recent time, but it was just that–luck.

    Also, most of the information I’m looking for isn’t even really evaluative but just *information.* I mainly want to know what kind of treatment “style” each doc has. I’m not at all fond of docs who take a micromanaging approach and who don’t want me to be adjusting my own basal rates, etc. I prefer docs who treat me like the intelligent, independent person that I am. There are other patients who prefer the micromanaging approach, and that’s fine. It would just be nice to be able to find out beforehand what a doc’s “style” is…

  7. RichW
    RichW October 30, 2007 at 6:11 pm | | Reply

    FICO scores for the state of our health…no way. Ours would be in the cellar. Mine would be down a mine shaft. I’m a Type 1 with heart disease and I had polio as a child. Polio is a problem because many who had it as a child become as disabled as they were before therapy when they get older. I’m in great shape – at least I think I am – but my FICO score would be terrible. When it comes to insurance companies I believe we should all just be a name and address to them. They need to know nothing more about me. Rating insurance companies and health care providers…great idea.

  8. AmyT
    AmyT October 31, 2007 at 7:02 am | | Reply

    OK, admittedly “comfort level” is an important measure. But it has a lot to do with personalities here, so it’s so very, very subjective…

  9. Chris
    Chris October 31, 2007 at 7:03 am | | Reply

    I would love the health FICO! Sure, I would lose some points for being diabetic, but I would gain them for being a non-smoker, for exercising, being an appropriate weight, etc. Despite being diabetic I am healthier than many non-diabetics. I should get credit in the health care system for taking care of myself. Seems like a good way to get people to see a direct relationship between their lifesytle and their cost/availability of health care.

  10. Scott Shreeve, MD
    Scott Shreeve, MD October 31, 2007 at 10:07 am | | Reply

    Rich,

    I understand your concern regarding the Healthcare FICO score being used negatively “against” you by a health plan. In fact, under the current arrangement they would absolute use this type of scoring system to kick their claim denial machines into high gear.

    But I can tell by your comments that you might be unaware of how insurers and the insurance industry actually works. Insurance companies are in the business of risk – they accept your premium dollars which they are anticipating will cover any “losses” they suffer due to your medical claims. As a diabetic with multiple serious medical problems you are a terrible “risk” to them because they KNOW you are going to cost them money (perhaps $40-50,000/year). Therefore, from the insurers perspective, how on earth can they “afford” to have you give them $10,000 worth of premium when they know you are going to “cost” them $50,000 in claims? What is the business model or how is that sustainable or why do you think that is cool to get $50,000 worth of value for only $10,000 dollars? What other industry would allow you to do that (er, the mortgage industry just had a little problem with doing this recently)?

    So the question is, what is the business model that allows me to provide $50,000 worth of care for $10,000 each year? In the past, it has been to spread the risk of excessive claims for one individual with the minimal claims of large populations of healthy individuals. When you aggregate populations, you are able to spread risk across many people and can do quite well financially (as demonstrated).

    However, I would suggest there are other ways to spread risk that might allow a viable business model to be created. What if instead of spreading risk across POPULATIONS, I chose to spread risk across TIME as well? What if instead of an all comers aggregation mechanism, I pooled my sickest patients together to create communities who help each other follow health best practices, get recommended treatments, and support each other. What if I financially rewarded this sick risk pool, not by comparing them to healthies, but by taking their aggregated FICO score and attempting to raise from whatever baseline I started? What if I was rewarded year to year by the annual increase in aggregated FICO scores? What if I could use information technology, predictive modeling, evidence based medicine, concierge style medicine, and all the great tools in place to engage my patients and activate them as informed consumers?

    Your very participation in this forum leads me to believe it is possible, neigh, inevitable that this is going to happen. In fact, DiabetesMine serves as an impressive aggregation mechanism and an early model of exactly what I am talking about. What if you got your insurance through DiabetesMine, had this incredible built in knowledge, support, and information resource as part of your overall care plan?

    You are beginning to see what I see, that in the new Health 2.0 paradigm, your Health Plan will be your advocate and will be rewarded financially for managing your “health”care (as opposed to “disease”care). They will be incented to ensure you are getting the best treatments, quick followup, and most effective counseling to help you manage your condition.

    There is a fundamental shift going on within healthcare because the system is headed for meltdown. I believe a convergence of reform initiatives, political climate, technology advances, product innovation, consumer advocacy, and absolute crisis will yield new models that enable us to “cross over” into new territory.

    Tomorrow marks a new day for the health care industry. Let it begin . . . again.

  11. CALpumper
    CALpumper November 2, 2007 at 7:46 am | | Reply

    I do like the idea of a personal FICO score but for my health plan (insurance company) and my doctor, NOT ME!

    Like Rich, I would be nervous as to how they would regulate this. “Pre-existing” condition is already a well known term in the insurance industry. Why give them more reason to see us as costly? Diabetic is enough, add more to it and what will they do with that?

    They say, we need a team of doctors. Even when I had health insurance that was hard to maintain. (Endo, Educator, Nutritionist, Dentist, Gyno, Opthamologist, Podiatrist, Primary Care Physician……)

    Also, Chris is right on the nose to. There are two sides to this FICO idea. I like it but we are human and sensitive. I do the right things but I screw up. I have habits and vices, who doesn’t.

    It comes down to this for me, I did not ask for this disease. I am diabetic. It does not own me, it is not WHO I am. Why should insurance companies be allowed to define me this way? I just need my supplies to live!

  12. RichW
    RichW November 2, 2007 at 11:04 am | | Reply

    Amy,

    I have been purchasing health insurance through my wife’s business for 10 years. Last year our insurance cost us $21,000. Thank God that’s all my health care cost me. Thank God people with few or no medical needs purchase insurance. I understand the business model but I believe there’s a lot that can be done to reduce the cost of health insurance. I agree there needs to be changes to the business model. I need to spend some time absorbing the concept of spreading risk across time. Thank you for your comments. If you’ve read my blog site you’ll see that I’m very interested in making changes in the health care and health insurance industries. FDR wanted to create a national health insurance plan at the same time he was trying to get Social Security passed by Congress. He was afraid that it would stall Social Security then WWII stopped any opportunity of addressing health insurance. I’m not sure if we’d be better off today. Again, thank you for your comment. It’s given me a lot of food for thought.

    Rich

  13. RichW
    RichW November 2, 2007 at 12:28 pm | | Reply

    Okay now I’m embarrassed. I thought the comment to me was left by Amy. I’ll fault it to trying to do too much in the time allotted. Scott, thank you for your comment; I’ll move a little slower next time. At my age (and health), the clock is ticking. I feel like the rabbit in “Alice and Wonderland.”

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