How do we measure health? If you ask 100 people—physicians, patients, hospitals, caregivers—you could get 100 different answers. Health can't be defined solely as the amalgamation of diagnoses made by a person's clinicians.
It must also reflect a person's perception and feelings about his or her own health.
When it comes to population health in the U.S., measurement has become an intriguing point of discussion. This is clearly reflected in HHS' 2016 goal to have 30% of fee-for-service Medicare payments tied to quality or value through alternative payment models.
At Humana, we're focused on holding ourselves accountable to our customers and their communities. Recently, Humana announced a bold goal: The communities we serve will be 20% healthier by 2020 because we will make it easy for people to achieve their best health. To help achieve that goal, we sought a metric that sufficiently measures overall health, yet is simple enough for everyone involved—the patient, physician, hospital, etc.—to embrace.
Health measurement today: There's no shortage of tools for measuring health. One option is the frequency of visits to the emergency room or hospital admissions, but these measures only quantify the health of a small subset of the population. Alternatively, prescription refill rates indicate the consistency with which a person is adhering to prescribed therapy. Commonly measured biomarkers (blood pressure, blood sugar, cholesterol, etc.) help quantify certain components of physical health. The health of large populations is often compared using prevalence of disease, life expectancy and mortality rates.
While all of these are important measures, they lack a common thread that ties them together into a simple reflection of the health of a population.
Such measures are also very physician- and health plan-centric. If someone is suffering from arthritis or anxiety, such measures may fail to quantify the impact of those conditions entirely.
It's also important to consider that data from the 46 million wearable devices (Fitbit, Garmin and others) we're projected to purchase in 2015—combined with the nearly 20 million wearables already in use—are creating a new set of metrics as more people use these devices to track their own health and activity, such as blood pressure, weight and steps taken.
Yet all these data might not be enough to answer a simple question: How do you feel?
Focus on Healthy Days: As an oncologist who practiced medicine for more than 22 years, I often learned much more from asking my patients how they felt than I did from evaluating lab values and diagnostic tests. If we're going to quantify the health of large populations, data tell us only part of the story. It's also important to know how people are feeling. Enter Healthy Days.
The Centers for Disease Control and Prevention developed the Healthy Days survey in the late 1980s to address physical- and mental-health- related quality of life. Healthy Days was designed to measure these qualities and has been widely used in many settings. The CDC uses it in national and state-based surveys, and it has been adopted by Healthy People 2020 as one of their general measures of health. State and local governments often incorporate Healthy Days into evaluations of their populations.
The brief Healthy Days survey asks people about their physical and mental health over the previous 30 days. Information from two questions is used to derive an index of their unhealthy days:
- Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
- Thinking about your mental health, which includes stress, depression and problems with emotions, for how many days during the past 30 days was your mental health not good?
The evolution of wearables and electronic health records and a new generation of medical devices will drive a massive influx of data into the healthcare system. As we move toward “the quantified self,” capturing a person's holistic view of his or her health is critical in measuring and improving the overall health of our communities. Asking patients about how they're feeling—and listening to them—is the crucial first step.
