REPOST: Tracking Your Own Health Data Too Closely Can Make You Sick

It’s an existing wisdom that routine general checkups bring peace of mind. However, benchmarking one’s health status based on vague sets of biometric measurements can create more harm than good as this article suggests.

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Studies show that having too many tests done too frequently is a recipe for getting sick, not staying healthy. 

Last week, Dallas Mavericks owner Mark Cuban caused quite a stir on Twitter by suggesting that people, if they could afford it, get quarterly bloodwork to establish a baseline of their own health. A big failing of medicine, he wrote, is that "we wait till we are sick to have our blood tested and compare the results to 'comparable demographics.' "

While that idea may seem logical, medical researchers have long cautioned that more testing is not a recipe for better health. I and others, including many doctors, countered Cuban's views, saying they could produce dangerous outcomes for patients. (You can find my summary here and here.)

Here's why: More testing leads to more false positives and incidental findings (abnormalities that don't pose a risk to your actual health). That leads to a higher probability of treatment. And treatment carries side effects.

The Society of General Internal Medicine explicitly discourages routine general health checks for adults who have no symptoms, saying they have not been shown to reduce illness, death or hospitalization, but do create "a potential for harm from unnecessary testing."

It was an interesting discussion, and Cuban did not back down. Indeed, some doctors said that Cuban's vision may be the way of the future, particularly as medical testing improves and patients grow more accustomed to managing their own health data. "Many companies are pushing big data in healthcare," writes Dr. Michael H. Tomasson, a hematologist at Washington University in St. Louis, on his blog. "I see no reason why Cuban can't push too in his own way."

I asked Cuban to continue the discussion in a podcast and an interview. He declined, saying my position on the issue rendered me partial. But he explains more of his thinking in comments he posted on The Health Care Blog.

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Mark Cuban, owner of the Dallas Mavericks, stirred debate last week with his suggestion that quarterly blood testing could help healthy people stay that way.

To get some additional perspective, I turned to Dr. H. Gilbert Welch, a professor of medicine at the Geisel School of Medicine at Dartmouth College. Welch is a leader in articulating the case against testing too much. His take on the question at hand was never in doubt, but the reasoning behind it is important.

This interview has been edited for length and clarity.

Is quarterly bloodwork for healthy people a good thing?

No. It's not. This is potentially a recipe for making all of us sick.

I guess the first thing to say is that we all harbor abnormalities, and increasingly our technologies are able to detect them — be they biochemical, be they structural. We can see things down to millimeters in size; we can measure things down to parts per billion; and we can sequence the whole genome. That's 3 billion data points.

So there's no shortage of biometric data that people could be collecting on themselves regularly, and by the way, there's a huge financial interest in having people do that. The market of the well is a huge, huge market.

The problem is you'll always be catching things out of what we would say is normal. This is anticipatory medicine at its worst, where you're really focused on what could be going wrong in the future and you're trying to pick up [a] signal.

The problem is there's so much noise — because the human body is a living organism. Variation is the very essence of life. People will start reacting to this data. I also think it's really important to label it what it is: data. To me it only becomes information to the extent that it accurately predicts something will happen in the future, and it only becomes useful knowledge — a higher level piece of information — if we can do something about it.

Cuban argues that any misdiagnoses and unnecessary treatment rests with the doctors, and not with patients owning their data. Do you agree?

I think there's a misunderstanding that diagnosis is some super clear black-white kind of distinction, when in fact there are 1,000 shades of gray in between. The time you get into that gray is when you're dealing with people who feel fine and have some detectable abnormality. That's how we get into it in cancer screening. We're looking for very early signs of disease. There's going to be great pressure to react to those abnormalities.

It's not fair to say the pathologists have misdiagnosed. Undoubtedly there is some misdiagnosis, but their standard for what constitutes cancer is the appearance of individual cells, and how they relate to one another — the architecture of the cells. That was a perfectly good standard when you were sending them cancers that you could feel, things the size of golf balls. But when you start sending them microscopic collections of cells, expecting them to make some prediction about the dynamics of that process and how that will interact with the host — that's you – it's understandably going to be fraught with uncertainly. It's all going to be probabilistic.

Some people say that medicine needs to move away from paternalism and more toward individual ownership of health. Patients want access to their own data, how and when they want it.

I'm a great believer in having patients share in decisions. At the same time, since I've actually cared for patients, I know that many times they're sick. They actually want to know what your advice is. It's too easy for doctors to come back and say, 'What do you want to do?' Obviously we have to find a balance between something that's totally on the patient to try to decide ... and the doctor simply asserting what the patient should do.

I think most patients want to be somewhere in between. They want to participate in the decision, and when there really are close calls, they want to participate in the close calls. We should recognize that some patients will want to do that more than others, and some patients will be more capable of doing that than others.

We should also be clear that there's a lot of bad information out there.

Cuban makes a distinction between making a diagnosis, and collecting a series of data points to "benchmark" yourself.

The more tests you do, and this is only the statistical process, the more likely one of them will be falsely abnormal. And the more times you do it, the more chance that something will be falsely abnormal.

There will be great pressure to take actions and that's how people will get hurt. It's going to distract them from the more positive things that they can do now.

It gets down to what health is. What I'm worried about is allowing health to be defined as some set of biometric measurements. ... Health is about more than a bunch of physical measurements. It's about a state of mind and we have to be careful not to undermine that state of mind. Ironically, part of health is not being too focused on it. ... Much better for people to develop good relationships, have good friends, be outside, eat well — find things that produce meaning in their lives.

Lawrence J. Wedekind founded IntegraNet Health to revamp healthcare delivery using a complete system of continuous care that maximizes the health and well-being of patients and improves the clinical and business operations of primary care and specialty physician practices. Contact IntegraNet Health through this website to join its network of trusted physicians and to know more about recent innovations in the healthcare delivery system.

Individualized healthcare plan: Basic components and inclusions

Estimates show that millions of children who are in need of Individualized Health Care Plan (IHCP). These children are identified to have medical conditions that potentially affect school attendance and academic performance.

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The IHCP helps ensure that the child receives the health services he or she needs during the time that he or she is not under direct care or supervision of a parent or a guardian. As it is not mandated by law for the IHCP to apply for all children, it becomes a must when a child has an emerging health problem that is categorized as mild to severe.

A comprehensive healthcare or health services plan facilitates communication and collaboration among families, the child himself (if applicable and appropriate), school health team staff including school nurses, and other healthcare professionals in the community. To keep an eye on youngsters, accurate documentation of their chronic medical conditions and individual needs is crucial.

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In order to avoid risks of error that may be due to unfamiliarity and complexity of health conditions, the following components must be explicit on an IHCP documentation:

1. Health services the child needs to receive at school;

2. When, where, and how health services will be provided;

3. Who will provide the health services;

4. Nursing assessments, diagnoses, interventions, and expected outcomes;

5. Information on child’s transportation requirements; and

6. Medical equipment, supplies, and other extra services necessary especially during special activities like classroom parties, off-campus, and field trips.

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The safety of the child is ensured with school health professionals meeting regulatory requirements and professional standards, with parents’ or guardians’ consistent and active involvement, and with an always updated individualized healthcare plan.

Larry Wedekind has an extensive experience and involvement in healthcare financing and healthcare delivery. Learn more on healthcare system innovations here.

The role of digital technology in health care

With the integration of digital technology in medical and other biological fields, ideas that seemed impossible years ago are now commonplace. Such concepts include wearable sensors, health and fitness mobile apps, smart prosthetics, software-managed diagnostics, and therapeutics, to name a few. These have become an ever increasing presence in daily life.

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With billions of dollars in funding going to the digital health space, the number of startups in life sciences has also climbed. Digital healthcare innovations are set to continue their upward trend in telemedicine, with visualizations combined with wearables bringing in a new era of medical advising and prescription. Physical attributes and vital statistics can be accessed remotely and patient record stored and re-accessible via cloud technology and in real time. This eliminates waiting time, personal visits to doctors and emergency rooms – all of which save effort, time, and money.

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Improved precision and accuracy in nanotechnology aids in both small and great feats - from designing drugs to treat specific ailments to tracing cancerous tumors that would be key to terminal illnesses. The limitless possibilities offered by artificial intelligence (AI) is still in progress for its specific functions basically because of possibilities also bring about uncertainties. But for medical reasons, AI is intended to be used for monitoring and tracking a patient’s vital signs to lookout for signs and symptoms of heart attack or stroke before it happens.

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All these exciting digital influences are also creating an impact on pharmaceuticals, and on the various business sectors as they are projected to bring potential competitive advantage to innovators, manufacturers, distributors, and healthcare providers who would opt to employ such technological products. It is primarily goal is, despite differences in the degree of advancement, frequency and extent of use, and ease of access constrained by geographical factors, that the outcomes of all collaborations will result to a global phenomenon promoting health care.  

After a successful career managing several hospitals in Texas, Larry Wedekind founded IntegraNet Physician Resources Inc., a network of physicians that aims to revolutionize today’s healthcare delivery system. Click here to learn more about the company’s vision.

REPOST: Driven by Fears: How to Get Consumer-Driven Health Plans in Gear

According to the Kaiser Family Foundation’s 2014 Employer Health Benefits survey, the enormous increase in healthcare cost has led many employers to consumer-driven health plans, which allow employees to make financial decisions on their health insurance. WorkForce.com offers the following advice for employers handling healthcare-related inquiries from their personnel:  

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Employees used to be able to choose between an HMO and a PPO and they were pretty much done with their health insurance decision-making for the year. “Decisions, decisions” could be summed up as “decision; done.”

Not anymore. Thanks to tremendous health care cost increases — average health insurance premiums for families jumped to $16,834 in 2014 from $9,950 in 2004, according to the Kaiser Family Foundation’s 2014 Employer Health Benefits survey — more employers are turning to consumer-driven health plans to help offset the costs.

The days of Door No. 1 or Door No. 2 are out the door.

In other words, employees are being asked to make financial decisions about their health care that they’re not accustomed to so they’ll have questions, and it’s up to benefits managers to have the answers.

For instance, what if your company offered a new high-deductible health plan? And say employees took up the new plan (or plans) at a truly impressive rate, which has you excited for the new era of health care consumerism. Good for you! Now you can just sit back and wait as all the changing behaviors and health care savings begin.

Well, maybe that’s a stretch. Sitting back is what happens on gigantic human resources teams. You work on a benefits team. There are only a handful of you, and while you all might collectively exhale and celebrate your triumph, you can’t really take the time to relax because a wicked number of first-quarter benefits questions this way comes, and you’re maybe a little bit anxious about what’s going to happen once employees start using those shiny new plans.

Don’t fret. That kind of concern is totally natural. Unfortunately, I can’t say it’s unwarranted. Thousands of your employees have just made decisions that will affect the way they’ve been brought up to understand managed care, and some might find the process frustrating and confusing.

You might not hear about these frustrations at first because employees frequently turn to their providers when health insurance questions pop up. But there’s a very good chance they’ll find their way to you eventually, so it’s a good idea to brace yourself for the challenges employees will seek guidance on in the coming weeks.

I’ll walk you through what you can expect, but first, let’s go back a few months and look at what happened during open enrollment.
 
What Happened?

You thought your people understood their plans. Sure, there were a few hiccups, education-wise, in the period leading up to enrollment, but that’s to be expected. Health insurance is confusing (I’m looking at you, deductibles and maximum out-of-pocket limits), and explaining the differences between health savings accounts, or HSAs; health reimbursement arrangements, or HRAs; and the limited and original-recipe versions of health care flexible spending accounts, or FSAs, can test even the most patient and beneficent of benefits professionals.

But you did it.

You and your provider spent weeks or even months lovingly pummeling employees and their families with useful HDHP resources, decision support and education, and with the help of your third-party administrator, you were able to get everybody’s accounts set up properly.

Everybody should be HDHP experts now, right?

Not so much. Here’s the thing — the biggest employee concern leading up to enrollment involves their plan decisions, their “What should I do’s?” and their “How should I feel about it’s?" It’s a tough row to hoe (for more on what’s going through your employees’ minds during this stage, see “Can’t Retain, so You Must Explain”), and exotic concepts like explanation of benefits forms and limited FSAs only make things harder.

What employees don’t want at this time is HDHP education. That doesn’t mean you shouldn’t make education resources available. It just means that employees aren’t interested in becoming HDHP experts. At the point of enrollment, they’re worried about knowing enough to make a decision, and when they start using their plans, they just want to know enough to feel comfortable and taken care of.

Now you’ll never be able to get an employee to want to learn about HDHPs for his or her own enjoyment, but you can help them with the things they need to know when they come to you for help. Like when there’s ...

Point of Service Perplexity

The first you’ll hear from employees after the business of choosing plans and setting up accounts is taken care of is when they start actually using their plans, and the questions you’re most likely to encounter are going to be about what happens at the point of service, especially with pharmaceuticals.
Expect some sticker shock. Like when your employees head to the pharmacy in the middle of flu season and discover their prescription for Tamiflu is going to cost $130 instead of the $20 they would have paid with last year’s prescription drug benefit.

Another source of frustration employees encounter happens at the doctor’s office. If they haven’t done any research ahead of time, they don’t know what they are going to have to pay at the time of service, and the doctor’s office staff can’t give them a straight answer because they don’t know the details of the plan.

Here are some steps to combat point of service perplexity:

1. Remind employees that spending for prescription drugs applies to their deductible.
2. Make sure to use a price transparency tool or service. Promote your transparency solution to employees as a “health care shopping service,” and show employees how it can make shopping easier while taking the mystery out of what they’ll pay.
3. Promote free prescription drug price comparison tools like goodrx.com, which show the costs of drugs at local pharmacies and provide coupons for discounts.

HSA Funds Befuddlement

HSA confusion comes in all shapes and sizes. You’ve no doubt witnessed this at open enrollment, but once the plan year starts, you’ll get new and different types of questions.

One of the first points of confusion to pop up, HSA-wise, happens at the start of the year when employees realize that they don’t have any money in their accounts yet. If you don’t load HSA accounts with funds available for immediate use, employees accustomed to how their health care FSAs worked could come knocking on your door wondering where their $600 contribution went.

Another common HSA issue involves the amount of money employees have chosen to contribute to their accounts. It’s important for them to understand that they’re not locked into what they thought they needed last year during open enrollment. They might have underestimated their health care needs or need to trim back the level of their contributions.

Here’s how you can help reduce HSA funds befuddlement

1. Remember all those resources you made to help employees understand HSAs during open enrollment? Start promoting them.  
2. Convert your HSA education resources into small messages that you can promote via email or social media. Nobody’s going to sit down and read the benefits guide over again, but a tweet-length email can certainly catch someone’s attention and jog that person’s memory. 
3. Think about the issues your employees might face and when they might face them. For example, January might be a good time to explain that employees can use HSA funds to reimburse themselves, so if they don’t have any money in their account for services today, they can pay themselves back later once their contributions start adding up.

Preventive Care Coverage Confusion

Imagine this: Your employees are starting to get the hang of their HDHPs and start becoming good health care consumers by taking advantage of their 100 percent covered preventive care. Great, right?

Of course it’s great. Preventive care helps keep people from getting sick, and helps detect diseases and medical issues before they become more serious. What’s not-so-great is the reactions some employees get when they receive unexpected bills for services they thought were supposed to be free.

Suppose an employee goes to a primary-care physician to get a physical. While there, the employee presents to the doctor allergy symptoms, so the doctor writes a prescription, and then a few weeks later the worker gets a bill and comes knocking on your door for an explanation.

Here’s how you can help clear up preventive-care coverage confusion

1. Encourage preventive-care use, but be sure to let employees know that when they start talking to a doctor about new or ongoing medical issues, they may be charged for the doctor’s efforts to treat those issues. These are not considered “preventive.” In other words, the diabetes screening will be free, but the cost of treating diabetes won’t be.
2. Make sure your preventive-care-coverage communication drives home the value of covered care in terms of real dollar values. For example, “Go see your doctor, and your plan will pick up the cost of your preventive care: Your physical is valued at $90, your standard lab tests are valued at $73, and your doctor’s evaluation of that pain in your back (or whatever else that ails you) is $38, but you’ll pay nothing for visit.”

EOB Ennui

The last HDHP challenge you’ll face is helping employees with the sense of tedium, weariness, and malaise caused by their explanation of benefits, or EOB, forms.

EOBs are confusing, rage-inducing, fonts of frustration. Anybody who considers themselves a fully functioning adult will recognize the layout of these things and reasonably think, “This looks like it’s a bill,” yet somewhere on the page is a line that says, “Not a bill.”

What gives?

Employees new to HDHPs, when they get their first explanation of benefits, don’t understand what they’re supposed to be about. What are they supposed to do with them? File them? Throw them away? Process a payment somewhere despite the “Not a bill” announcement?

They’re also very likely going to suffer a bit of sticker shock. After all, they’re not reading the average, run-of-the-mill explanation of benefits one might get for getting coverage out of network. What they’re getting is an EOB for an HDHP, which is a delightful way of seeing in black and white how none of your services are covered by insurance.

Now since the logo on the top of the EOB page is going to belong to your provider, you may not hear anything about explanation of benefits at all, but if you do, you’ll probably find yourself talking to employees who want some sort of validation that everything was processed correctly.

Here’s how you can treat EOB Ennui:

1. If there ever was time to talk about the value of having lower monthly premiums, this is it.
2. Check with your provider to see if they’ve prepared any “how to read our EOB” resources, which can walk employees through their EOBs on a line-by-line basis.
3. Be ready to explain how deductibles and maximum out of pocket limits are met, how the provider pays the medical provider (remember—not a bill), and what kinds of things will be covered and at what levels (like preventive care) before the deductible and MOOP are met.

Founded by Larry J. Wedekind in 1996, IntegraNet is an independent physician association that works closely with various healthcare plan providers to ensure the delivery of quality and affordable medical care. Subscribe to this blog for more healthcare-related discussions.