When former Vice Presidential candidate Sarah Palin infamously predicted that the Affordable Care Act would create “death panels”, I wanted to wring her neck. She took an incredibly important, albeit difficult, issue and trivialized it for the purpose of promoting her election/brand. With this hyperbole, I reasoned, we would not be able to have the serious national discussion about wasteful spending on end of life care.
And we haven’t.
Little did I know that there would be another issue — one which has not yet hit Ms. Palin’s sound bite radar that could potentially be more problematic, and politically explosive, concerning our efforts to control healthcare costs: the use of big data to influence lifestyle behaviors in a quest for effective population health management.
Merchant marketers are already doing it. A woman who has just found out she is pregnant, visited a Target store. Flush with the news, she made several purchases that would suggest she was pregnant. She told no one except her husband. Yet, two weeks later, she received a direct mail product promotion hyping all the things that a new mother will need. How did they know? Simply by looking at her purchases using marketing algorithms specifically designed for this purpose. Voila, a slick direct mail brochure customized for her medical condition that was supposedly a secret.
In what I believe will become a major professional/moral clash between the financial imperative to modify unhealthy lifestyles in order to lower our astronomical healthcare costs and the patient’s right to privacy, healthcare systems are beginning to mimic the retail industry.
Bloomberg’s BusinessWeek magazine recently revealed that large health systems are acquiring consumer data streams so that they can be, theoretically, proactive in managing their patients’ health, a financial imperative in the healthcare system of the not-to-distant future.
The illustration they selected to prove their point: a Marcus Welbyesque physician looking at a female patient with the caption: DON’T LIE TO ME SUSAN, I KNOW ABOUT THE 2 A.M. PAPA JOHN’S DELIVERIES.
“Imagine getting a call from your doctor if you let your gym membership lapse, or make a habit of buying candy bars at the checkout counter, or begin shopping at plus-size clothing stores.” For patients who use the Carolinas Healthcare System, that day could be sooner than they realize, the article predicted. They have begun plugging in the consumer data of 2 million people into algorithms designed to identify high-risk patients so that doctors can intervene before they get sick.
The hospital is developing risk scores for patients, and within two years the health system plans to routinely distribute those scores to doctors and nurses who can then reach out to the patients suggesting changes before they become ill.
Dr. Michael Dulin, Chief Clinical Officer for Analytics and Outcomes, posited that many retail companies are already using data to encourage people to buy things that may not be in their best interest. “We are looking to apply this for something good,” he told BusinessWeek.
That may be, but I can already hear the talking heads decrying this inappropriate intrusion by Big Brother.
I do not believe this characterization of an important population health management strategy is fair, but in this current political environment, if you want fair, come to Dallas in October. They call it the state fair.
© 2020 John Gregory Self