Thursday, August 18, 2011

Dinner out!

Well, I survived my meals out, difficult after my new dietary restrictions.  Thank you both to Zander and Allan for your kindness today.  A special thanks to Roger Berkowitz of Legal Seafood fame for sending us this delicious (and healthy!) dessert!

Wednesday, August 17, 2011

Need, Want & Would Like

In many discussions over what is ideal primary care, it occurs to me that there is a bit of a definition problem worth certain words people throw around.  I am not taking about Patient Centered Medical Home, Care Cycle, and Quality measures.  Rather, I am referring to three very simple words:  Need, Want & Would like.  I would like to propose operational definitions for each of these words, to better guide solution design for health care.  And perhaps other things about which I am less qualified and therefore less apt to comment.

1.  Need.  Cannot do without; Necessary (in the Necessary/Sufficient paradigm).  An example:  Someone with a new Drug Eluting Stent in their coronary arteries NEEDS dual anti-platelet therapy (perhaps Aspirin and clopidogrel).  Without, chances of death are unreasonably high.  That is a need.  People NEED health care over their lifetime.

2.  Want.  Desiring something enough to give something up for it (or pay for it).  This falls under the common law doctrine of no consideration, no contract.  If you want something, you are willing to pay for it, in money, time, trade, opportunity cost.  For example:  Last year I wanted an iPad, so I bought it.  Wants are not needs, although sometimes it feels like a want has to approach need status before one will pay for it.

3.  Would like:  Desiring something, but not enough to pay for it.  I would like an iPad 2.  But I am not willing to by one yet.  If someone gave it to me free, I wouldn't throw it away.  The difference between Would Likes and Wants comes at payment time.  If you'd rather walk away without paying, it is a Would Like.  You don't value Would Likes enough to pay for them.  Remember that.

There is definite confusion of terms.  I have noticed in health care, and in most situations in which a government is handing things out seemingly for free (whether it is your parents and an iPhone or the Federal Government and Medicare dollars, Really big Wants often get upgraded to Needs, and almost every Would Like is considered a Want.  It is a way of getting things without paying for them.  In this environment, showing weakness is a strategy for gain.

In the world of the marketplace, of producers and negotiation (aka the real world), the opposite is true. Needs get dressed down as Wants, Wants as Would Likes, and I Wouldn't touch that with a 10 foot pole!  This too is a way of paying less for things.  In this environment, hiding weakness is a strategy for gain.

So when deciding on things in your life, first figure out if you are in the government world in the real world, and categorize your priorities accordingly.  But even more so, when designing solutions (for healthcare in this case) really figure out what everyone means, and agree upon the definitions above (or some other standardize set).  Enough with the grandstanding and positioning, just figure out how to get what you need, pay for what you want, and accept what you would like.

Thursday, August 4, 2011

Games, a solution for health?

In this week's New England Journal of Medicine, Volpp and colleagues (article linked through the title of this post) comment on the use of immediate incentives to improve employee health through redesigned health benefits plan.  This space has fascinated as it combines two of my areas of interest: health, specifically the delivery of superior health care, and games, specifically PC games.  How did I draw this conclusion?

In the article, the authors comment that adding immediate upside incentives will cause behavior change toward the incentive.  This is what I have tried to explain to the non-gamers around me... you keep pushing the button, ultimately because there is a reward for what you do.  In my preferred case, completion of some task which is fun in its own right, leads to the continuation of a narrative which better be interesting!  Games that lack either a fun mechanic or a decent story tend not to make it into that "classic" realm.

Similarly, benefit design has historically been designed with no incentives (no game mechanic) or worse, perverse incentives (a truly evil game).  The narrative reward--better health, has theoretically always been there, but not quite as explicit as it could be.  One interesting company, Redbrick Health has been doing just what is described in the article, adding a game layer to the world, a brilliant line I have borrowed from Seth Priestbach.