Carrots Vs. Sticks: Can Consumer Data be Used to Promote Healthy Habits?

I’m one of those people who wants to hear the story behind everything. When someone is telling me something I want details and color. I want to be able to visualize the sights and sounds of where you were and what you were doing. If a friend goes out to dinner, I need to know what she ate, how it tasted and if she would go back to the restaurant. Information without context is of no interest to me.

For example, friends’ posts sharing their Runstastic stats, “I just ran 3.11 miles,” are so completely boring to me that I’ve trained myself to recognize the icon and keep scrolling without reading. Now if you “just ran 3.11 miles because a pack of wild dachshunds were nipping a my heels,” that would be worth reading.

Others, however, seem to have a bigger interest in seemingly innocuous data than I do. Take Carolinas HealthCare System for instance. In a recent Bloomberg Businessweek article, “Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her,” the system’s chief clinical officer for analytics and outcomes, Michael Dunlin, shares that its medical centers are very interested in data such as what you purchased at the grocery store using your credit card. Did you charge a bag of Doritos at the gas station during your last road trip? The health system wants to know. They probably even care about your boring Runtastic posts.

#HITsm TweetChat (2)Just what is the health system doing with this information? It’s placing it into a system that takes the data and assigns risk scores to patients. If your consumer activity points to unhealthy behaviors, you earn a higher risk score and perhaps a phone call from your physician or a nurse.  According to Durlin, the goal is to help health care providers head off problems before they happen. If they notice a patient with diabetes has a daily Dunkin Donut run and has not refilled his prescription for his diabetes medications, they can intervene before the patient ends up in the hospital.

Is this proactive patient care or an invasion of privacy? If we’re willing to let everyone know about our Runtastic scores, should we be also be willing to let them know about our Dorito-eating tendencies?

To many, letting others have this level of access to our consumer information seems scary. Will hospitals or insurance companies be able to charge patients more for coverage or care because they’ve been labeled with a higher risk score based on their consumer spending habits? Remember how insurance companies refused to cover people with preexisting conditions because they were deemed more costly? Will we go down that road again with enormous premiums this time based on credit card statements?

There’s already the practice of charging smokers more for their health insurance premiums. Many argue this is justifiable since it’s known smoking increases health costs due to increased prevalence of cancers and chronic diseases. In a 2011 NPR-Thomson Reuters Health Poll, 59% of 3,000 adults polled said smokers should pay more for health insurance than non-smokers. Many say it makes financial sense to charge those who use more health care resources more for health care coverage.

Some health care organizations have gone as far as instituting policies that state they will not hire employees who smoke. In a 2012 USAToday opinion piece, physician Paul Terpeluk outlined The Cleveland Clinic’s rational for not hiring smokers. “As a health care institution, whose inherent mission is healing the sick and cultivating a healthier community, does it make sense to support a habit that leads to disease, disability and death?”

As pointed out in an opinion piece in The New England Journal of Medicine, another argument that is often made against hiring smokers is that people need to exercise personal responsibility and be accountable for their health decisions.

Can’t the same be said for those who don’t exercise or who eat junk food? Just as many see smoking as a choice and a habit that can be stopped, can’t the same logic be applied to other unhealthy habits? I know that water is better for me to drink than Pepsi. Should I be penalized for choosing the less health option?

I am definitely not saying that smoking, junk food or lack of exercise is a good thing. But if decisions about health coverage or interventions are going to be made based on consumer data, we definitely need to take a positive rather than punitive approach to promoting healthy choices.  Health care providers need to work with patients to foster good health. They need to get a full picture of why a patient is behaving in a certain way to help them find the reasons and motivation to change their habits. I don’t know that assigning a risk score based on consumer data without context will do that.

To me, a risk score assumes negligence on the patient’s part. It assumes they are being irresponsible and don’t care about their health when there could be more to the story.

Take the diabetic patient who did not get his diabetes medication prescription refilled. Looking at this data and assigning a risk score is not enough in my opinion. Perhaps the medications didn’t get refilled because the patient can no longer afford the co-pay. We need to know why they are engaged in these behaviors if we want to have success in changing them.

I think on some level that’s the intent of gathering this data and assigning the score. It could possibly be a tool to alert providers when patients are having trouble and allow them to intervene before serious damage to their health happens. However, based on the way we have used personal information in the past, I could see this type of data collection becoming a way to try to get people to change through threats and punishment. If we truly want this type of data collection to work, we can’t wield it as a stick. Instead, we’ll need to use what we learn in a positive way that will get patients be motivated to eat their carrots.

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Jennifer Thew, RN, MSJ

Jennifer Thew, RN, MSJ, is a registered nurse and journalist who has covered healthcare issues and how they relate to the nursing profession. She began her nursing career as a neuroscience nurse at Rush University Medical Center in Chicago and then transitioned to journalism after receiving a degree from Roosevelt University in Chicago. She has edited and written numerous articles on a wide range of nursing and healthcare topics like Accountable Care Organizations, evidence-based practice and telehealth.

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