Using Health Records to Segment Society

An article this morning (Obamacare Will Question Your Sex Life) warns that Obamacare will require physicians to ask patients a wide variety of personal questions not relevant to the physician’s specialty or to the patient’s condition.  The information will be stored in the patient’s electronic health record which will, in turn, become part of a giant national electronic database.

Glenn Beck noted that the huge database of personal health records represents a concern beyond the obvious privacy concerns.   Beck remarked that those who collect the data see it as a tool for social planning; they realize that  “the more information [we collect],  the more we can look at you as a collective, and the better we can treat things…”

Unfortunately, Beck is right.  Using health data to categorize people has been in the works for some time.  An example that comes to mind — “Bridges to Health” — focused on separating the curable from the incurable, and the healthy from the frail.

Six years ago Joanne Lynn (long-time colleague of Donald Berwick) and several health policy masterminds argued in favor of  “Using Population Segmentation to Provide Better Health Care for All.” (Milbank Quartlerly, PDF here)

Though the plan was called “Bridges to Health,” it was not so much about bridges “to health” as it was about bridges to death. For the most part, Lynn’s studies have focused on how to restructure “efficient end-of-life care.”  (Incidentally, two of the authors have influenced the “care transitions” projects discussed elsewhere in this blog).

Lynn et al. called for an overall transformation of our healthcare system, requiring “changes in how we assess and monitor the quality of health care, pay for health and reimburse care, … [how we] define optimal health, and prioritize health needs.”

They admit that “tailoring services in an ad hoc way to match each citizen’s situation … would be difficult and costly.”  So, throwing individual choice out the window, they recommend “stratifying the population based on health prospects and priorities, rather than on the health care provider of the moment.” The population would be broken down into roughly the following 8 categories:
1. Healthy
2. Maternal and Infant
3. Acutely ill but mostly curable
4. Chronic condition, normal function
5. Stable but significant disability
6. Short period of decline near death
7. Organ system failure
8. Long dwindling course (frailty, dementia)

Note the table showing the relative cost of each group (“Initial Estimates of Population Size and Annual Cost“); and a table that indicates how electronic health records might be employed in the process (“Priorities for Use of Interoperable Health Information“).

Say what you will about our health care system’s present shortcomings (many of which were caused by government planning and over-regulation in the first place), we still have some choice as to which providers we visit. If these planners have their way, a variety of projects (many of which are funded by the CMS Innovations Center) will nudge our health care to a transformed system; one that is perhaps very efficient, but is neither liberated nor life-affirming.