You are most likely right on this. I was probably short-sighted. I do agree there is a health-seeking type. I am sure some of my relatives would fit.

I have a brother who was in getting knee surgery with an MRI in hand a few weeks after he twisted it. Needless to say the surgery didn’t really fix anything.

I am going to read your papers on this. I think I may have found a group like this at the health plan.

The reason why I am confident that finding and engaging these folks could lower costs is because none of them know their pattern of thinking has the outcomes it does. They believe they’re doing what every DTC drug ad tells them is good for them. You will always find this type dominating health care focus groups. These are the people who have a higher rate of sending back health care related mail surveys. They like ‘engagement’ and volunteer to be members of clinical trials and online panels. They are smart, knowledgeable health care consumers who work hard at being informed.

I am confident that, if informed about the outcomes of their type, a small percentage of them (maybe 5%) would be motivated to change. And they only need to change two things to match up with the predisposition pattern of a truly healthy type with very lower health demand. I’ve estimated that a one percent drop in the prevalence of this type throughout the U.S. would lower health care spending by $5 billion per year.

Unlke Fred I don’t think you could “tailor” the intervention. Has to be a clear either-or point in time.

We have come up with a simple solution for 85% of the problems with the following changes to the Medicare benefit program. Pay all our Medicare members $20 per day for any days that they do not seek services but instead can produce proof of attendance at a bingo game, dance, exercise program or community outing. Converselyl, charge no co-pay for biannual check ups to pcps and $20 co-pays for every specialty care visit and a 20% co-pay on all tests. Keep all other benefits in play .

The active care-seeking, high cost group is defined by a complex profile of thinking patterns. The pattern of predispositions impacts health risk prevalence, disease prevalence and demand (see http://www.pathinstitute.com/Individual1.htm and “click” the link under “PATH Types At A Glance” and look at Type 7)

At this point, practically no one knows how their own pattern of thinking influences their health or care seeking. A fascinating point of luck is that this active care seeking group only differs from a very healthy, low care seeking group (path type 8) by only a couple of predispositions. Because of this I am confident that if the active care seeking group were made aware of their pattern (plus the risks associated with medical errors), perhaps 5% would change and work to adopt the pattern of the lower cost, lower demand, healthy type. The lower health care demand and reduction in spending that would result would NOT require any changes in the system, no changes in formulary pricing, no changes in co-pays structure, etc.

Let’s consider this in real numbers. The Type 7 pattern is found in about 14% of adults. That’s about 29.4 million adults in the U.S. 5% of this number is 1.5 million. In metro areas of 500,000 adults, this means getting only 3,500 to change.

FHN

As to the order of interventions, I do not agree with Al’s order. The assessment and counseling interventions should come first, and immediately. If we wait for “system changes” we will wait forever. The care seeking propensities form in the early adult years and are consistent throughout life. We don’t have to wait for a claim to occur and for each person to show up in the system before we act. We can identify each type in about 3.5 to 4 minutes. If we identify the active care seekers and intervene early, we can potentially head of trillions of dollars in unnecesary care seeking.

Consider this: If the focus was put only on the 50+ population, and through psych interventions we reduced the active care seeking group by 1% to 2%, we could shave trillions off of future Medicare spending. As I said, this focus is a “psych” one; the focus is not on health risk factors but on psychological risk factors NOT linked to any mental health disease.

FHN