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You will never be able to measure wellness and you actually don't want to
I recently attended a terrific Care Continuum Alliance (CCA) conference, and kudos to the new regime with Chris Coloian and Fred Goldstein.
LewisOne highlight was a packed-house panel discussion, hosted by Dee Edington, featuring myself and three other panelists Bob Stone, Sean Sullivan and Tom Parry. Panelists largely agreed that the population health industry, broadly speaking, had failed at outcomes measurement after 15 years of trying. One commenter hoped we wouldn’t be having this discussion 15 years hence. To the consternation of other panelists, I opined that we would probably be having this exact discussion in 15 years.
There are several reasons for that:
Even if we could standardize measurement, do we want to? Standardization is the enemy of innovation. You can see the insidious effect of standardization in health risk assessments (HRAs) today. They are the most standardized tool in all of wellness and are also about three years behind U.S. Preventive Services Task Force guidelines. An HRA committee needs to read the guidelines, agree that there needs to be a change to the HRA, rewrite it, get it revalidated, resubmit it for approval, and then convince customers that it is worth changing to the new HRA, even though the new results won’t be comparable to the old ones.
On the other hand, consider the recent innovation of well-being. Well-being obsoletes many typical wellness tools and metrics. If there were standard measurements of wellness success, well-being might flunk them. Do we want to discourage well-being just because it would score lower in some preordained categories than wellness does? Would well-being have its own measurement categories?
Perhaps instead of attempting to standardize reporting, we should standardize integrity in reporting. Rather than standardizing metrics, standardize validation. A validator could agree to certain criteria, like disclosing biases. So that if a result is based on participants vs. non-participants, a validator would acknowledge that limitation and bias. And, like an auditor in the real world, a validator couldn’t just run away from the validation after the check clears-validators would need to put up a bond to back their attestations so that end-users could have faith in them like stockholders have faith in an auditor’s letter.
This isn’t a wacky hypothetical idea.
The alternative is to own a validation monopoly in an industry asymptotically approaching irrelevance due to in-fighting over the quixotic quest for a measurement ideal that can and should never be achieved.
Al Lewis is an MHE Editorial Advisory Board member and the executive director of the Disease Management Purchasing Consortium