Health Scores

The concept of an individual health score is intriguing. It’s the other side of the coin of population-based health.

Health scoring makes health more fun and social by boiling a lot of data down to something people can track and understand. It’s similar to how credit scores are used to summarize the credit worthiness of an individual. (Interestingly, credit scores have evolved from a tool used only by financial institutions to a personal tracking tool – I’m using the the credit score tracker from Mint and it’s great.)

A health score could be used by insurance providers and healthcare organizations — and potentially by individuals — to risk stratify and intelligently offer different levels of service based on someone’s health score. Insurance companies use data to assess current and potential members, but this involves pulling back the curtain on that scoring and data and using a relatively standardized health scoring methodology.

What is required to come up with a health score that means something? Not surprisingly, it starts with a lot of data about an individual. Conditions (past and present), medications (adherence data if you have it), vitals (BP, heart rate, weight, mood, etc.), activity, genetics, access to care (potentially type of insurance coverage), family history, social factors (both social engagement as well as typically social history – smoking, alcohol, drugs), employment, nutrition (not sure how you’d assess this one), income, and a host of other factors. What am I missing? You don’t need all of that data, or maybe even most of that data, to come up with a score.

Once you have data, which is a massive feat, you need an algorithm that weights different aspects of that data and is intelligent enough to take into account both negative and positive (or mitigating) factors. Ideally those factors and weighting would be well understood, though it doesn’t necessarily have to be an open source scoring mechanism, and scores would be validated and tweaked over time.

A few companies are trying to figure out the health score. An interesting one out of Chicago is higi. It has created a smart kiosk that can be placed in supermarkets and grocery stores. It also offers a mobile app.

Higi is essentially replacing the dumb blood pressure monitors that are in pharmacies, supermarkets, gyms, and other common spaces with a smart kiosk. The higi kiosk allows users to create a profile and track data over time. It’s a smart distribution strategy, as it is one of the few ways that people are already used to engaging in their health — they already use the dumb kiosks today.

Higi has come up with the concept of a health score, which gives individuals a single number to track ongoing. It’s intended for personal use. No third parties are using it, though exposing the score, the data entered, and the usage statistics of the machines should be valuable.

Another potential health score or currency for health and wellness is NikeFuel. When Nike got into the digital health tracking business with the FuelBand and suite of apps for running and fitness, it went beyond just using a step counter and instead created an algorithm that uses steps, demographics, and activity measurement to come up with something called Fuel. After using a FuelBand for a couple of years, I doubt that the Fuel algorithm is all that sophisticated, but I still like the concept.

Nike continues to support Fuel despite leaving the hardware business. The company is pushing it as a way for app developers to include a similar algorithm and activity score in their apps. Of course it is Nike’s score, so getting third-party adoption is a significant benefit for Nike. And I’m betting Nike Fuel will  be integrated as a card in Apple’s new iOS Healthbook application at launch or shortly after.

Nike Fuel is different from the a health score in that it simply adds up over time. It doesn’t go down. It’s more of a cumulative activity score.

It’s interesting to think about how a health score might evolve. Credit scores are created dynamically based on the data received get from financial organizations and institutions. They vary among the credit organizations that collect and analyze information on individuals. Experian, Equifax, and Transunion will come up with a slightly different score even though they use the same credit score scale.

I imagine (since I know very little about credit scoring) that the difference in scoring is partly due to differences in weighting of factors such as amount of debt, employment history, and other financial data points. Additionally, I also wonder if some of that score discrepancy is based on differences in data that they are receiving from banks or credit card companies.

It will be interesting if we can get to an agreed-on health score range. Nike’s Fuel score is meant to be an activity score because it’s essentially an activity metric you accrue over time. You may get 3,000 or 5,000 Fuel in a day and it just keeps adding up over time, with hundreds of thousands and eventually millions of Fuel. It’s not terribly powerful.

The way that higi is doing it might be powerful. The key is an accepted range of scores. Maybe it’s similar to credit score ranges, but the idea is that the range is consistent and you can see ongoing how you’re doing. Physicians and healthcare organizations would be able to standardize and simplify complicated data into something that’s easy to track.

The other thing about credit scores is they’re only one level. You can drill down into the credit reports behind the scores and come up with a more meaningful assessment. Digging deeper allows you to individualize and understand whether it was debt, employment, or something else that impacted the score.

In healthcare, the ability to go from the macro score — presumably based on a bunch of data points — and drill down into each one of those data areas is something that more engaged or interested individuals could do.

This goes back to that previous post about the recent Gigaom report that discussed aggregating data points on a platform. This is what credit organizations are able to do in pulling data data from a bunch of different places. That isn’t happening in healthcare, but the ability of individuals to pull that data from health insurers and provider organizations is opening.

Prime is an example of a company taking advantage of that individual access. They are doing it across multiple PHRs and systems. The PHR data (CCD, CCDA, etc.) can can then be combined with data from organizations like higi and Nike.

It remains to be seen what the healthcare equivalent of Equifax, TransUnion, or Experian will be, but it’s going to be a very valuable company. The EHR vendors think they can do it, but I’m betting they can’t. Data warehousing companies like Health Catalyst might. These are probably unlikely examples, but Nike, Fitbit, and higi are trying to do it and they’re getting traction with employers, retail locations, and even some insurers.

The idea of a health score is something that inevitably falls out when you start mashing up multiple sets of data on individuals, just like the credit companies were able to do as financial data silos opened up. We’ll have to wait and see how the next five to 10 years shape up and we see if the industry can come up with a score.

Would you care about a health score for yourself or for a patient of yours?


Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

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