Which Health Systems Provide the Most Health?

Imagine choosing a health system based on the health of those members who are most similar to  Consider how health markets would transform if health system reimbursement were based primarily on the amount of health added by each system. Envision employers choosing health systems knowing which ones best preserved employees' productivity. Although these scenarios were formerly imaginary, advances in technology and prediction now make them possible.

Measuring Health Is Now Possible

The amount of health added by a health system is no longer inestimable. Advances in computing power and predictive analytics enable accurate group-level estimations with predictors that are mostly available in existing administrative and clinical databases. For example, our group estimated the amount of health added by alternative investment decisions to guide goal setting in a large integrated health system.1 Estimations can be performed based on mechanistic models,2,3 statistical models,4 machine learning, or hybrid models that attempt to disentangle prediction from causation.

Priorities of health system leadership

Leadership often prioritizes aspects of health system performance with bottom line impact, particularly reimbursement and market share. Adding health does not necessarily increase reimbursement or improve market share, aside from unusual circumstances when quality-based performance bonuses align closely with quantity of added health. Assessing health added might even harm the bottom line if results are unfavorable. Additionally, highlighting the amount of health added is untested as a marketing strategy.

Regulatory inertia

Regulation and quality assessment of health care has become a lucrative industry. Entities invested in the status quo oppose changes that would increase costs without necessarily increasing revenue, such as changes in measurement tools. There is inertia once business models and industries develop around particular measures and outcomes, even if these measures and outcomes do not capture what is most important.

Consumer demand

People with active health problems may choose health systems based on access to a particular provider, institution, or patient experience; or on cost rather than on amount of added health. People without active health problems may view health system performance as a contingency (eg, what if I became sick?) rather than a certainty, a different vantage point from other wellness-oriented industries where maintaining or improving health is paramount.

Policy Implications

Two pathways could elevate HVUs as a health system performance metric. First, the Centers for Medicare & Medicaid Services could link reimbursement to quantity of health added, phased in concurrently with existing payment models such as Accountable Care Organizations. Other payers likely would follow, as has occurred historically. Second, a disruptive innovation could occur if health systems can gain market share through horizontal integration, co-marketing or co-branding with wellness providers (eg, diet organizations, fitness centers, spas). Health systems might market membership as a wellness product for otherwise healthy people rather than a contingency in case of illness. Conversely, wellness providers may find it advantageous to offer scientifically validated health improvement in addition to targeting conditions such as weight loss and mindfulness.

Conclusions

Metrics matter. Valuation and remuneration of health added would improve health system efficiency and lead to greater population health. The methods to compute a health-added metric now exist. It remains to be seen whether this technical ability will be animated by market traction, regulatory impetus, or visionary leadership.