How to rein in the escalating cost of health care is generating fierce debate across the U.S. Many politicians and health-care professionals are focusing on big targets like legislation and the pharmaceutical industry. But the savings we're all looking for may well come from far smaller sources, like the personal health devices that many Americans have so readily adopted.
About half of all Americans have one or more chronic conditions — heart disease, diabetes, kidney disease, arthritis, and asthma, to name a few. Many chronic conditions arise from unhealthy lifestyles that include the usual suspects: poor diet, little or no exercise, and stress. These conditions account for the majority of deaths in the United States, and up to 86 percent of health-care expenditures.
Look at diabetes as an example. Nearly 30 million Americans are now living with diabetes, and another 86 million have prediabetes, a higher-than-normal blood sugar level that can lead to diabetes. This disease accounts for unnecessary loss of vision, amputations, heart disease, kidney damage, and premature death. It also costs Americans $245 billion a year. But chronic diseases like diabetes need not take such huge personal or economic tolls. Easily implemented changes that digitize components of health and health care can lighten the load for people, their doctors, and the country at large.
Millions of Americans already use devices to monitor their health and fitness. These include scales, activity monitors (Fitbit, Apple Watch, Microsoft Band, and the like), heart rate and blood sugar monitors, and more. The data they record can help people take more control over their health and lifestyles. They can also help doctors keep track of their patients' health, as information from these devices can be uploaded into electronic health records. Data from such devices could also alert doctors or first-aid workers to a problem that requires immediate attention, like a stroke or heart attack.
Personal health devices are already — or soon will be — sophisticated enough to detect medical conditions. For instance, if your fitness device indicates that your usual activity level has fallen off but your heart rate is higher than usual, it could be a sign that you are coming down with the flu or other infectious disease.
To be sure, the jury is still out on how effective these devices will be. According to one randomized trial, Fitbit wearers did indeed exercise more but not enough to ensure weight loss and improved fitness — the keys to battling chronic diseases.
On the other hand, at least 21 ongoing studies are examining how the Fitbit activity tracker could be used to help make cystic fibrosis patients healthier, to diagnose and treat chronic obstructive pulmonary disease, to help teens stop smoking, and more. A trial by Takeda Pharmaceuticals and Cognition Kit is using Apple Watches and Microsoft Bands to monitor physiological signs for indications of oncoming bouts of depression. Poole Hospital in the United Kingdom and its partners are developing a solution using the Band to provide more effective care for people with epilepsy.
For many users, these devices are a fun way to keep track of their performance. Users can connect with and compete with friends, and give themselves pats on the back via badges and positive feedback. In effect, the devices and their associated apps can "gamify" personal health and fitness.
But what's fun for users could also help curb health-care spending. Offering users of personal health devices more tangible incentives, like cash or discounts on health insurance, could encourage more physical activity — the most important way to prevent and treat many chronic lifestyle-related diseases.
Employers and insurers are already trying this approach. Under a provision of the Affordable Care Act, employers can offer wellness incentives to their employees (paid for by insurers) if they agree to wear a fitness tracker or pedometer or use a fitness app to record their activity. Incentives such as gift cards and rate discounts are available through some national insurers. UnitedHealthcare, for example, offers employees covered through some of its plans up to $4 a day for meeting certain daily walking goals.
There is, of course, a potential downside to collecting such personal data. One concern is that smart devices could be used to determine if an individual has a pre-existing condition — maybe even one he or she wasn't aware of. A company could use that information to dump the individual as a customer or place him or her into a high-risk and high-cost customer pool. Health data collected by an employer as part of a wellness program, or by an insurance company as part of an incentive program, may not be subject to the same privacy laws as health data collected by doctors or hospitals. This information is held in databases that don't necessarily have the same security regulations as electronic health records. It could be sold or hacked.
Employers could also use data from fitness devices to weed out unhealthy employees who might end up costing them more money because of chronic lifestyle-related diseases. And if an employer decides to adopt the gamification approach and make fitness a group effort, it could subject employees to "fat shaming," or even discrimination — penalizing employees for pounds — causing extra stress and possibly contributing to unhealthy lifestyle behaviors and the lack of motivation the program was supposed to resolve.
I believe that despite the dearth of overwhelmingly convincing data on the effectiveness of personal health monitors and their inherent risks, the health industry will turn to them as a way to reduce costs. It must do something. U.S. employers insure about 170 million people and spend, on average, more than $12,500 in premiums for each employee and his or her family. By 2025, that figure will reach $24,500. A big chunk of that bill is due to preventable chronic diseases.
Activity trackers and other devices can motivate their users to live healthier lifestyles, especially as technology improves to become more precise and accurate (we're not quite there yet). Incentives to use these devices are likely to grow, though employers, insurance companies, and health-care providers will have to convince people that the data generated by the devices won't be used against them.
This digital health-care revolution may not be the all-encompassing solution to the chronic diseases that threaten to break the health-care bank, but it is one that can doubtlessly have a great and lasting impact.
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