Using Person-Centered Health Analytics to Live Longer

Dwight McNeill, PhD, MPH, is a teacher, writer, and consultant. He is a Lecturer at Suffolk University where he teaches courses in population health and health policy. Dwight has published two previous books on health analytics, including A Framework for Applying Analytics in Healthcare: What Can Be Learned from the Best Practices in Retail, Banking, Politics, and Sports and (editor) Analytics in Healthcare and the Life Sciences: Strategies, Implementation Methods, and Best Practices. He has also published many journal articles, including "Building Organizational Capacity: A Cornerstone of Health System Reform" (with Janet Corrigan) in Health Affairs. Over his 30-year career, he has worked in corporate settings, most recently as Global Leader for Business Analytics and Optimization for the Healthcare Industry for IBM, and previously at GTE; government settings at the federal (Agency for Healthcare Research and Quality) and state (Commonwealth of MA) levels; analytics companies; and provider settings. He consults on analytics innovations to improve population health management and person-centered health. Dwight earned his PhD from Brandeis University in Health and Social Policy and his MPH from Yale University in Public Health and Epidemiology.

Introduction 1
Background 4
Solutions 7
Toolkit for People 7
Opportunities Portfolio for Stakeholders 12
Stakeholders 12
Barriers to Widespread Adoption of pchA 13
Areas of Opportunity 14
Visualize SOPrDiMoCa 14
Design for People 15
Tailor Best Fit 15
Sustain Passively and Actively 16
Discover Alien Intelligence 16
Extend...Don't Stand Alone 17
Shape Momentum 17
Rework Hackathons 18
Assure Privacy 18
Welcome Aboard 19

PART I: IMPROVING HEALTH OUTCOMES: THE FUSION OF HEALTH, ENGAGEMENT, DEMOCRACY, TECHNOLOGY, AND BEHAVIOR 21
Chapter 1 It's About Health Outcomes 25
Health Care's Veiled Purpose 25
Measuring Health Outcomes 27
The Uneasy Business of Health Outcomes 31
Missed Opportunities 31
New Pressures on the Business and Analytics 34
Occupy Health Care 36
Rebuilding the System 36
Generation Unmoored 37
Taking Off the White Coat 39
Chapter 2 More Prevention, Less Treatment 43
It Has to Be More about Health than Health Care 43
More Prevention, Less Treatment 44
More Upstream, Less Downstream 45
More Socialized, Less Medicalized 46
More Systems Thinking, Less Siloes 49
More People, Less Patients 51
Personal Behavior = 67 51
Chronic Diseases "R" Us 51
Measuring Burden and Risk 53
Learning from Finland (Maybe 56
Let's Get Back to the 67 57
Everyone's Eyes on Five Behaviors 58
Five Behaviors and the 20% Rule 58
Whose Responsibility Is It 62
A Culture of Health 62
Chapter 3 Driving Health through Engagement 65
Integrating Our Four Selves in Health 65
Consumer 66
Patient 67
Citizen 68
Customer 69
Our Integrated Self 69
Patient Engagement: What, Why, and Why Not 70
What Is Patient Engagement 71
Why Patient Engagement 72
Why Is Patient Engagement So Rare 73
Making Patient Engagement Work Better 76
What Health Care Organizations Can Do 76
What Patients Should Do 83
Becoming Un-Patient 84
Chapter 4 Forces of Democracy for Health 87
Data Truths 87
Whole Health Catalogue 87
Show Me the Data 88
The Case of 23andMe 90
Am I Lab Worthy 91
Superconsumers 92
A Caveat on Self-Service 94
Redirecting Our Free Time 95
Crossing the Gap 97
Relying on Me...and We 98
Health Social Networks 99
Examples of Health Social Networks 100
Observations 104
Chapter 5 High-Definition (HD) Health Data 105
Overview 105
pchA Data 105
pchA Technical Cornerstones 106
Beyond Personalized Medicine 107
Genomics 108
Consumer Genomics 110
What's a Person to Do 113
Sensors 114
Not Ubiquitous, but Promising 116
Achieving Results with Sensors 117
Finally...Proof 121
HIT and Health Records 122
Electronic Health Records 123
Challenges 124
Kaiser Permanente 125
Personal Health Records (PHRs 125
Two Best Practices: Blue Button and My Health Manager 127
The Connection between Data Availability and Quality of Care 129
Chapter 6 The BIG Challenge of Behavior Change 131
Paternalism 132
Making Behavioral Changes Happen 134
An Example: CAD 134
Approaches to Behavior Change 135
Comprehensive Modulate Programs 138
Integrative Lifestyle Medicine 138
Stages of Change 139
Trusted Peers 141
Common Features 143
New Wave: Behavioral Economics 144
Connected Devices and Apps 146
Social Networks 147
Gamification 148
Overall: Promise and Pitfalls 149
Analytics to Support Behavioral Change 150
Opportunities/Challenges 151

PART II: BUILDING THE TOOLKIT FOR PERSON-CENTERED HEALTH ANALYTICS 155
Chapter 7 Getting Started with the Toolkit 159
Driving Directions 160
Knowing Me 160
Protecting Health 160
Minding Illness 161
Managing Data 161
Rules for the Road: A Top-Ten List 162
Chapter 8 Driving Directions 165
The Five Stages of Change 165
Chapter 9 Knowing Me 171
Health Status and Risks 172
Annual Physical Exam 172
Health Risk Assessment (HRAs 174
Well-Being Measurement 177
Genomic Health Risks (Optional 180
Engagement and Self-Care 182
Patient Activation 182
Social Risks 185
Personality 188
Analytics Capabilities 189
Health Literacy 191
eHealth Literacy 192
Digital Competencies 193
Summary of Knowing Me Toolkit 195
Chapter 10 Protecting Health 197
Self-Monitoring 200
Sitting 201
Eating 204
Smoking 206
Drinking 207
Information 208
Summary of Protecting Health Toolkit 210
Chapter 11 Minding Illness 213
Self-Monitoring 216
Diabetes 216
Ischemic Heart Disease 220
Taking Medications 222
Self-Triage and Peer Communities 224
Self-Triage 224
Peer Communities 228
Summary of Minding Illness Toolkit 230
Chapter 12 Managing Data 233
Get Data 234
Portals 236
Services 238
Choosing Providers 241
Store Data 244
What Needs to Be Stored 246
How to Store It 248
Protect Data 251
Computer Hygiene 253
Social Media 254
pchA 255
Summary of Managing Data Toolkit 259

PART III: STAKEHOLDERS SUPPORTING PERSON-CENTERED HEALTH ANALYTICS 261
Chapter 13 Stakeholders: Influencing the Adoption of pchA 263
Roles of Key Stakeholders 264
Health Care Providers 265
Health Companies 266
Health Insurers 267
Government 268
Technology 269
Working Together 270
Chapter 14 Barriers to Widespread Adoption of pchA 271
Physician Practice 272
Value for the Patient 272
Help or Hinder Practice 273
Organizational Integration and Approval 273
Payment and Cost 274
Reimbursement 275
Payment System 276
Cost 276
Proof 277
Tools Ordered by Doctors 277
Tools That Substitute for Doctors 278
Nonmedical Tools 278
Proof Summary 279
Pleasing the Customer 279
The Fizz in Digital Health Product Development 279
The Fizzle in Consumer Demand 280
From Slick and Click...to Tick and Stick 282
The Job Consumers Are Trying to Do 283
Privacy 284
Obfuscation 284
The Feds Taking Notice 285
Chapter 15 Opportunities for Stakeholders to Advance pchA 287
Visualize SOPrDiMoCa 287
Design for People 289
Understanding the Customer 290
Multiple Methods for Designing for People 290
Tailor Best Fit 291
Learning from Radical Personalization 292
All the Data That's Fit for Modeling 293
Sustain Passively and Actively 294
Sustain Passively 294
Sustain Actively 295
Discover Alien Intelligence 296
AI Maturity, Finally 296
AI for Health 297
Extend...Don't Stand Alone 298
Integrated Systems 298
Health Management Programs 299
Medicare and the ACA 300
Shape Momentum 300
Government Actions 301
Multisector Partnerships 302
Profuse Funding 302
Rework Hackathons 303
Hack This 303
Swimming with the Sharks 305
Assure Privacy 306
Regulation 306
Industry Code of Conduct 308
Epilogue 311
Wrapping Up 311
Looking Forward 312
Staying Current 314
References 315
Index 353


How to dramatically improve health outcomes by using data, technology, and behavioral science to empower individuals as agents of change.