Bad news is good when it motivates

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By Ann Geracimos

Barring expensive DNA testing, what hope is there for motivating Americans into doing what they know it will take to improve their health?

DNA testing, which can reveal an individual's genetic propensity for certain diseases, at least might scare someone into action. The problem of the moment is one of perception: Most of us think we are healthier than we are, according to a survey of 1,000 adults sponsored last year by Cigna HealthCare, an insurance firm. Even when we know better, apparently, we are loath to take all the steps necessary to stay healthy: stop smoking, eat less and exercise more.

Respondents from the District showed especially unrealistic self-assessments in the survey, a telephone sampling conducted by Yankelovich Inc. A vast majority of District residents said physical wellness is the most important factor to their sense of well-being — a number that doesn't correlate with national statistics from the Centers for Disease Control and Prevention that show an estimated two-thirds of adults are overweight or obese.

Enter the entrepreneurial businessmen, advanced computer software in hand, to help solve the problem of motivation. Health-risk assessment tests marketed to employers are among the latest tools for bringing perception in line with reality. Most such tests are base-line indicators of an individual's physical health and, depending on the outcome, urge intervention of some kind. Lacking intervention, a person is likely to incur higher health care costs for himself and his employer.

Not surprisingly, one of these is Cigna itself, which licensed a Trend Management System, developed by the University of Michigan Health Management Research Center. Analyses are based on "risk clustering"; answers are judged in context to identify, in priority order, behaviors that require attention to forestall future problems. Privacy laws mandate that a cooperating employee must consent to have details of his assessment known beyond the final score.

"What if I am 37 years old and have no [insurance] claims but haven't had a physical examination in spite of having a family history of diabetes? You start to see a picture of someone building risk," says Dr. Daniel Ober, Cigna's senior medical director for health advocacy, explaining the power of perception over reality — and why the mention of diabetes or cancer risk may not be a springboard for some people to seek preventive care.

"Our visual image of the condition may be based on [one's] historical life experiences," he says. "Is that a picture of a grandfather who had prostate cancer or diabetes? Add fact-based information — some people have none — and the terms, such as stage one or stage two, which can be either the image of something eating your body or of someone who survived. Add to that a third level, which is the cultural environment and whether such matters are in the open."

He quotes the American Medical Association as saying that more than 70 percent of diseases such as diabetes and obesity are due directly or indirectly to lifestyle. He also considers that "there are things that we have a lower level of consciousness for," such as counting times we may eat in places like the car or while watching TV.

BioSignia, a biotechnology company in Durham, N.C., claims its Know Your Number program approaches the issue differently by targeting an individual's chances of developing America's chief chronic, preventable killer diseases — heart disease, diabetes and stroke — and tells that person the likelihood of developing one within five years.

Nothing is completely predictable, agrees Tim Smith, company president and chief operating officer, asserting that this program goes beyond other health-risk assessment models available in the marketplace. The total cost for getting data for the program, "including getting blood drawn," he says, is $50 per employee. Clients have included Chevron, International Truck Co., Abbott Labs and others, he says.

Among them is the Bankplus Community Bank of Mississippi, headquartered in Jackson, where 750 employees — or 95 percent of the total — have taken part, according to Vice President Elynn Fish. The bank has an incentive system based on the steps individuals take to improve their health status; employees get a certain amount of their insurance paid depending on the number of criteria they meet. Documentation is required. In four years, the number of major late-stage heart disease and cancer cases among employees has decreased by 21 percent, Ms. Fish says.

"The point is to manage the problems before they turn into late stage," she says.