“Welcome to the New York Health Exchange! At the closing bell on Dec 31, 2008, you saved 40% of your allocated money for the year, received dividends amounting to 10% of your starting balance, benefited from a 15% appreciation in your health indices, and a corresponding drop in your mortality markers. The NYHE reminds you to ease on the holiday gorging and wishes you a healthy Q109.”

I had an interesting conversation yesterday with Jessica Shambora from Fortune. Whether patients will own and control their health information through personal mobile technologies was one of the topics we discussed. It became clear to me that while we will have the ability to browse our medication histories on our phones, we need to look beyond technology if we want to get our health system back in shape.

Thanks to Mikhail Elias who recently joined our team at Dimagi, I have been learning lots about Health Information Exchanges. They form a cloud of health information between institutions and stakeholders that make it easier (at least conceptually) to share data. So in theory we can have a central way to access all of our data. But we can do more than that.

We need some innovations in health financing (eg HSA 2.0) that’ll make spending or saving on healthcare fashionable. Put control of the purse with the patient and their family/network since the patient is where all pieces of the puzzle converge. Run the dollars and data through a centralized exchange; so a patient is able check the status of a lab (with simple interpretation) and also the balance in a health dollar account. The data is all there, but focusing only on fixing the data exchange misses the bigger picture. That is, of making all the hard data work relevant to a patient.

Back in the day we made a video game for children with diabetes. People criticized us, saying that patients would compromise their health for the sake of the game. The good news (or bad news for those who work on behavioral change) is that patients are more sensible than that. If given the means, they will do what they think helps their health. An exchange where they also can make some cash by saving the health system some dollars (eg. prevent hospitalizations by taking those asthma meds) can change the game. Or as John Hammergren of McKesson says in his aptly titled book, we will change the game when we give patients some Skin in the game.



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