The three-letter initials “PHM” appear almost daily in articles on solving the healthcare cost crisis. While the “HM” initials always stand for “Health Management”, the “P” varies widely in its denotation. I have seen it used for “Population”, “Preventive”, “Proactive”, Prospective”, “Pre-Emptive”, “Predictive”, “Pervasive”, “Productivity”, “Performance”, and there may have been some I’ve missed. But ultimately, they all involve some combination of “Payer”, “Provider” and “Personal” health management, depending on which of these three main stakeholders in the process are the focus of the effort.

Almost all discussions of “PHM” apply to efforts by payers and providers (adding their own “P”s, since Physicians, Pharmacists, nurse Practitioners, Physicians assistants, and a wide range of both traditional and complementary/alternative Practitioners are involved). Advice to and examples of such efforts focus on how these stakeholders can manage the lifestyle and health behavior of individuals and populations, achieve compliance with medications regimens, adherence to health/wellness promotion, risk reduction and chronic disease control prescriptions or recommendations.

But the ultimate challenge is necessarily personal health management – the continuous self-monitoring, self-motivation, and self-discipline of individual persons, with the aid of their family and friends, co-workers, support networks, and often their peers who are seeking to achieve similar health goals. As a career marketer, I have bridled and laughed at discussions of “customer management”, as if that source of all marketing success could actually be manipulated and controlled by sellers. Even the “management” of employees, of soldiers, or prisoners is at best a cooperative endeavor requiring the willing acceptance of direction by the individuals and populations involved.

Any solution to the national healthcare cost crisis — or to the particular micro-crises of particular insurers, government agencies, or employers – requires to types of personal self-management, both of which are usually, if not always jointly mentioned as key to reform. First is personal self-management of sickness care demand and use by patients, including self-care when that is the best option, rather than seeking help from providers that cost someone money.

Champions of sickness care self-management call for a shifting more of the burden of paying for such care — through “consumer-directed health plans”, and some form of sickness care spending account, or simply reducing the share that third parties will cover. Combined with widespread access to information on which treatments and providers represent the “best deal” in terms of quality and costs, this cost-shifting first automatically reduces the burden on third parties, while being expected to turn consumers into prudent and cost-conscious purchasers of sickness care.

This same combination of incentives, both positive and negative, is supposed to work toward making consumers more prudent and cost-conscious managers of their own health behaviors and status. This form of personal self-management includes primary, secondary and tertiary prevention services, which are increasingly being covered by payers as part of their “value-based purchasing” and the intended “value-based utilization” by consumers. And the value intended is any combination of: 1) health/wellness promotion, 2) risk behavior and condition prevention or reduction, 3) chronic disease self- management; 4) symptom and sickness care demand management; and 5) disability self-management.

To support individual persons in their PHM efforts, payers are going beyond simply covering more proven-value services to reduce or eliminate financial barriers thereto. United Health Group, Minneapolis, for example, offers support to “covered lives” as consumers to optimize their use of covered services that can help in their personal self-management. This support comprises first the use of United’s proprietary “Consumer Activation IndexSM” based on analysis of claims data, to gauge how thoroughly and consistently individuals take advantage of available healthcare resources to improve or maintain their health/wellness and quality of life.

In its pilot test of this index, United found that 46% of the employees insured by six national employers were not taking optimal advantage of routine screenings for diseases or risk conditions, or of preventive services that can protect their health and save their employers sickness care costs plus improve employee productivity. The program separates employees and their dependents into a “life stage” (singles, young families, mature families, or empty nesters) or chronic disease segment for tailored support based on individual members index score.

[“United with MeSM Helps Employees Become More Engaged Health Care Consumers” BusinessWire.com Oct 3, 2007]

“Singles” would be logical targets for reminders to get covered screenings or preventive services, or invitations to enroll in a Health Savings Account lest they miss out on an opportunity to qualify for employer-contributed funds. “Young families” might get advice on prenatal care of child development and protection. “Mature families” may get advice on avoiding chronic illnesses whose risks increase dramatically with age, while empty nesters might get advice on the importance of managing their health, as well as wealth, in order to enjoy a comfortable and happy retirement. “Chronic disease” segment members would logically get referrals or invitations to disease management programs.

By customizing communications to particular segments, with a consistent theme of taking advantage of existing coverage and services available to help them, individuals can be engaged more broadly and intensively in efforts that will protect and improve their health. Since this will also tend to reduce their use of sickness care, while reducing the incidence, prevalence, or effects of acute and chronic disease or injury on workforce productivity and performance. This makes this kind of program a “Win-Win-Win” for the three stakeholder categories involved, and enables insurers to strengthen their relationships with both employers and employees.