Health Score Card
The Health Score Card: Five Measurements That Are Good Enough
One of the questions I keep coming back to is how we get a more accurate depiction of someone's overall state of health. Not a lab value. Not a symptom. The whole picture.
In 2027 we'll be rolling out the health score card. The idea is simple: the same way a business has a scorecard, a person should have an objective evaluation of where their health actually stands — and a way to tell, year over year, whether it's getting better or worse.
Why a Score Card
An article that changed how I think about metrics was Michael Porter's work on measuring outcomes in health care. Porter spent his career writing about strategy and management, and when he turned that lens on medicine he pointed out something uncomfortable: health care measures what's easy to measure — process, volume, compliance — rather than the outcomes that actually matter to the person receiving care. His argument was that value is outcomes divided by cost, and if you're not measuring outcomes you have no idea whether you're delivering any.
That's the problem I'm trying to solve at the clinic level. We're charging people money. I want to be able to demonstrate that what we do actually moves their state of health compared to the standard of care — and I can't demonstrate that without a defensible, repeatable measurement.
The Trend Is the Point
One of the consistent themes in health and in life is that the trend matters more than the snapshot.
At any age you can make improvement on an untrained system. If you've never lifted, you can get stronger than you are right now. If you've never done any cardiovascular training, your cardiovascular fitness will improve. If you've never worked on body composition, it can be changed. If you've never tried to move your metabolic risk factors, there are more tools available than most people realize.
The complication is that somewhere around midlife you stop competing against your own untrained baseline and start competing against time. The objective in the back half is to slow the rate of decline. Some people believe science will eventually blunt that downside completely. I'm personally less optimistic — but I don't need to win that argument to be useful. Slowing the slope is worth doing either way.
Good Enough, Measured Consistently
Here's the principle underneath all five of these measurements: a good-enough test you run every year on every patient is worth far more than a perfect test you run on nobody.
Every one of these tools has a better, more expensive, more precise version. In almost every case we chose the cheaper one on purpose, because the value of a metric comes from repeating it, and anything we can't afford to repeat doesn't make it onto the score card.
1. Body Composition Testing
The InBody assessment we run in clinic may be the single most valuable objective tool we currently have.
The general rule of thumb is to lose fat mass and increase skeletal muscle mass. When someone does that, the metabolic labs almost always follow. Visceral adipose tissue — the fat around your organs — tends to come down with it, and that reduction lowers systemic inflammation.
Two other readouts make this machine worth the space. The first is the ECW/TBW ratio (extracellular water versus total body water), which helps identify whether someone is relatively dehydrated or carrying inflammation. Compared against lab results, it tends to be fairly accurate. The second is phase angle, which serves as a surrogate for cellular health.
The limitation: unlike a DEXA scan, the InBody can't assess bone density. That's a real gap in higher-risk populations — patients on long-term steroids, thin women, and anyone with a family history of osteoporosis. Those people should still get a DEXA.
Why we chose it anyway: no radiation, so it doesn't need its own shielded room. Results in minutes. Low maintenance. That combination is what makes it repeatable.
Goals
Improve over time
Body fat: men <20%, women <30%
Visceral fat: <2 lb
2. Grip Strength
We use grip strength as a surrogate for whole-body strength because it's historically validated — there's a substantial body of research correlating it with mortality and functional decline.
I'll be honest that parts of it don't make sense to me from a mechanical perspective. Longer fingers mean better leverage and a higher score, and long fingers travel with being bigger overall, which isn't itself protective. The short answer is that strength is generally favorable for resilience and function, and grip is a cheap proxy for strength.
Why we chose it: the assessment takes about ten seconds. No barbell to load, no leg press to occupy a room, minimal cost, essentially no floor space. Squeeze as hard as you can for a couple of seconds and you're done.
Grip strength is the clearest example of a tool that is good enough.
Goals
Improve over time, or maintain
Above the 90th percentile for age and sex
3. VO2 Max
This is a functional assessment of cardiovascular fitness. There are a lot of protocols; the most formal ones run 30 to 40 minutes plus a 5 to 15 minute warm-up.
Grip strength and VO2 max share a failure mode: people start training for the test. I don't believe the point of cardiovascular training is to score well on a cardiovascular test. Do some cardiovascular exercise because it's good for you. The test exists to tell us whether your fitness is moving in the right direction.
Why it's been a thorn in my side: just getting testing equipment ran about $15,000, and that was doing it as cost-effectively as I could. It's more equipment to maintain, and there's a per-test cost to run it. An academic-grade metabolic cart would have been closer to $150,000. So we compromised for good enough — again.
For the physical we'll be running an 8-minute protocol. Formal VO2 max testing isn't necessary for what we're asking: where are you now, and on the repeat test a year from now, are you better or worse?
Goals
Improve over time
Above the 90th percentile for age and sex
4. Life Insurance Labs
The panel includes a CBC, comprehensive metabolic panel, lipid panel, hemoglobin A1c, and GGT.
Those labs alone get you roughly 80% of the picture of someone's metabolic state of health. Conservatively the whole panel costs under $40, and it's probably closer to $20 — about one tenth the price of the comprehensive panels being marketed today.
That price ratio is the entire argument. The return on adding more labs drops off a cliff, because most of the additional markers are downstream reflections of the same metabolic health these five already describe. If something on this panel looks wrong, that's when a deeper dive earns its cost.
Goals
Improve over time, or maintain if already good
All values in normal range
5. Comprehensive Symptom Questionnaire
Symptoms are subjective, and the questionnaire measures how someone feels about their own state of health. That matters — how you feel about your health is part of your health. It also converts something subjective into a number we can compare year over year.
My bias is that I don't weight feeling and measurement equally. I weight objective to subjective 4:1.
The goal in primary care should generally be to make people metabolically healthier, which usually improves symptoms. But not always, and the exception is worth understanding: if your body is completely inflamed, you may be getting so much noise — so many warning signals at once — that you stop listening, and it starts to feel normal. As you get healthier, you get more attuned to the signals your body is actually sending.
Which is why it's not uncommon for someone to lose weight and not feel better right away. They're not doing worse. They're noticing more.
Goal
Reduce symptom score over time
What This Doesn't Do
A scorecard that oversells itself is worse than no scorecard, so here's what these five measurements don't cover.
They don't screen for cancer. They don't assess bone density. They don't measure sleep, and they don't evaluate mental health, both of which drive a great deal of what shows up in the other five. They're a point-in-time snapshot, and any single measurement can be thrown off by a bad night, an illness, or a hard training week the day before.
None of that makes the score card less useful. It just means it's an assessment of your metabolic and functional state of health, not a complete medical evaluation — and it belongs alongside age-appropriate screening, not in place of it.
What We Do With It
In aggregate, these five give a reasonably good assessment of where someone stands. We'll take those scores, compare them against population data, and give each person a picture of their overall state of health. Then the goal every year afterward is straightforward: make individual progress.
My entire philosophy is to nudge patients toward health over time. Primary care is a longitudinal relationship, and over a couple of years those nudges compound into changes that are hard to produce any other way.
This is also the start of building a system to assess how effective the clinic actually is. We're charging people money for our services. I want to validate that we're doing something that genuinely supports their state of health — not assume it.
3 Bullet Point Summary
You can't manage what you don't measure, and in health almost nobody is measuring the right things. The health score card — rolling out in 2027 — is an objective, repeatable assessment of someone's overall state of health, built the way a business builds a scorecard.
"Good enough" is the design principle, not a compromise we're embarrassed about. Five measurements — body composition, grip strength, VO2 max, life insurance labs, and a symptom questionnaire — capture most of the signal at a fraction of the cost of the comprehensive version, which means we can actually run them every year on everybody.
The number that matters is the trend, not the score. Any untrained system improves at any age. After midlife the game changes from improvement to slowing the rate of decline — and either way, the only meaningful comparison is you against you, a year ago.
Three Practical Takeaways
Get a baseline this year, even an imperfect one. You cannot evaluate a trend from a single point, and the first measurement is the one that makes every future measurement mean something. Body composition and grip strength are cheap, fast, and available now — there's no reason to wait for the perfect version of the test.
Train the system, not the test. Grip strength and VO2 max are thermometers, not thermostats. Lift, do your cardiovascular work, and let the scores report on the training. If you find yourself practicing for the assessment, you've inverted the point of it.
Judge yourself against your own last measurement. Population percentiles tell you where you're starting. They don't tell you whether you're winning. At any age an untrained system will improve, and after midlife a slower decline is a genuine victory — both of those show up only in your own year-over-year comparison.
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