Health & Wellness
One Friday afternoon three years ago, Harvard Professor Ashish K. Jha found out his father had been taken to "one of the most dangerous places in the world." Knowing as I do the energetic and courageous Professor Jha, I pictured a more senior version of him sky diving or climbing Mt. Katahdin. Unfortunately, the reality was far more banal, though still dangerous — Dr. Jha's father was taken to an American hospital.
The good news is Dr. Jha's father made a full recovery after only a few days in the hospital. The bad news: at least three potentially harmful errors occurred during those days. "On Saturday afternoon, he was given an infusion of a medicine intended for another patient — an infusion that was stopped only after I insisted that the nurse double-check the order," recounts Dr. Jha. "After she realized the error, she tried to reassure me by saying, 'Don't worry, this happens all the time.'"
Indeed, Dr. Jha agrees this "happens all the time," but it's not reassuring to him at all. In addition to being a concerned son, the professor is an expert in patient safety. He knew only too well the dangers his father faced — the legions of rampant errors, accidents and infections in hospitals throughout the United States.
Employers are trying hard to reduce health care costs and create a healthier, more-productive workforce. They have tried to optimize employee usage of services offered by their health plans and invested in wellness programs. They are now beginning to consider (or have implemented) cost transparency tools and second opinion and telemedicine services.
All these approaches are right!
What employers are missing is an understanding of how employees are making health care decisions and how that impacts their health care costs.
A large population of health care consumers are starting with a search engine to find health care information online. In the past year, 72% of U.S internet users have gone online specifically for health related information, and 77% of them begin their research at a search engine.1
And age has nothing to do with it!
Of those who seek health information online, 73% are 50 years of age or older.
At the same time, many doctors are urging patients to not rely so much on Google for health research. Doctors lament that they often have to correct misinformation or incorrect conclusions after patients do health research online.2
An Ideal Health And Wellness Program
Based upon our actuarial analysis we find that as much as 75% - 85% of the potential savings from health and wellness programs can be directly attributed to six specific and objectively measured factors:
- Obesity (i.e., as measured by the BMI or Body Mass Index)
- Fasting blood sugar
- LDL cholesterol (i.e., bad cholesterol)
- Blood pressure
- Smoking/non-smoking, and
- Personal fitness
Ironically, all of them with the exception of smoking/non-smoking are directly related to Body Mass Index. As individuals solve their Body Mass Index problem, they gradually solve most of their other problems. Some individuals with genetic predisposition to certain conditions may require ongoing medications to keep one or more factors in control, but the vast portion of problems can be significantly improved and eliminated by eliminating obesity and achieving an ideal Body Mass Index or by at least improving it and moving closer to the ideal level.
This suggests that significant gains can be made by creating a BMI-focused health and wellness program. Since smoking/non-smoking is somewhat independent, perhaps a two pronged program (i.e., BMI and smoking cessation) is the best way to implement a program. This "tight" focus enables the program to quickly succeed, where other "loose" focus programs have failed or had significantly less results.
Although the actual results are significantly impacted by characteristics of the studied population (i.e., the population's average Body Mass Index scores and the proportions of smokers to non-smokers), we find that in a fairly typical population, overall health care costs can be reduced by as much as and possibly more than 20% - 30% if each of the individuals in an overall population advance to their ideal health status. On an individual by individual basis the cost reductions on some is much more than this. A tangential benefit of this improvement is that the cost savings continues to occur for many years, not cost savings in just one year.
Emergence Of Health And Wellness Programs As A Solution
For many years wellness has been viewed from somewhat of a skeptical perspective. However recent studies and improved implementation programs are showing considerable health cost savings are associated with health and wellness programs. Our firm's most recent estimates show that an effectively implemented health and wellness program can reduce aggregate health care costs by as much as 20% - 35%. In addition, these costs savings continue for more than one year. Health and wellness provides a meaningful solution of the affordability crisis. Although there continue to be significant opportunities for efficiency improvements within the health care system, the emergence of the health and wellness solution is encouraging.
Illustrative Impact of Health and Wellness Changes
Health & Wellness
* Source: Dee W. Eddington, Ph.D., Director of the Health Management Research Center at the University of Michigan
Table 7 shows that with a modest shift in health and wellness level health care costs are reduced 24%, and with a more significant shift costs are reduced 34%. These shifts are very possible under an effectively implemented health and wellness program. These projected savings compare favorably with the potential for efficiency improvements. However, they bring a much more important quality to the table, these are politically correct and desirable initiatives. The efficiency savings, although real savings, have become less desirable for a variety of reasons.
Improving Affordability Through Health And Wellness And Improved Efficiency: An Overview
As we enter a presidential election year, health care reform continues to be a key talking point for all of the candidates. Today's major health care issues are much like those of the past, just exacerbated with today's financial uncertainties. The ever-escalating costs above and beyond the rest of the economy, the growing uninsured and related health care access issues, and ongoing quality of care concerns dominate the dialog. These critical issues can be captured by a few poignant questions:
- Can we afford our health care system today and in the future?
- If we improve the affordability of the system, will the issues be mitigated?
- What are the most obvious ways to improve the affordability of the system?
- Is a complete overhaul of the health care system required?
This series focuses on proposed answers to the above questions and integrates current information with updated research and analysis presented by the author on these important topics.
Affordability, particularly health care affordability, has been misunderstood and oftentimes confused with cost. Affordability is best defined as a measure of someone's or something's ability to purchase a good or a service. It describes whether a person or organization, with limited resources, is able to make a purchase without unacceptable or unreasonable sacrifices. It assumes there is a limited amount of resources to purchase life's necessities.
Health care affordability describes whether a person or organization has sufficient income to pay for or provide for health care costs and not significantly impede their ability to purchase other important services.
Housing affordability is often defined in terms of the ratio of how much it costs to purchase the median-priced home in a particular marketplace (i.e., mortgage payment with 20% down) to the average income in that particular market. For example, if the median price for a new home is $500,000, an 80% mortgage would be $400,000. The monthly payment for that mortgage at 6% interest would be about $2,400. If the average annual income in that community is $75,000, one metric of affordability would be as follows:
($2,400) / ($75,000 / 12) = .384 or 38.4%
This says that 38.4% of the average person's gross income is required to pay the mortgage payment for the median house. If another region has a lower ratio, their housing would be more affordable, and vice versa.
Health care affordability could be defined in a similar way: how much does health care cost divided by how much is available to spend on health care?
Did you get enough sleep last night? Feeling droopy from working on a late-night project? Maybe you caught the red-eye from the West Coast and are starting to feel groggy.
Join the club, but beware.
Some of the most spectacular accidents of the last century have been caused by human fatigue. This includes the oil spill of the Exxon Valdez, the fatal navigational error of KAL Flight 007, the Union Carbide gas leak at Bhopal India and the Three Mile Island nuclear disaster. Less heralded are other accidents that have employee fatigue as a causative factor.
The National Highway Safety Council estimates that thousands of accidents per year are due to trucker and driver fatigue. Medical residents in training pull 36-hour shifts and are prone to fatigue-induced judgment errors. Stockbrokers rise in the middle of the night to juggle huge sums of money on foreign markets. Some lawyers are so burned out by the billable hour treadmill that they are looking at alternative careers. No telling how many bad business decisions flow from sleep-deprived executives burning their candles at both ends.
In isolation, these developments may not seem serious. In some corporate cultures, herculean hours and fatigue are viewed as badges of honor. The consequences of mind-numbing fatigue, however, can cause bodily injury, property damage and business blunders with a high price tag. C-suite executives must be attuned to operational and cultural factors that heighten the perils.
Underlying seemingly disparate losses is a common thread of human fatigue, stretched taut by downsizing, re-engineering, technological advances and the pressure of global competition.
Executives ignoring these factors can find themselves — and their companies — facing grave safety and loss control risks. There is an increasing amount of caselaw holding employers liable when their employee's fatigue injures or kills others. Personal injury lawyers are bringing the science of sleep into courtrooms. Lawyer publications such as Trial magazine contain articles on suing companies who let workers burn candles at both ends. Courts increasingly say that corporate fatigue management is the business of an organization. Companies ignoring this will receive painful reminders in the form of jury awards and high settlements.
Aside from the loss control consequences, accident and health costs loom as well. Fatigued workers are sicker workers, spawning absenteeism, excessive sick days and inflating the tab for a company's employee benefits program.
While there is ample evidence that human fatigue is a factor which loss control professionals should address, there is scant practical advice on exactly how risk managers can go about this task. Therefore, let's examine some hands-on steps that C-suite personnel can take to tackle this growing problem.
Receiving the call from the claims adjuster was not what I wanted to hear. After an accepted mild back strain, I, the permissibly self-insured employer am informed of continued physical therapy two times/week for 6 weeks as well a prescription for opioids to treat the chronic, yet unresolved pain. This injured worker has been off work for more than 6 months, with work restrictions that cannot be accommodated due to the collective bargaining agreement, and escalating claim costs. Frustrated, I ask the claims adjuster what the options are for claim resolution. Sadly, it appears to be business as usual until the doctor determines a stay in maximum medical improvement. We have been down this road before. An injured worker, an open claim, more medical treatment and I feel as if I have lost the key to open the lock to break the chain that binds. We conclude the call with a diary to discuss next week after the physical therapy is underway.
Business Insurance Associate Editor Matt Dunning in its 9/25/11 Business Insurance magazine stated the opioid problem began with about 20 states relaxing laws that had discouraged doctors from treating "chronic, non-cancer pain" with opioid prescription pain medications, an occupational medicine expert said.
The trend, which began in the late 1990s, allowed "extreme permissiveness" in increasing opioid doses prescribed to injured workers, said Dr. Gary M. Franklin, medical director for the Washington State Department of Labor and Industries and a research professor in the departments of Environmental and Occupational Health Sciences and Medicine at the University of Washington in Seattle.
Consequently, the increased use of opioids to treat workers' compensation injury claims is creating challenges for employers in resolving claims with injured workers with chronic pain. Medical, indemnity and prescription costs continue to rise and employers are looking at ways to limit liability, close claims and get the injured worker back to work.
One of the opportunities for California employers is the use and understanding of Medical Treatment Utilization Schedule (MTUS) and American Medical Association guidelines in the treatment and utilization of medical procedures in the claims handling process. Utilization review is also a venue to help employers have appropriate medical treatment given for the injured worker.
I believe it is very important that agents fully understand the mechanics of America's healthcare delivery system, why it is broken and what it might look like if it's successfully overhauled.
The fundamental problem with the American healthcare system is that we hardly spend any money on basic, general care which causes us to spend a whole bunch of money on specialty care. The fact is that five chronic diseases account for 70% of our country's $2.6 trillion annual healthcare expenditures. Those diseases are coronary artery disease, congestive heart failure, diabetes, depression and asthma. The status quo of the way we deliver healthcare is conducive to inadequate management of chronic illness.
There's not a lot of money in educating a family on what brings on an asthmatic attack and what to do in case a child suffers from one. But there's a whole lot of money spent when an asthmatic is admitted to the hospital. The lack of proper care and management of diabetes can lead to very expensive care including amputations, dialysis at $10,000 a day and maybe even a new kidney at $250k. Outreach programs to help diabetics methodically check their blood chemistry, see their doctors regularly and gain access to nutritionists are generally poorly funded, if they exist at all. So it's no wonder that diabetes alone accounts for 35% of Medicare expenditures.
Shortages in access to primary care due to lack of financial incentives (why be a general practitioner when you can make three times the money being a specialist?) cost our system hundreds of billions of dollars a year. Unless our country does more to encourage chronic disease management, the healthcare cost curve will continue upward and ultimately drive our country off the edge of an economic cliff.
Having said this, our system appears to be in the early stages of changing for the better.
As the author of this article I have an honest confession to make. In doing so, it is my hope that you will read its content with greater receptivity as you realize how near and dear this issue is to me.
It's been ten years since the day I straddled two medical-quality scales and discovered the monumental 467-pound challenge that lay ahead of me. Ten years ago I turned my very existence in a completely new direction as I began my journey into a state of rediscovered health and well-being. You see, I'd been living a life of profound hypocrisy. My personal health and public career as a physician didn’t jibe. Daily I gave medical advice while constantly having to qualify my own overweight, out-of-shape body with the words "Do as I say, not as I do."
It's not that I didn't recognize I was severely overweight — there were daily reminders. A 60-inch waist makes for a very limited wardrobe. I couldn't fit into an airplane seat, wear shorts, or climb a flight of stairs without becoming winded. I dreaded going to an unfamiliar restaurant, worrying I might not fit into the booth or chairs. Diabetes and high blood pressure were lurking around the corner and were inevitable consequences that I would soon have to deal with. I needed to make a change, but I kept making excuses and rationalizing the error of my ways. Until a bout with testicular cancer forced me to deal with the consequences of my poor health decisions. Though the cancer was unrelated to my excess weight, it caused me to confront head-on my own mortality for the first time in my life. As a result, I suddenly saw my physical health as a precious gift that I could no longer take for granted and a gift that I was now eager to take much better care of. When I recovered from the cancer, I decided I could no longer go on killing myself with an avalanche of calories and a lack of physical activity.
In early 2001 I stepped off the scales with a newfound inspiration and determination and set out for a whole new way of life. After much reflection and personal inventory taking, I decided to take an unconventional approach — I’d combine doing something good for my health — diet and exercise — with something I loved — baseball. It would be my "radical sabbatical." Over the course of the next year, I traveled over 38,000 miles in an old RV, visiting every state in the continental U.S.A. and every Major League ballpark. I enjoyed over 110 games, but rather than feasting on junk foods, I stuck to an aggressive, medically supervised meal plan that still provided me the basic and essential nutrition I needed. Through that diet, coupled with consistent and intense daily exercise, I lost a total of 270 pounds. And it's not about losing the weight. It's about losing and never finding it again that really matters. Today, exercise and healthy eating are a major part of my life. I'm enjoying focusing on my personal fitness and encouraged by the slow but steady improvement in my body's shape and composition. Whatever pleasure I lost from overeating has been replaced many times over by the blessings and opportunities that result from my transformation. The old saying really is true: "Nothing tastes as good as healthy feels."