Tag Archives: smoking

Educating Smokers: the Best Insurance

Picture a field army of insurance agents, whose mission is to help people live longer and no longer suffer from an addiction that benefits no one, not even the beneficiaries of a life insurance policy.

Picture these agents not in fatigues but shirt sleeves, campaigning like citizen soldiers and delivering relief to their respective communities. Picture these agents neither in a battle of arms nor a contest of strength, but a war for the hearts and minds—and lungs—of smokers; of men and women who want to quit smoking; of individuals who want to end their cravings for tobacco and their consumption of nicotine.

Picture a constituency equal to this army, whose lives would otherwise end in tragedy and whose deaths would have no meaning in a library of statistics. Picture more of the same in which, according to the Centers for Disease Control and Prevention (CDC), cigarette smoking is responsible for more than 480,000 deaths per year in the U.S., including more than 41,000 deaths resulting from secondhand smoke exposure.

See also: Wellness Industry’s No-Good, Very Bad Year  

Picture harmless ways to quit smoking. Picture seminars and workshops. Picture corporate partnerships and public meetings, where insurance agents are themselves agents of change rather than a series of changing faces; where the perception of agents changes to the reality of agents as leaders of every community they represent.

We cannot afford to perpetuate the current image, which costs $170 billion per year in treatments for tobacco-related illnesses.

We cannot afford to continue to ignore the obvious: that the economic cost of smoking a pack of cigarettes a day is $177 per week or more than $9,200 per year.

We cannot afford to lose so many so often. We must not habituate ourselves to the emotional wreckage of a deadly habit; because the second we cease to absorb the enormity of this problem—the minute we distance ourselves from the size of this plague—is the moment we abandon our moral authority and the morale of Americans nationwide.

Insurance agents have it within their power to do more than sell policies or find the best prices for smokers who want to buy insurance.

They have the expertise to speak to smokers about the bottom line, that they can quit smoking without risking their already fragile physical or psychological health. They can help smokers convert the money they waste on cigarettes, as they lay waste to their bodies, into a commodity that protects their health and lines their pockets with cash: insurance.

Coverage is what smokers need.

An effective—and harmless—way to quit smoking is what these individuals must have.

See also: 2018 Workers’ Comp Issues to Watch  

Let us resolve to promote healthy living by saving the lives of those whose health is in danger.

Let us eliminate the fog of uncertainty and the cloud of indecision, because we must not be enablers of cigarette smoking or passive smokers in our own right.

Let us summon that field army into action.

Let us earn this victory, so we may celebrate this achievement.

To Hellness With Wellness

It seems the only people made “well” from corporate wellness programs are those who collect $6 billion in annual costs. Still, all is not lost. If we use the most basic workings of human nature as a guide we can salvage a more reasonable realm for the notion of employer-sponsored “wellness.”

Corporate wellness is seriously flawed on the grand scale it once proclaimed. Here are four reasons why, in my opinion:

First: Wellness costs too much and thereby sets a high threshold for return on investment (ROI), which begs failure by any score based on savings. Let’s say you have a 500-person workforce. After a couple of years of “wellness,” 10 smokers legitimately quit for life, and five obese employees legitimately get to normal BMI and sustain it. For these individuals, the wellness program is an amazing success with great implications for future health. Unfortunately, with the average cost per employee in corporate wellness programs at more than $500 per year, two years costs more than $500,000, and a calculation of ROI depicts an abysmal failure.

Second: The profit motive of wellness purveyors supersedes common sense. Their sweeping approach provides incentives for assessments to identify candidates at risk and assumes that simple potential indicators of unhealthy lifestyle or other conditions create a savings opportunity. This is absolutely false. One fact is missing. Of the persons targeted, only a precious few are at a personal decision point and have the will to actually attempt difficult lifestyle changes.

Targeting must take human nature into account. We can properly diminish the presumed footprint of wellness if we look back and study individuals with actual historic success. Let us understand what indicators of personal human attitude that handful of successes gives us to use as a second-step screen. How much easier is it to realize ROI when only spending $500 per head on a smaller number of likely candidates?

Third: There is an absurd, blind thirst in both the private and public sectors to find believable reductions in projected future healthcare costs. The hype of wellness is perfectly suited to quench this thirst. Unfortunately, the absurdity is legitimized by governmental acceptance of the fool’s gold of claimed lower healthcare costs to gain leverage in negotiating state-worker union contracts, rigging budgets and passing federal legislation. (Can you spell ACA?) The term “fool’s gold” has the word “fool” in it for a reason.

Fourth: The wellness industry ignores lessons that should be learned from success in its sub-area of  disease management — specifically, that human nature feels no call to action until mortality comes knocking. Disease management savings can be documented in examples like the PepsiCo program called Healthy Living, initiated in 2003 and providing real savings today. Why does disease management work? In my opinion: People with a disease feel their mortality and are inclined to follow any program that might help.

Disease management supports a population with more personal incentive and will. Conversely, the debunked lifestyle approach targets an abundance of people who are personally happy while smoking or overeating. Fewer are suffering the acute implications of their lifestyle. “Wellness” money spent on them is useless.

Quick Tip: Trade “Big Wellness” for disease management with limited lifestyle programs

Don’t throw the baby out with the bathwater. There are many people who need and will accept disease management. As far as lifestyle, there are but a few people ready to commit to change. The good news is that over time, and organically with no cost, these few might spark an interest by others in any employer population. Keep the doors open for them and keep awareness high. In the meantime, don’t waste real money or use gimmicks on them.

I suggest wellness vendors create a new approach that unlocks the psychology of raw lifestyle change, targets the few and is willing to take on smaller footprints. Accept less money but stay for the longer haul.

You owe it to the tarnished notion of “wellness” to fix what you broke.

Affordability, Effectiveness, and Wellness, Part 5

This is Part 5 in a five-part series which presents a creative solution for today’s health care crisis. Additional articles in the series can be found here: Part 1, Part 2, Part 3, and Part 4.

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.

Every health and wellness program needs reliable ways of accurately measuring the program's effectiveness. Each of the above six factors can be objectively measured through relatively inexpensive means. For example, a simple blood test can be used to measure blood sugar or LDL levels. Blood pressure can easily be measured by a trained individual or even by automated machines. Fitness can be broadly defined as the ability to function efficiently and effectively, to enjoy leisure, to be healthy, resist disease and to be able to cope with emergency situations. The health related components of physical fitness that could be measured include body composition, cardiovascular fitness, flexibility, muscular endurance and strength. There are various ways to measure fitness depending on available resources and facilities. There are several available Health Risk Appraisal (HRA) packages that can give a report that incorporates both objective measures as well as subjective responses to a set of questions.

As mentioned earlier, it is also critical to provide hope to the participants. A believable example or champion is always beneficial to motivate participants. One interesting example of this is one of the authors of this series of articles.

Nicholas J. Yphantides, MD, Dr. Nick as he is known, the author of “My Big Fat Greek Diet”2, used to weigh 467 pounds, has lost more than 270 pounds, and has successfully kept it off for almost seven years. His significant and relatively quick weight loss journey is chronicled in the book. Dr. Nick outlines Seven Pillars of Weight Loss Success, which are critical to successful weight loss and are integrated in the Individual Change Management Model.

They can be summarized as follows:

Pillar I: “Change the way you see before you can change the way you look.” As discussed, change is at the core of what is needed but rather than focusing on changing specifics, first one has to undergo a change in their perspective which will naturally lead to a change in habits and behavior.

Pillar II: “Slash your calories by eating for the right reasons.” Way too much focus is spent on diets and what to eat. Critical to healthy living is having a healthy relationship with food and rediscovering its role as fuel and not as a means of dealing with any number of other personal emotions or needs.

Pillar III: “Fill your tank with the right amount of the right foods.” Rediscovering an appropriate sense of satiety by responding to the body's signals and as a result of eating an appropriate amount of the right kind of food is core to learning how to eat to live healthy.

Pillar IV: “Burn calories like never before.” It is imperative and necessary not only to lose weight but not to rediscover it again once lost (i.e., gain it back). As individuals become more physically active, they will keep it off. Strategies to have fun and pleasure burning calories are important for it to be a sustainable habit.

Pillar V: “Plan a radical sabbatical.” Most need to take some kind of a break from the routine if we are going to establish a healthier lifestyle. Combining pleasure and benefit and carving out time that one can focus on their health as a priority for lasting vitality is core to successful weight loss.

Pillar VI: “Don't travel alone.” The assumption is that this is an ongoing journey for most. There are times where initial momentum is present but for many, the notion of support, encouragement and some level of accountability are going to be key factors to long term success. It is so important to people committed to the group nature of accountability and healthy co-reliance on healthy living.

Pillar VII: “Realize that your weight loss journey is for a lifetime.” Many people see weight loss interventions as a temporary lifestyle modification where in reality it is a lifelong commitment to a new set of habits and behaviors. Its not about losing the weight. Its about losing it and not rediscovering or finding it again that really counts.

Weight loss programs (i.e., Body Mass Index improvement programs) aligned with these key principles have demonstrated much greater success than those missing these. Most current efforts fall short of lasting impact in that they target the stomach. Many overweight people who have health related consequences for their extra weight do not have a problem with their stomachs as much as they do with their “heads and hearts.”

Focusing first on those with Body Mass Index concerns accomplishes the greatest value in the health and wellness program. Dr. Nick's approach proves to be quite effective in making those changes. The second focus is on those currently smoking, using traditional smoking cessation programs and interventions. This approach could be called wellness triage, focusing on those who need it the most. The prioritization in such a program is as follows:

  • Body Mass Index improvement
  • Smoking Cessation
  • Blood pressure reduction and control
  • LDL reduction and maintenance
  • Fasting blood sugar reduction and maintenance
  • Fitness improvement

Integration With Health Benefits Program
The above health and wellness approach can be further enhanced through the integration of it with the health benefits program. Combining an organization's change management model along with the individual model could lead to a radical transformation in the workplace and in the individual's lifestyle. There are several approaches that can be used to effectively accomplish this, however, one popular approach is linking the six key health status indicators to a health and wellness points system, and then linking the points system to a particular benefit level.

One effective approach provides individual incentives for improvements in each of the targeted health and wellness categories. Linking benefit design, employee cost, and health and wellness results provides strong motivation for health and wellness change. This type of program builds on the concepts discussed earlier:

  • Incentive driven — the better the wellness scores, the lower the deductible; best benefits are given even if there is one bad area
  • Redemptive — encourage those who are trying by giving partial credit
  • Hope-filled — build wellness program around concepts that work
  • Focused — BMI-centric with wellness triage

It is critical that programs of this kind consider federal anti-discrimination regulations. It is our understanding that current regulations permit health and wellness programs which reduce deductibles/copays for improved health status. Regulations impacting this are continually changing, and it is critical to keep this in mind when designing such programs.

Health and wellness programs can be structured in many different ways. As health plans and plan sponsors decide to impact the wellness of their customers, it is critical that the programs achieve the financial success they were intended to get. Since so much change is happening today, it is important to track these issues very closely to assure the greatest health cost savings possible.

There is a significant potential for health cost reductions from appropriately implemented health and wellness programs. Not every program will be able to achieve the entire 20% – 35%; however, in the current economy, a minimal savings of 5% – 10% would be significant to most health care planners. Additional savings can be achieved if health and wellness principles are strategically combined with effective care management principles.

2 Yphantides, Nicholas, “My Big Fat Greek Diet”, Nelson Books, 2004, ISBN 0-7852-6025-0

David Axene collaborated with Nicholas Yphantides in writing this series of articles. Dr. Nicholas Yphantides serves as the Consulting Chief Medical Officer for San Diego County and is the National Director for Health & Wellness with Axene Health Partners. He is a cancer survivor and is an advocate for those in his community who need it the most. For nine years, Dr. Nick served as Chief Medical Officer of one the largest network of Community Clinics in San Diego County.