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)
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
Blood pressure reduction and control
LDL reduction and maintenance
Fasting blood sugar reduction and maintenance
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.