How to Change the Way Employees Think about Their Health and Why

How to Change the Way Employees Think About Their Health and Why According to the AMA, "70% of health care costs can be attributed to lifestyle-related illnesses and therefore are preventable."

How to Change the Way Employees Think About Their Health and Why

According to the AMA, "70% of health care costs can be attributed to lifestyle-related illnesses and therefore are preventable."

According to the Centers for Disease Control & Prevention, "90% of health care costs can be attributed to lifestyle-related illnesses and therefore preventable."

"Pick the pig you want to kiss."

A little phrase I once heard a preacher say that has stuck in my head for years and I like to use it quite a bit actually to make a point obvious and, my point is this ....

Regardless of whom you believe; the AMA or CDCP, the fact is: "unhealthy lifestyle behaviors are largely attributable to the majority of health care costs."

In Fact, at current health care trends, a 1,000 employee company can expect to spend over $50 million on health benefits over the next five years!

As an industry, since the early to mid-80s, we "shot ourselves in the foot" with the introduction of "UCR" (Usual, Customary & Reasonable) based benefit plans and have been trying to walk without a limp ever since. In our competitive greediness to sell the new "UCR Mousetrap" we (the health insurance industry) are solely responsible for "starting the fire," but not solely responsible for fueling it. It didn't take long for providers of care to figure out that they could quite literally charge the prices they wanted for their services and get it largely unchallenged. Not long after, (we) the insurance industry realized too little too late that the building was a raging inferno as employers unknowingly transitioned from defined-contribution health plans to defined-benefit health plans.

Fast forward, to 2006. In the last 25 years, the federal government, employers, providers and the health insurance industry together and, independently of one another, have developed and implemented strategies, plans, rules, procedures and protocols one on top of another to try and control the cost and utilization of health care in America. In retrospect, with the exception of a few consecutive years at a time; nothing ventured has effectively solved the high cost or over utilization dilemma that continues to plague the health care industry today. Incremental measures designed to minimize health care cost and utilization over the past 25 years have done nothing to address the fundamental issues that threaten to continue to drive the cost of providing health care to unsustainable levels. Moving forward, what's next? There are many brilliant minds at work across all channels who are trying to come up with the next idea that will provide the long-term relief prescription for out of control health care cost and utilization, but the reality is that it's the consumer who holds most of the "trump cards." Why? Because outside of unforeseen accidents and the sudden onset of illness, it's still the consumer (patient) who first decides when and where to seek health care and, the problem remains that "the system, et al" simply does not encourage, engage, educate and empower, or motivate employees to become savvy health care consumers. Like children of alcoholic parents, we (the industry) continue to enable consumers to live their lifestyles status quo. As harsh as that analogy sounds, it is quite true as it accurately describes what "we" have become - enablers with no real hard line position ever taken to force employees to think about their health let alone change their lifestyle behaviors.

The objective is not to focus only on those employees who are chronically ill; that's easy to do because they are easy to identify having already been imbedded into the system. Yes, they must be educated and coached and attended to so that they can learn how to better manage their condition(s) and improve their quality of life which will ultimately result in lower utilization and less cost, but they represent just 2% to 4% of the total insured population.

Great strides have been made over the years to intervene and educate the chronically ill, but given the fact that more than specific 20 diseases account for 40% of total health care spending, the cost to care for the chronically ill is not the whole problem. In addition, there are those who are at high-risk, moderate-risk and low-risk given their lifestyle behaviors just waiting in the wings to become the next group of chronically ill members of your plan. Furthermore, it is equally important to reach those who are the healthiest to keep them motivated to maintain their good health.

The objective is to implement a carefully designed, totally comprehensive Health Wellness & Disease Management Program; fully integrated with and supported by state of the art Utilization Management that touches 100% of your plan's population. Anything less is a good start, but ultimately not enough to bring about the maximum desired results for the long term.

"You can lead a horse to water, but ...sometimes you can't."

Well, that's not exactly how the saying goes, I know, but when it comes to managing health care you can set conventional wisdom aside. Fact is, after more than two decades of enabling employees to continue their ways, (and paying for it) they're not about to change voluntarily. In fact, the evidence all around us would indicate that most are very content to continue their lifestyles and can't be led at all by any means of incentive let alone be enticed to change anything. Obesity rates are at an all time high. Smoking continues to plague our society and sedentary lifestyles are becoming the norm as we continue to become a more service-provider workforce. Heart disease, diabetes, asthma, CHF, cancer and other pulmonary diseases top the list and clinical studies have shown that all of these conditions can be diet and lifestyle induced.

Faced with a decision, employees will decide, but your health plan can no longer afford to pay the full cost of (support) employees' poor lifestyle decisions. In today's highly litigious and non-discriminatory environment, it is more imperative now than ever before to design a Consumer-Directed Health Plan" (CDHP) that includes incentives and penalties for 100% of your total population without regard to any one specific class, individual health state, medical condition, or lifestyle behavior.

The foundation of a CDHP strategy must be built to withstand legal and discriminatory scrutiny over the long haul and, the first course of block is called the indiscriminate row meaning, 100% of your total population must have the same choices to make regardless of lifestyle behavior, state of health or employee classification. These choices may include, but not be limited to:

1. Participate, or not participate in an online Health Risk Assessment (HRA) program. 2. Agree to, or disagree to Body Mass Index (BMI), Nicotine, Cholesterol, HBP, Stress Test and Blood Glucose screening. 3. Participate, or not participate in employer sponsored, smoking cessation, weight-loss, diet/nutrition counseling and exercise programs.

Forcing employees to choose, forces them to think about their health and their lifestyle behaviors. Forcing employees to think about their health is the number one objective of a successful CDHP. Getting employees to think about their health is the first step to engaging them in the process. Once engaged they are then educated which empowers them with knowledge; motivating them to make a personal decision. That decision may or may not be to participate or agree to any of the Health & Wellness initiatives of your plan, but each decision carries with it a reward and/or penalty. Compliance or non-compliance then is totally dependent upon the employee whose personal decision ultimately determines the benefit plan they are eligible for and how much it will cost them.

Healthy, unhealthy, smokers or non-smokers, obese or non-obese, high-risk, low to moderate risk, or chronically ill - regardless of employee class and without regard to any specific condition, disease state or behavior - ALL employees are subject to make the same choices and receive the same benefit and cost options contingent upon their personal decisions and, willingness to take action.