PICK THE PIG YOU WANT TO KISS

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

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

According to Employee Benefit Consultant, Mark Capuano; "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, so believe me and; "Pick the pig you want to kiss, ‘cuz they’re both ugly”

Did you know: 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, from the late 70s to early 90s, we "shot ourselves in the foot" (and didn’t know it) with the introduction of "UCR" (Usual, Customary & Reasonable) based benefit plans and, we have been walking with a limp ever since. In our competitiveness to sell the new UCR Mousetrap back in the late 70s, we (the health insurance industry) were responsible for "starting the fire," but not solely responsible for fueling it. It didn't take long for healthcare providers to figure out that they could quite literally charge the prices they wanted for their services and get it largely unchallenged. Not long after, 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 2007. In the last 30 years, the federal government, employers, healthcare providers and the health insurance industry together and, independently of one another, developed/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 us all today. Incremental measures designed to minimize health care cost and utilization over the past 30 years have done nothing to address the fundamental issues that threaten to continue to drive the cost of providing health care to unsustainable levels – unhealthy lifestyle behaviors.

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 solution for out of control health care cost and utilization, but in the end 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 (employee-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. In fact, we continue to enable consumers to live their lifestyles, status quo, with no real hard line position ever taken to force employees to think about their health let alone change their lifestyle behaviors.

Nonetheless, great strides have been made over the years to intervene and educate the chronically ill, but given the fact that “more than 20 specific diseases account for 40% of total health care spending,” the cost to care for the chronically ill is not the entire 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 health plan. Furthermore, it is just as equally important to reach those who are the healthiest and keep them motivated to maintain their good health.

The objective is not to focus only on those employees who are chronically ill; that's easy to do because they are easily identified 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, ultimately resulting in lower utilization and less cost, but they represent just 2% to 4% of the total insured population.

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 costs in the 21^st century 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 (and support) employees' poor lifestyle decisions. In today's highly litigious, non-discriminatory environment, it is more imperative now than ever before to design a “Bona-Fide Health & Wellness plan complete with 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 successful Health & Wellness 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 on-site 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/provided, 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 Health & Wellness plan. 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; hopefully motivating them to make the right personal decision for their own good health. However, their decision may not be to participate in or agree to any of the Health & Wellness initiatives of your plan, but each decision carries with it a reward and/or penalty.

With certain exceptions under the “alternative provisions” of a Bona-Fide Health & Wellness Plan; compliance or non-compliance then is totally dependent upon the employee whose personal decision(s) may ultimately determine the benefit plan(s) 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 lifestyle 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 (or unwillingness) to act.