Changing the Conversation: Health vs. Healthcare

The statistics are foreboding: since 1980, growth in healthcare spending has outpaced all other consumer spending by a factor of nearly three, while increasing from 5% to 18% of GDP. Looking just 3 years ahead, this figure is projected to reach at least 22%.  Despite so much of the national conversation focused on managing “healthcare”, employers remain confronted with:

  • Healthcare renewal costs that are unsustainable
  • Plan design changes that have reduced benefits
  • Employee dissatisfaction with reduced benefits and increased costs

To understand why a shift in the national conversation from healthcare to health is necessary, one needs only to consider the implications of the data provided by our medical professionals:

  • Nearly 75% of Americans are overweight, and 33%  qualify as obese
  • Cardiovascular disease and stroke are now the leading cause of death
  • 17.5 million Americans will be afflicted with diabetes, and 25.1 million with cardiovascular disease
  • 1 in 3 children born after 2000 will develop diabetes by age 50
  • 29% of adults with high blood pressure are undiagnosed
  • 70% of all claim costs are the direct results of behavior
  • 74% of all claims are confined to four chronic conditions: cardiovascular disease, diabetes, cancer and obesity

For those business owners seeking real solutions to rising healthcare costs, we propose the need to change the conversation on how to improve the health of those who are employed.

Understanding that the cost of improving health is far lower than the healthcare costs associated with combating increased disease, companies must learn how to build a culture of health improvement and engage employees and families in order to achieve sustainability in healthcare costs. To do so, employers can take a “measures-based approach” to identify risk within the employee population, develop strategies to facilitate positive change among high risk individuals, and strategies to keep the healthy population healthy.

By learning and adopting new strategies that emphasize and reward employees and their families to embrace healthy lifestyle choices, employers can help employees and their families become far more efficient healthcare consumers, and move towards a zero trend health plan (for our next discussion).

Thomson Reuters Health Care Spending Index: Insurance Costs Climb 4.0% for Q3 2011 

Is Obesity an Infectious Disease?

Changing the Conversation: Health vs. Healthcare, is an editorial series designed to advance the health improvement model as a business strategy, supported by medical research, academic and corporate case studies. Scott Bradley is a Sr. Vice President with Cook, Hall & Hyde, Inc., a health and welfare advocate supporting middle market employers to design, implement and manage employee health improvement and insurance programs.     

America’s Best Hospitals

Amy Camarow of US News & World Report speaks about the methodology used to determine America’s best hospitals.

That patient, who truly needs outstanding care, is the target of the annual U.S. News “Best Hospitals” rankings, in which hospitals are judged not in routine procedures but in difficult cases across an entire specialty. This year, the 19th, hospitals are ranked in 16 specialties, from cancer and heart disease to respiratory disorders and urology. Out of the 5,453 hospitals put through a rigorous statistical mill, only 170 scored high enough to appear in any of the specialty rankings. (Data for military and veterans’ hospitals are unavailable.) And only 19 of the 170 made the Honor Roll of medical centers ranked at or near the top in at least six specialties, as explained on Page 72. This year, for the first time, data and scores are available online for more than 1,500 hospitals that in the end fell short of being ranked.

Insurance Carriers Will Stop Paying for Medical Errors

The Institute of Medicine had reported in 1999 that up to 98,000 people had died in hospitals as a result of medical errors.  Today the number is estimated to be 200,000+ and costing billions of dollars.  Not to mention the medical errors that occur that don’t result in death but result in increased medical costs, cost of ongoing care and disability.


Medicare, Well Point, and Cigna are taking a stand by announcing plans to stop paying for care that’s triggered by a host of medical mishaps.  Doctors will not be paid for surgical procedures on the wrong side, wrong person, wrong body part and or wrong site.  Cigna is adding a list of “potentially non-reimbursable” mishaps that will mandate quality of care.


Click here for more


Fundamental Change Needed to Improve Health Care in the U.S

The Commonwealth Fund/Modern HealthCare Opinion Leaders Survey findings continue to support the need for significant fundamental and systematic changes to the healthcare delivery system.


When polled about specific strategies for improving the system strengthening primary care, encouraging care coordination and the management of care transitions and promoting care management of complex patients.  Reforming the provider reimbursement model from a fee for service to a results based systems is imperative.


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Watson/NBGH Study: Employers still smitten on CDHPs

By 2009, nearly 55% of U.S. corporations plan on offering a consumer-directed health plan, reports Watson Wyatt and the National Business Group on Health.   For Lydell C. Bridgeford’s full story click here  

Aetna Takes the Lead on Personal Health Records

Aetna deserves praise for being out in front with the first-ever personalized search engine that mines information from Aetna’s vast data resources to deliver meaningful, personalized health and health benefits information to Aetna members.  Aetna partnered with Healthline Networks to develop Aetna SmartSource.  Aetna SmartSource is available online and can be accessed through Aetna Navigator®, Aetna’s member self-service website, the CareEngine-powered Personal Health Record (PHR), and Simple Steps To A Healthier Life®, Aetna’s online wellness program. Aetna will pilot Aetna SmartSource with several large, pre-selected customers throughout 2008.

Click here for more on SmartSource.

Pay for Performance

Will P4P initiatives transform behaviors by providers and hospitals to improve healthcare quality, costs and outcome targets?  This is a loaded question that has many moving parts.  I believe the P4P model will replace the fee for service model but will require a monumental effort on the part of insurance carriers, hospitals, physician, and legislators.  The Common Wealth Fund reviews a case study with Partners Healthcare and Blue Cross Blue Shield of Massachusetts that centers on paying providers to adopt and implement EMRs and then using EMRs to evaluate patient outcomes. A must read for all interested in a Value Based Purchasing Model.  Click here

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