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.     

IBM Plans to Cover Its Employees’ Deductibles, Copays for Primary Care Services

As reported by the American Academy of Family Physicians, IBM plans to eliminate copays and deductibles for primary care physician services for most of its employees in January, a move that could prompt other large companies and employers to eliminate financial barriers for primary care services as well, according to analysts interviewed by AAFP News Now.

“IBM is doing this because we think it is the right thing to do,” said Paul Grundy, M.D., M.P.H., IBM’s global director of health care transformation. “We have really listened to our patients. They want a meaningful relationship with their doctor. They want to have a healing relationship, and they want us to support them in having better access and more convenience around their care.”

IBM is one of the nation’s largest employers, employing about 115,000 people who reside in nearly every part of the country. The new ‘first dollar’ for primary care program essentially will make primary care services free for 80 percent of the 328,888 employees and dependents who are enrolled in IBM’s self-insured plans. It does not apply to the 20 percent of employees and their dependents who are enrolled in the company’s HMO.

Grundy expects that the elimination of copays and deductibles for primary care services will “create much better value for our employees and for IBM.” The company spent $79 million on a series of wellness programs between 2005 and 2007, which helped the company save $191 million, said Grundy.

“We feel if we can get much more robust prevention, if we can focus on an early diagnosis, it will save on expenses like hospitalizations, (sub) specialist care and emergency room care,” said Grundy. In turn, this should lead to increased productivity among the company’s employees — perhaps the greatest benefit for IBM, according to Grundy.

Stores Offering Free Antibiotics and Updated $4 Generic Drug Deals

NJ Prescription Drug Price Registry

The NJ Prescription Drug Registry will help consumers compare retail prices charged by pharmacies for the most frequently prescribed prescription drugs. By comparing prices here, consumers can see what a pharmacy has reported to the state that it charged for a specific Rx. You will find that prices for the exact medication will be different from pharmacy to pharmacy and from town to town. To use this registry click here, this link will also be on the right side of my blog titled NJ Prescription Drug Registry. New York and Connecticut have a similar site called Prescription Drug Prices in New York State and CT Attorney General’s Prescription Drug Page.



Cuomo Battles Health Insurance Carriers and Posts a Victory for Consumers and Transparency

Cuomo Speaks Out on Victory

Back in February 2008 I reported NY Attorney General, Andrew Cuomo was investigating United Healthcare and has subpoenaed 16 other health plans including Aetna, CIGNA, Humana, and Well Point a subsidiary of Empire Blue Cross Blue Shield to determine how they calculate UCR. UCR is the usual customary and reasonable payment made for medical services rendered outside of the insurance carrier’s network.

Yesterday United Healthcare agreed to close down two Ingenix databases used to determine usual and customary payment rates for services for out of network doctors and pay 50 M to establish a new database that will be run by an independent nonprofit.  This much criticized database was run by Ingenix a subsidiary of United Healthcare. 

Cuomo’s investigation found that the UCR determined by Ingenix database for claims led to underpayments by iurers anywhere from 10 to 28 percent.   United wasn’t the only carrier using this database.


This is a huge victory for healthcare transparency for consumers. Under the agreement the new database will come with a web site that allows consumers to see how much they will be reimbursed for services in their area for out of network services

David Patterson explains Obesity Tax

Patterson addresses obesity epidemic head on when he presented the state budget last Tuesday and proposed a tax on sugared beverages like soda. Research has demonstrated that soft-drink consumption is one of the main drivers of childhood obesity. Read more 

Here is NYS Gov. David Patterson:

Hewitt Data Reveals Little Change in U.S. Health Care Cost Increases for 2009

This Hewitt report indicates that the average health plan increases across the U.S will average between 6%-7% for 2009 with several exceptions for metropolitan areas that experienced increases as high 11%.  


Jim Winkler, North American practice leader of Hewitt’s Health Management Consulting business states “The “Employers continue to diligently manage health care costs through a combination of approaches, including continued cost shifting, tougher negotiations with health plans, and expanded health and wellness programs with incentives to encourage behavior change.


Read more

Highmark’s Employee Wellness Program Demonstrates ROI

Highmark’s program and has shown that employers can save $1.65 in healthcare expenses for every dollar spent on a comprehensive wellness program.  Click here to read more.      

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