On warpath against well­ness

Au­thors say com­pa­nies should fo­cus on out­liers

Modern Healthcare - - BOOKS -

De­spite the grow­ing de­bate over the value of cor­po­rate well­ness pro­grams, ma­jor em­ploy­ers con­tinue to in­vest time and money in set­ting them up. A re­cent RAND Corp. study showed that while they may gen­er­ate sav­ings in the long run, there was lit­tle ev­i­dence to sug­gest most well­ness pro­grams have an im­me­di­ate im­pact.

Some em­ploy­ers are be­gin­ning to ask ques­tions about their value. In­tel re­cently moved to a nar­row net­work health in­sur­ance plan af­ter ad­mit­ting its well­ness pro­gram had failed to con­strain costs. The au­thors of a re­cent book on the sub­ject say more should fol­low in their foot­steps.

Mod­ern Health­care Edi­tor Mer­rill Goozner re­cently in­ter­viewed Tom Em­er­ick, an in­de­pen­dent con­sul­tant whose cor­po­rate ex­pe­ri­ence in­cludes 15 years in ben­e­fit de­sign for Wal-Mart Stores, and Al Lewis, author of Why No­body Be­lieves the Num­bers and pres­i­dent of the Dis­ease Man­age­ment Pur­chas­ing Con­sor­tium, about the rad­i­cal ad­vice they are of­fer­ing cor­po­rate ben­e­fit man­agers in Crack­ing Health Costs, pub­lished by Wi­ley.

Mod­ern Health­care:

You’re on the warpath against well­ness. What got you started on this? Al Lewis:

I had a well­ness client. As part of the eval­u­a­tion, I com­pleted a health risk as­sess­ment. When I got it back, I could not be­lieve what they told me to do: get a PSA test, get an EKG, get a phys­i­cal, even though I was lowrisk on all the fac­tors. I put down I was on seven or more meds. Yet they didn’t even men­tion it. I just put it down to see if they would catch it. MH:

Yet a lot of the ven­dors de­sign­ing well­ness pro­grams claim they get big sav­ings. Are they be­ing disin­gen­u­ous? Tom Em­er­ick:

I saw a num­ber of wellde­signed well­ness pro­grams, but if you looked at it af­ter three years, it was as if you never did it. They can’t pos­si­bly be get­ting the re­sults they claim they’re get­ting. MH:

But isn’t it help­ing com­pa­nies iden­tify po­ten­tial health prob­lems in their work­ers be­fore they evolve to se­ri­ous con­di­tions? Lewis:

Em­ploy­ers are try­ing to cre­ate well­ness by telling peo­ple they are sick. One pro­gram in Ne­braska told 40% of the peo­ple who were screened that they were sick. Em­er­ick:

A lot of what we’re do­ing in well­ness to­day is in­creas­ing stress on work­ers. We’re cre­at­ing the wor­ried well in or­ga­ni­za­tions through the monthly no­tices like blood pres­sure the silent killer; strokes the silent killer; can­cer the silent killer. This is just stress­ing peo­ple. MH:

So what should com­pa­nies be do­ing? Em­er­ick:

There are things that com­pa­nies can do to im­prove the health of their work­ers. But so many are ded­i­cated to do­ing this that it is keep­ing them from do­ing the right thing. Com­pa­nies see what they want to see. MH:

What is the right thing? Em­er­ick:

There’s been a sea change in who spends the cor­po­rate health­care dol­lar. About 6% of the mem­bers are now spend­ing 80% of the dollars. About 10% to 20% of those out­liers are com­pletely mis­di­ag­nosed and about 40% have in­ad­e­quate and in­com­plete treat­ment plans. Com­pa­nies are spend­ing 90% of their ef­fort man­ag­ing peo­ple who aren’t caus­ing the prob­lems.

If your 6% out­liers are spend­ing 80%, and 10% are be­ing mis­di­ag­nosed, that means 8% of your plan spend­ing—far more than any­one could achieve with well­ness—is be­ing wasted on peo­ple who won’t ben­e­fit. MH:

One in 10 peo­ple are mis­di­ag­nosed? That seems aw­fully high. Em­er­ick:

There are nu­mer­ous ex­am­ples. Women are dif­fer­ent than men. When they re­port hav­ing atyp­i­cal angina, it’s in the mid­dle back. More and more women are be­ing di­ag­nosed with hav­ing a mus­cu­loskele­tal prob­lem when they have a blocked artery. We need to fo­cus on peo­ple get­ting the right di­ag­no­sis, and get­ting peo­ple to places that fo­cus on ap­pro­pri­ate medicine and not on money-driven medicine. MH:

Can em­ploy­ers in­flu­ence providers at that level? Em­er­ick:

This wasn’t pos­si­ble when 30% of the peo­ple caused 80% of the spend­ing. If they were to fo­cus a frac­tion of what they spend on well­ness on the out­liers, they could have a ma­jor in­flu­ence over providers. They could start by send­ing your high-cost pa­tients with back prob­lems or heart prob­lems to cen­ters of ex­cel­lence. Wal-Mart and other com­pa­nies are do­ing that. Hos­pi­tals will have to fig­ure out how to be­come a cen­ter of ex­cel­lence rather than be­ing a loser. MH:

What de­fines a cen­ter of ex­cel­lence? Em­er­ick:

The ones that do it right have a num­ber of things in com­mon. First, the doc­tors are ac­count­able. They won’t let doc­tors sit around do­ing in­ap­pro­pri­ate surgery. That’s the hall­mark of a Mayo or Cleve­land Clinic. The doc­tors are salaried. They’re eval­u­ated on hav­ing the best pa­tient out­comes and they use the safest and least in­va­sive op­tions, not the most in­va­sive and riski­est op­tions. Lewis:

It is a nec­es­sary but not suf­fi­cient con­di­tion to ex­cel at what you do and com­pen­sate your doc­tors not ac­cord­ing to the num­ber of surg­eries but on the ba­sis of out­comes. MH:

It sounds like you’re blam­ing the doc­tors. Lewis:

We’re blam­ing the hos­pi­tals be­cause they’re not tak­ing the tough steps needed to bring the docs on board. If you at­tend con­fer­ences where they talk about what to do to be­come an ACO, it’s all about blam­ing the pa­tients for non­com­pli­ance and their need to lead health­ier life­styles in­stead of show­ing gump­tion and get­ting the doc­tors within their four walls to stop over­diag­nos­ing and stop overtreat­ing. In­stead they point out­wards. MH:

There doesn’t seem to be a lot of ev­i­dence that em­ploy­ers are drop­ping the well­ness pro­grams in fa­vor of ag­gres­sive man­age­ment of high-cost em­ploy­ees. Em­er­ick:

In­tel is a first sign. We will see the end game in well­ness when em­ploy­ers start do­ing two things. One is to stop do­ing things to your em­ploy­ees in the name of well­ness that are in­ef­fec­tive and start do­ing things for your peo­ple. Lewis:

We like the well-be­ing con­cept. It’s more com­pre­hen­sive. If your pro­duc­tiv­ity is low one day, it could be any num­ber of things that are both­er­ing you. It could be your boss.

A well­ness pro­gram is the dif­fer­ence be­tween a de­odor­ant and tak­ing a shower. You have to fig­ure out what is stress­ing your peo­ple out. If you are a gen­eral lead­ing troops into bat­tle, would you rather have soldiers with low morale or soldiers with low choles­terol?



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