I Feel Fine...

The Case for Prevention

Transforming Healthcare from Reactive to Proactive Can Positively Impact the Bottom Line

by John Denery

Mr. Denery is Executive Vice President and Director of Life and Health with Stephens Insurance, LLC., a pharmacy benefits consulting platform for large self-funded employers. Visit http://stephens.com/.

The rising cost of healthcare is quickly becoming, if not already, unmanageable—and there are no quick fixes. PwC Health Research Institute found costs are rising at more than 6% annually over the past five years. In 2016, the rate 6.5% is more than eight times the rate of inflation (0.8%), according to the Bureau of Labor Statistics. For employees, spending on deductibles has gone up more than 250% and contributions toward premiums jumped 83%, from 2005 through 2015, according to the Kaiser Family Foundation.

And yet, all the spending in the current healthcare structure is not necessarily making anyone healthier. A study published by Edward Gregg in The Lancet Diabetes & Endocrinology has predicted that for every American born from 2000 – 2011, 40 percent will develop diabetes. This is a dramatically increased risk of more than double compared to those born just a decade before.

Similarly, metabolic syndrome, which can increase chances of heart disease, stroke, diabetes, and many other medical problems, now affects more than one in three U.S. adults, according to the Journal of the American Medical Association. Both diseases are largely preventable and cause expensive consequential illness.

Enter ACA

Policymakers have placed an emphasis on widening access to coverage through the Patient Protection and Affordable Care Act (ACA) and therefore extended healthcare coverage to roughly 20 million Americans since its passage, according to the Department of Health and Human Services.

While more people than ever now have health insurance, rapidly rising costs haven’t necessarily changed the financial burden. The core of the current healthcare system remains cost, not health. How do we revamp the healthcare system to be functional, affordable and effective? A good start would be by focusing on those who can affect the greatest change towards that objective.

Focusing on Health: “Feeling Fine” Doesn’t Equal Healthy

For many Americans, maintaining health is not a priority. As long as they “feel fine,” most people tend to ignore regular checkups and ongoing health maintenance. Dr. Scott Conard, MD, DABFM, FAAFP, Medical Director at Stephens Insurance, LLC, experienced this first-hand with his own patients early on in his career. He saw three different patients deliberately ignore his diagnoses of pre-disease and recommended treatments because they told him they “felt fine.” Their unwillingness to take action to improve their health led to the worst outcome possible. All three of those patients died due to treatable illness within three months of their last office visit.

“Feeling fine” doesn’t mean that someone is truly healthy. Often there are markers that show early-stage underlying health issues – if health professionals are able and empowered to look for them. Our body is a well-oiled machine as long as it receives good maintenance. Just like your car, if you want it to last and perform at its best, you must perform the factory suggested maintenance at specific intervals. Ongoing health maintenance including annual biometric screenings, and age- and gender-appropriate screenings provide the necessary maintenance for your health.

In most cases, people begin their lives in optimal health and over time their health deteriorates. This leads to various stages of health and illness, ending up with costly long-term conditions such as heart disease and diabetes. The key to preventing these diseases and to lowering costs is to focus on maintaining optimal health throughout our lifetime, rather than only treating illness when it occurs.

It’s through this idea of truly “being fine” rather than simply “feeling fine,” that Stephens’ Blueprint was born. At its core, Blueprint for Health recognizes that employers are often the first line of defense for encouraging employees to focus on their own health.

Armed with data to identify and work with at-risk employees, and partnered with motivated, caring primary care physicians and other healthcare providers, employers are able to lead their employees from merely treating symptoms to halting disease progression or prevention before it even starts. This ultimately enables employees to have a higher quality of life, and as a bonus, lowers medical costs for all.

Employers Can Be the First Line of Defense to Lowering Costs

While more people than ever now have health insurance, rapidly rising costs haven’t necessarily changed the financial burden

Our data indicates on a consistent basis that year in and year out a small set of an employer’s population (4-5%) consumes the majority of the healthcare dollars (60-70%). What’s equally intriguing is that up to half of this group had no previous claims history at all. In other words, prior to their health event they all felt “fine.”

The key to cutting overall healthcare spending is to shift the focus from just treatment of disease or “illness” to preventative care. This allows physicians to identify and treat patients before they develop advanced disease and become part of the high-use group of employees.

The opportunity to lower costs presents a compelling case for employers to take a greater role in shifting focus from treating illness to maintaining health. Employers wield a great deal of influence with their employees; therefore, they play a key role in helping individuals maintain health and keep up with preventative care.

Clearly detailing the health benefits provided by preventative care and offering small incentives, such as an HRA contribution, a premium discount or an extra vacation day for employees that complete their annual physical exam, can greatly increase the number of employees taking proactive action for their health.

Achieving Better Health while Lowering Costs… It Can Be Done

Stephens Insurance is at the forefront of this positive “paradigm shift.” Working alongside Dr. Conard, we implement the Blueprint for Health to focus our client’s health insurance programs on preventative healthcare and employee education so they see their individual health as a priority.

A simple reorientation of the employer-sponsored healthcare system toward preventative medicine can reduce and sometimes eliminate the highest-cost claims, according to results from clients who have implemented the Blueprint.

ArcBest Corporation is one example of an early adopter of the Blueprint for Health program. They first engaged Stephens Insurance in 2012, and have since built a company culture around wellness and proactive health management. Together with Stephens Insurance, ArcBest has created an incentivized wellness plan, which has benefitted the health of many employees and their families.

ArcBest began offering monetary incentives to employees who completed basic biometric screenings, established a primary care physician relationship and completed age- and gender-appropriate screenings. When the program launched in 2012, only 30 percent of employees participated, but by 2015 that number reached 51 percent and is expected to grow even higher this year.

Changing Behaviors

The key to seeing success like ArcBest’s is an organization-wide commitment to changing behaviors that lead to better health. From C-suite executives to middle management, ArcBest has seen strong support and commitment for this movement from all levels of the company.

“Our commitment to holistic employee wellbeing is a win-win for both our employees and our company. Not only are employees seeing better health outcomes but our company has seen a reduction in health care spend and a more highly engaged and productive workforce. We have seen improvement in employee engagement scores around wellness and an improved health plan performance in 2015,” says Rich Krutsch, Senior Director, People Services, ArcBest Corporation.

This “paradigm shift” from providing health insurance for employees to actively engaging employees to ensure they understand their risks, are engaged in their own care, and are empowered with a clear path to use responsive, competent providers may seem daunting. However, rising cost of healthcare trends over the last decade demonstrate the current system is likely to yield annually-increasing costs and no real solution for largely preventable health problems.

Examples like ArcBest’s program prove that lowering costs through preventative care is possible, but we must forgo the notion that “feeling fine” is the same as being healthy. The first step is for employers to help shift the tide by engaging employees in their own health. Employers’ encouragement of employee engagement in their “health maintenance” through prevention and disease management is the way to truly help employees be healthier and lower costs over time.