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Our Veterans Deserve Better

January 31, 2014
1:45 pm

Last year, the book “Best Care Anywhere:  Why VA Health Care Would Work Better for Everyone” entered its third printing.  The book tells of a Veterans Administration healthcare system that, according to the author, is far superior to the private sector in both quality care delivery and cost containment.  The message delivered in this book, in fact, became something of a core liberal talking point during health reform debates – that the wonders of single-payer, government-run healthcare can be seen on full display at the VA.

This week, CNN is painting a different picture of the VA system, reporting that at least 19 veterans have died as a result of delays in receiving routine diagnostic exams such as colonoscopies and endoscopies.  This follows an earlier CNN report that as many as 7,000 veterans in just two states alone – South Carolina and Georgia — are on a backlog list to receive these fundamental diagnostic screenings.

And, as the cable network points out, not a single person has been dismissed or demoted as a result of this substandard care, and the VA is consistently ignoring congressional committee requests for explanations and accountability.  One has to agree with Rep. John Barrow (D-GA) who said, “We have a duty to make sure the veterans who serve get the best health care possible.  And it is very obvious that, for too long and for too many folks, that hasn’t happened.”

This is not to say that the VA doesn’t carry out some aspects of healthcare very well.  The institution has, for example, been among the early adopters in demonstrating the effective use and value of electronic medical records.

But in terms of the argument that all of American healthcare should emulate this type of bureaucratically-run system, it’s been made clear this week that several thousand service men and women have reason to disagree with that thesis.  For too many who have dedicated their lives to serving their country, the concept of getting the right care at the right time isn’t happening.  That’s simply unacceptable.

Healthcare Leaders Meet the Press

January 07, 2014
12:28 pm

Let’s give credit to “Meet the Press” for choosing to address healthcare in its January 5 installment by turning to actual health industry leaders instead of the usual Washington, D.C. talking heads.

Cleveland Clinic CEO Toby Cosgrove and Mayo Clinic CEO John Noseworthy, both physicians as well as hospital executives, joined host David Gregory to discuss the implementation of the Affordable Care Act and, just as importantly, other healthcare issues that deserve more attention than they generally receive in the media.

Both Dr. Cosgrove and Dr. Noseworthy, for example, emphasized the importance of improving a Medicare program that is headed toward insolvency, saying that this a key to addressing healthcare costs.  To quote Dr. Noseworthy, “The long-term sustainability of Medicare is something no one has taken on yet.  The nation has to have the courage to step up to the looming insolvency of Medicare.”

And Dr. Cosgrove also emphasized the critical role of wellness and disease prevention in achieving health system sustainability.  Mentioning the cost ramifications of the growing obesity epidemic in the United States, he said, “We need to have incentives for individuals to take care of themselves, and that’s not a big enough part of the new law as it should be.”

Dr. Noseworthy and Dr. Cosgrove are both members of the Healthcare Leadership Council.

You can see the video of their Meet the Press appearance here.  Articles about their comments can be found here and here.

The Truth About Wellness

December 22, 2013
10:31 pm

Posting a summary of the remarks offered by one of its recent featured speakers, the secretary-treasurer of the National Union of Healthcare Workers, the National Press Club headlined its synopsis with “Union Official Debunks Workplace Wellness Programs.”

The problem with that headline is simply, well, he really didn’t.

John Borsos’s Press Club remarks could be boiled down to these points:

•    There is no evidence workplace wellness programs improve health or save money.
•    Wellness incentives are unfair to those who don’t choose to try to achieve them.
•    Wellness programs are an invasion of personal privacy.
•    What America really needs is a single-payer healthcare system.

What America actually needs is a discussion about wellness and disease prevention that relies more on facts than hyperbole.  Employers throughout the country have, in fact, developed firm evidence that wellness initiatives are bringing greater health to employees and reducing healthcare costs.  You can find specific metrics on many of these successes in a compendium we have published, The Future Is Here.

On the topic of how to make wellness programs work in the workplace setting, I urge you to read the post by Colin Watts of Weight Watchers below.  He offers an insightful discussion on the relative efficacy of carrots versus sticks in these programs.

And, as to privacy, as Kaiser Permanente, CVS Caremark and others have pointed out ad nauseum, wellness profiles of employees are collected and viewed in the aggregate.  Individual privacy is constantly respected and protected.

The fact is, we are facing a significant, disturbing escalation in chronic illnesses like diabetes, heart disease and pulmonary illness that will affect both the health and finances of the U.S. population, not to mention the sustainability of our healthcare system.  We need bold action to address this growing problem, and that action cannot exclude the eight or more hours each day that millions of Americans spend at their workplace.

Guest Post: What Drives Engagement in Workplace Wellness Programs — Carrots or Sticks?

December 18, 2013
2:24 pm

(The following post was authored by Colin Watts, President of Weight Watchers Health Solutions.  Weight Watchers is a member of the Healthcare Leadership Council.)

In our conversations with employers, we’re often asked: What works better when it comes to employee wellness programs – penalties or incentives? In other words, should we use a carrot, a stick or some combination? It’s a great question and one we’re studying closely through our research.  One interesting example is a program Weight Watchers is supporting for the Oregon Educators Benefit Board (OEBB) and Oregon Public Employees’ Benefit Board (PEBB), which provide health insurance coverage to state teachers and public employees.

In 2009, obesity-related ailments were driving health care costs for the State of Oregon public employees and educators to the tune of nearly $1.6 billion. At the same time, in partnership with OEBB and PEBB’s health plan providers (Providence, Kaiser Permanente and ModaHealth,) Weight Watchers – both meetings and online tools – was offered to all of OEBB and PEBB’s covered lives.   If a participating member attended 75 percent of their Weight Watchers meetings, the cost was completely covered.

That year, PEBB decided to introduce financial incentives into their benefit design, which included completion of a confidential health risk assessment (HRA) and participation in at least two resulting action steps, which could include a weight management program.

During the first year of the program, they charged employees a penalty of $17.50 per month if they failed to take a baseline health risk assessment and follow through with lifestyle recommendations. That first year, 70 percent of employees completed their assessment and took action.

The following year, in 2010, the penalty was switched to a $17.50 per month reward for participation and a $100 higher deductible per person for those not participating. This action resulted in a 7 point increase in the percentage of employees completing the wellness recommendations and action steps.

This example would suggest that both penalties and rewards impact employee participation. That said, it would also indicate that rewards lead to better participation than penalties. While participation is highly linked to outcomes in several weight management studies, it has not been rigorously evaluated with the inclusion of a mandatory penalties/rewards program.

While not definitive, the results in Oregon are promising. Between 2009 and 2012, a time when rates of obesity were increasing among the State’s general population, obesity rates decreased among state employees and educators from 28 percent to 22 percent. Given the PEBB experience, OEBB started a similar program in 2013.

“These results show that a well-designed wellness program coupled with financial incentives that prompt and reward healthy behaviors can work,” said Joan M. Kapowich, administrator at PEBB. “Setting up programs that help employees succeed in changing their habits and rewarding them for doing so was really key for us. It has demonstrated success in reducing our cost trends and improving the health status of our members.”

Joe Camel and the Marlboro Man Need Not Apply

January 30, 2012
3:33 pm

If you smoke tobacco, you’re not going to be hired for a job by the Baylor Health Care System.  For that matter, you don’t need to waste time filling out an employment application form at the Cleveland Clinic either.  Both healthcare providers have made it clear that they will not accept smokers within their respective workforces.

In its editorial today, USA Today says this type of policy is wrong.  The newspaper argues that employers like Baylor CEO Joel Allison and Cleveland Clinic CEO Toby Cosgrove (both members of the Healthcare Leadership Council) have every right to offer smoking cessation programs to their employees and even to make smokers pay more out of pocket for their workplace-provided health insurance.  But, USA Today says, it is improper to penalize a job applicant for practicing a legal habit on their own time.

According to the newspaper’s editorial, “A bit further down (this) road lies hiring based on genetics.  In that world, inheriting that shows a predisposition to a costly disease could cost you a job.”

USA Today is wrong, and not just because of its nonsensical comparison of a voluntary activity like smoking to an individual’s genetic makeup.

Today’s healthcare providers are expected not only to provide excellent care for the patients, but also to encourage wellness, disease prevention and healthy behaviors among all individuals they have the ability to influence.  As Dr. Paul Terpeluk of the Cleveland Clinic said in his “opposing view” in USA Today, “We have a unique perspective on the burden of chronic disease.  We not only treat disease, but we also play a vital role in educating patients and employees about lifestyle choices.  It is only right to practice what we preach.”

There’s also a significant economic issue involved here.  When an employer, particularly one who provides health coverage, hires an individual, they are assuming the burden of his or her healthcare costs.  An individual may smoke on their own time, but the employer winds up footing much of the bill for the chronic illnesses associated with smoking.  Should an employer be allowed to consider the increased health costs, absenteeism and loss of productivity associated with a voluntary, unhealthy behavior like smoking?  It’s hard to argue that they shouldn’t.

And in an environment in which five percent of the population is responsible for 50 percent of our healthcare costs, this is a concern that goes well beyond Baylor and the Cleveland Clinic.

I know both Joel Allison and Toby Cosgrove.  They are both gentlemen who have dedicated their lives and careers to providing better health to their fellow citizens.  Their no-smoking policies are neither mean-spirited nor discriminatory.  Rather, they are intended to make a vitally-needed statement about wellness and healthy living both within and outside the confines of their respective institutions.