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What is Our Health Care Problem Really About?
Our current dysfunctional “sick care” system - and the claims management process put in place to control it – too often ignores primary prevention. Rather than being designed to prevent chronic disease, the system exploits the current epidemic.
…The Root of the Problem
Consider:• Rising chronic disease burden (133
million Americans have one or more chronic diseases)
• 75% of all health care spending on one or more chronic diseases
But it’s All Genes Anyway, Right?
Factors contributing to all disease (CDC data)• 20% - heredity• 10% - lack of access to health care• 19% - environment
>50% lifestyle choices 80% of heart disease and
stroke, most of diabetes, 40% of cancers preventable with lifestyle changes
It’s really Quite Simple
Behaviors Change• We become less active (“watch your
kids do it”), yield to “convenient” food sources, and…
• Gain 11-16 pounds- double your risk for diabetes, or…
• Gain 17- 24 pounds- triple your risk
Health Behaviors that Drive Costs
AbsenteeismAlcohol abuseExisting medical conditionHigh Blood pressureInactivity Life dissatisfactionLow back painHigh total cholesterol
Low HDL cholesterolNegative health perceptionNo seat belt/helmet useOverweightStressSmoking
Cost Risk Levels
Low- 1-2 risks / “baseline spending”
Medium- 3-4 risks / up to 50% more than baseline spending
High- 5 or more risks /150 to 300% additional spending per year per person
Typical Employee Population Profile
Low 30-40%
Medium 30-40%
High 20-30%– (2-3% migration to worse health risk status
every 3-5 years)
Prevention is the solution
Milken Study*Primary prevention (wellness, health promotion)Secondary prevention (early
detection/diagnosis)Tertiary Prevention (chronic condition
management)
Could have an economic impact of $1 trillion annually…
“An UnhealthyAmerica” 2007 study, Milken Institute
Wellness Risk Reduction Goals
1. “Zero trend” 2. Reduce high risk
population 3.Increase low risk
population
Health Awareness…
Posters, pedometers, check stuffers, T-shirts, free fruit, health fairs and newsletters…..
Health education and population based programs….
12 week walking programFitness courses“Biggest Loser” contests8 week men’s health course twice a year Smoking cessation classesStrength training classes
and…. health education coaching from health “experts”…..
Client Centered Health Behavior Change
Reducing individual and group risk burden by redcui9ng at risk behaviors improves quality of life, decreases medical spend within the group and enhances productivity
Why Do People Change?
People change because..They want to… (their idea)
The behavior they have decided to change has become a significant liability to them…(importance)
They have come to believe they can change…(confidence) and
A particular change at a particular time in their life is a high priority (readiness).
Intrinsic Motivation to Change
The convergence of importance, confidence and readiness) to change.Achieved through collaboration, evocation of intrinsic beliefs and values and preserving autonomy!What does it sound like???
Losing Weight…
HC: Let’s look at your risks (obesity, nutrition, exercise, seat belt )C: I’ve been wondering when this would happen.HC: When what would happen?C: You’re going to tell me to lose weight.HC: You’re weight is a sensitive issue.
Losing Weight….
C:Well, it’s so hard to lose weight and I wonder if I really need to?HC: Your weight is not really problem for you.C: I didn’t say that.HC: Tell me what you think about your weight.
Losing Weight…
C: It’s not that I wouldn’t like to lose weight- I guess I really should- but I just don’t know how I can do it.HC: Tell me why you think you should.C: Well, my foreman, Luke, is really overweight and he missed all of deer season last year after his heart attack. Hasn’t been out this year either.HC: Any other reasons
Losing Weight…
C: Well, my wife says my knees would do better and I could keep up with my grandkids.HC: It’s not that losing weight is not important to you, it’s the “how” that worries you.
Losing Weight
C: Well, I sure don’t want to have to quit deer hunting like Luke did after his heart attack, but I can’t stand diets. I am hungry all the time and I always gain all my weight back.HC: Losing weight might keep you deer hunting and help your knees, but it has been hard for you in the past.
Losing Weight….
C: Sure! That’s right.HC: Well then, on a scale of 1-10, where would you rank the importance of losing weight?C: I should lose weight. I know that- so I guess a 7 or 8. But how???
Losing Weight…
HC: There are two ways to lose weight. Eat less of exercise more. Do either of these appeal to you?C: I stay active with chores and work but I don’t like to exercise. If I try to eat less, won’t that just be a diet?HC: Exercise is out and eating less may be too hard.C: How much less?
Losing Weight….
HC: Tell me what you ate for breakfast.C: Well, for breakfast I had 3 slices of bacon and a bowel of oatmeal with a couple tablespoons of sugar, a glazed donut, 2 cups of coffee with milk and a banana.HC: You are eating some healthy stuff and that is a great start. Any place in there you might make a change? Just so you know, if we can weed out 3500 calories over the course of a week you will lose a pound a week. If it takes 2 weeks that is fine too. That might be easier than you think.
Losing Weight….
C: No kidding? Maybe a slice of bacon and some sugar? I guess I could live without the donut.HC: There’s 300+ or so calories right there?C: That’s not much.HC: It’s a good start when we are looking for small painless changes that you can stick to and add to over time. 10 days of this totals 3000 Calories! Do you think you could look at all your meals and snacks this way and make some small cuts in calories, or should we just stick to breakfast now?
Losing Weight….
C: Yeah, let’s stick to breakfast. I just wonder if it will work? HC: Don’t be in a rush to see weight loss. We have plenty of time. Let’s remember that small, easy to reach goals work best. Is it fair to say your goal is to figure out how you can cut some calories (shooting for a total of 3500 every week or two)?C: Yes, that’s ok. HC: And the first thing you will do is look at what you are eating now for breakfast and change or substitute where you can? I will show you a web site for counting calories.C: That will be great.
Losing Weight..….
HC: Any questions? I will see you in a couple of weeks to see how you have done.C: No questions. This may actually work.HC: If it doesn’t, we’ll spend time next time figuring out how to improve the plan!
5 Year Experience (large company)…
$1,110,444.00
$2,400,459.00
$1,612,396.00
$401,169.00
$1,272,213.00
2006
2007
2008
2009
2010 TOTAL SPENDING DECREASE$6,796,681.00
Productivity Lost
PRODUCTIVITY LOSS ANALYSISCompany: Duratherm
RISKS
% OF PRODUCTIVITY
LOSSAVG # WORK
HOURS / YEARAVG. EMPLOYEE
WAGE
# PEOPLE CURRENTLY WITH RISK
PRODUCTIVITY LOSS
ALCOHOL ABUSE 0.007 2077 $18.34 4 $1,066.58BACK PAIN 0.13 2077 $18.34 7 $34,663.88INACTIVITY 0.022 2077 $18.34 32 $26,816.89DEPRESSION 0.074 2077 $18.34 1 $2,818.82NO SEATBELT 0.022 2077 $18.34 9 $7,542.25OVERWEIGHT / SERIOUSLY OVERWEIGHT 0.01 2077 $18.34 28 $10,665.81STRESS 0.048 2077 $18.34 4 $7,313.70TOBACCO SMOKE 0.018 2077 $18.34 20 $13,713.18
0.04 2077 $18.34 $104,601.13
Productivity Gained
PRODUCTIVITY COST SAVINGS ANALYSISCompany: Duratherm
RISKS
% OF PRODUCTIVITY
LOSSAVG # WORK
HOURS / YEARAVG. EMPLOYEE
WAGE# PEOPLE
REDUCING RISKPRODUCTIVITY LOSS SAVINGS
ALCOHOL ABUSE 0.007 2077 $18.34 0 $0.00BACK PAIN 0.13 2077 $18.34 5 $24,759.92INACTIVITY 0.022 2077 $18.34 9 $7,542.25DEPRESSION 0.074 2077 $18.34 1 $2,818.82NO SEATBELT 0.022 2077 $18.34 6 $5,028.17OVERWEIGHT / SERIOUSLY OVERWEIGHT 0.01 2077 $18.34 4 $1,523.69STRESS 0.048 2077 $18.34 11 $20,112.67TOBACCO SMOKE 0.018 2077 $18.34 2 $1,371.32
0.04 2077 $18.34 $63,156.83
Case study
Two remarkably similar companies2,000 employees eachHeavy construction/manufacturingCompany A – comprehensive wellness in place for 10+ yearsCompany B – no wellness at time of snapshot (a new OMC client)