As both employees and clinicians, providers at hospitals and physician practices have an excellent opportunity to be at the forefront of reforming healthcare, by helping to change behaviors that lead to a wide range of self-inflicted chronic health issues.
To accept that challenge, you need to buy into four premises:
- A large percentage of our healthcare costs (much more than infrastructure or design inefficiencies) are driven by high rates of chronic health issues in our population.
- A large percentage of chronic health issues are the result of poor lifestyle choices.
- The fact that a large percentage of our population relies on its employer to provide (and pay a significant portion of) health insurance gives the employer the opportunity to motivate behavior change through incentives.
- The easiest incentive opportunity is to vary how much the employee pays for healthcare based on his or her health status.
In other words, let’s provide our employees with the same type of free-market incentives and accountabilities they face in many other aspects of their lives as a way to motivate them to improve their health status. We can be role models to show other employers the way.
The government has already provided employers the opportunity to do so by virtue of HIPAA, under which employers can vary the amount of premium contributions required from employees as long as the employer “wellness incentive program” meets the following criteria:
- The reward or penalty must not exceed 20 percent of the cost of employee-only coverage (premium) under the plan.
- The program must be reasonably designed to promote health or prevent disease.
- Employees must be eligible to qualify for the reward at least annually.
- The reward must be available to all similarly situated individuals.
- A reasonable alternative standard or waiver must be available to individuals for whom it is unreasonably difficult to satisfy the otherwise applicable standard due to a medical condition.
Appleton Cardiology has taken this challenge to heart and is now in the second year of its Health Metrics program, which provides considerable rewards to employees who attain desired health status. Our employee health metric targets, all of which are obtained as part of clinical testing that occurs in our annual Health Risk Assessment, are as follows: LDL Cholesterol <130; blood glucose <113; blood pressure <130/85; body mass index <25; and absence of nicotine use.
We chose these metrics largely based on the HERO study, which demonstrated that employees with chronic health conditions cost employers consideraby more, versus those without these conditions. Our goal is to help employees and spouses avoid the costs and personal impact of tobacco use, hypertension, hypercholesterolemia, obesity and diabetes.
Our program is offered in conjunction with our health insurance plan and is very simple. Employees and their spouses who meet each metric can earn a discount each pay period toward their premium contribution and save as much as $1,500 per year if they meet all the metrics.
Is this the perfect solution for our country’s health care challenges? No, but I’ll argue that government reform will have limited impact on our overall health consumption, i.e., costs, without reducing chronic disease and improving the health status of the population overall. While it’s too early to form a clear conclusion, our initial results suggest that the size and type of our metric incentives are motivating change.
Imagine if all employers offered similar incentives to their employees. It may be what it takes to finally change behaviors and dramatically reduce costs on a national scale.