This series has been discussing what a company should look for when selecting a program to improve the health and productivity of their employees. We have explored wellness, preventive medicine, and the accreditation. This column will briefly discuss some of the reasons why the old approaches failed and recommend a book that is a great resource.
The gist of this series has been on why prevention is so important and what is needed to effectively confront the continuous growth in health care costs. To answer this as with any problem, one needs to understand the root cause and then put in place validated programs that solve the problem. Dee W. Edington, PhD, from the University of Michigan is one of, if not the leading researcher in the area of employee health. From the website at the University of Michigan:
Dr. Edington studies the relationships between individual health behaviors and future health care utilization and costs for both individuals and organizations. His research focuses on the health behaviors of individuals such as physical inactivity, overweight, smoking, high blood pressure and high cholesterol. He is interested in how these health behaviors and risks interact to result in poor health status and future increased utilization of the health care system.
His most recent book is Zero Trends: Health as a Serious Economic Strategy.
For the past decade or so, companies and insurers have focused on programs to manage those who incur the most costs, people with chronic diseases such as diabetes, heart failure, etc. Chronic diseases typically account for 70 to 90 percent of health care costs depending upon the payer.
The thinking has been that better managing these people will lower the increase in health care costs as they become healthier and consume fewer resources. While this is important and as discussed in a previous piece, is tertiary prevention within the clinical model of preventive medicine, it has one fatal flaw. It does nothing to stem the Natural Flow (Dr. Edington’s model) of people into the bucket of having a chronic disease to begin with. In fact it is now clear that much of our growth in health care costs has been due to an increase in the prevalence of chronic diseases and that many of these diseases and conditions are preventable.
Type 2 diabetes is a perfect example of this. The disease used to be called Adult Onset Diabetes, and typically occurred in seniors. Today we see type 2 diabetes in children and recent studies have estimated that as many as 1 in 3 U.S. adults could have type 2 diabetes by 2050.
One of the major premise’s of Zero Trends is “enabling the healthy people to stay healthy.”
This is very different from the usual disease management approach that not only focused only on those with a chronic disease, but typically claimed to use predictive modeling to focus only on the sickest of the sick and left the others with chronic disease to in effect, fend for themselves. So while the DM companies were focusing on the small percentage of lets say diabetics of a high acuity, others with diabetes, who were of a lower acuity, were in many cases progressing to a higher level of acuity and costs, while newly diagnosed diabetics were entering the “pool” every year at a growing rate. Its no wonder that within our current health care system costs continue to grow at an unsustainable rate.
In Zero Trends, Dr. Edington discusses what the data shows, how health risks impact health costs and employee productivity, and what individuals and companies should do based upon his and others research. In the end, our Mission should be to create a “Culture of Health” that engages all employees, including those who are currently healthy.
I would recommend Zero Trends to anyone involved in health care from providers to employers, benefits managers to consultants. The book is chock full of data in an easy to digest format and ultimately a blue print for how to bring health care costs down to a growth rate in line with normal inflation.