Tag Archive: health promoting behaviors

Politicians focus on wrong part of health-care problem: Advisor

Carolyn McClanahan, a certified financial planner and physician, believes there are some commonsense solutions to fixing the health-care system, and she feels the politicians are actually the problem and not the problem-solvers. “With the health-care system being so complicated, one of the problems I have is that the politicians are focusing on the wrong things,” said McClanahan, founder and director of financial planning at Life Planning Partners. “The No. 1 concern with health care right now is that we have a broken system and we need to fix the system. “And politicians are unfortunately focusing on how we pay for health care and not focusing on the cost of health care.”

Source: Politicians focus on wrong part of health-care problem: Advisor

McClanahan’s right. A far more holistic analysis is necessary whenever dealing with a complex system such as medical care costs and their financing. Since most agree costs have grown to unstainable levels and chew up far too many public and private dollars, that deserves a lot of attention. As well as thorough root cause analysis that takes into account population wellness and specifically how to increase it.

McClanahan’s thinking is on the right track. Fortunately, most people don’t need much medical care. The goal should be to ensure that cohort remains the majority and grows. We can’t get there with more medical care. Instead, more health care – engaging in health promoting behaviors and lifestyles — and developing health education and social values that support that are key.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Doubts over wellness programs could unravel employer health coverage

Questions over the effectiveness of employer wellness programs intensified this month and could mark the beginning of the end of employer-sponsored health benefits that have already been eroding from the bottom up in the small group market segment. Wellness programs seek to improve the health status of large employer risk pools in order to reduce the utilization of high cost medical services and to hold down premiums for large insured employers. Now that their efficacy has been called into question, it also begs the larger question of the degree of control large employers have over health care costs. The experience with wellness programs suggests little if any. As Bill Leonard writes for the Society For Human Resource Management:

Even with the modest rise in health care costs over the past several years, sources familiar with the issue believe businesses have reached a tipping point and that the expense of providing medical benefits to workers has become unsustainable. Cost-containment efforts therefore are putting more pressure on wellness programs to deliver on the promise of reducing health care expenses. However, as the CHRO survey and other recent studies have shown, wellness plans may not be producing the return on investment (ROI) that employers expect and need.

The sense of no control over rising costs could prompt large employers to increasingly throw up their hands and cease offering health benefits. The money saved could then be redirected to higher earnings and compensation that couldn’t be done when the U.S. government established wage and price controls during World War II and employers first began offering employee health benefits in lieu of higher compensation. That in turn would create pressure to repeal the Patient Protection and Affordable Care Act’s mandate that employers with 50 or more employees offer health coverage.

There would also be a philosophical motive. Employers and employees alike could rightly declare health is an individual responsibility. Accordingly, the role of employing organizations would shift from a medicalized view of wellness – one that wellness program critics equate to nannying — to one that promotes a culture of wellness that supports healthy lifestyle choices and affords their members sufficient schedule control to engage in health promoting behaviors such as adequate sleep and exercise. Those behaviors require time and commitment in order to become healthy lifestyle habits. For office-based knowledge workers where the greatest occupational hazard is sedentary lifestyles that lead to preventable chronic health conditions, giving them greater control over when and where they work would provide a mutually beneficial tradeoff for taking responsibility for their health. That could pay bonuses in the form of increased engagement and staff attraction and retention.
 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Employers shouldn’t be in the wellness business

Many American employers are looking to establish employee wellness programs – something that Princeton University health care economist Uwe E. Reinhardt believes they shouldn’t be doing. People should be aware of their health and what they need to do to improve and preserve it. But their health status is not — nor should it be — the responsibility of their employers, Reinhardt said in this interview with Managed Care. (Reinhardt’s comments on this topic begin at 15 minutes into the interview)

Just as government price controls instituted during World War II incented employers to offer health plans for their employees and led to today’s system of employer-based coverage as the norm for most working age Americans, Reinhardt takes a similar view of wellness programs. “I think in America, employers stumbled into this by default,” Reinhardt observed. “I think it’s sad, very sad. Employers should not be doing it.”

I agree with Reinhardt. Health maintenance is ultimately a personal responsibility and not that of one’s employer, health plan and for the vast majority of people, their health care providers. Most human beings naturally tend toward health at all life stages if they live in a healthy environment and engage in health enhancing behaviors relative to diet, plenty of vigorous exercise that raises the heart rate and getting 7 to 8 hours of sleep every night.

Rather than set up formal wellness programs, employers should support people’s decisions to engage in these behaviors and provide them to ability to do so while recognizing everyone has their own personal journey toward health.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Media coverage of ACA insurance market reforms stereotypes entire demographic as chronically “sick”

In the recent past, the word “sick” used as an adjective in the medical context referred to the temporary state of an individual. Someone got sick such as with the common cold or influenza. Then they recovered. Less fortunately, they died.

Now the term “sick” is being used in media accounts in a much broader sense to refer to a permanent state of an entire demographic group. As in “sick and older” in the public dialogue over the Patient Protection and Affordable Care Act, aka Obamacare, and its individual health insurance market reforms. A recent example:

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said the industry plans to fight a tax on full-coverage plans that, while intended to pay to expand coverage and bring in more customers, may cause premiums to go up, according to insurers. They’ve also argued against more comprehensive coverage, as well as more relaxed rules about charging sick and older more money for insurance than they do young people. (Emphasis added)

Not all older people are “sick” all of the time or even most of the time. Like younger folks, they sometimes get sick and then get better. Many are quite healthy and are very aware that their bodies require more diligent maintenance in the form of health promoting and preserving lifestyles than in their more forgiving youth. Reading many media accounts, one might think everyone age 50-65 is “sick” and thus creating a major actuarial burden on individual health insurers.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Morale hazard a major risk facing health plans

Insurance no matter what variety assumes two kinds of risk. First, the underlying peril that could result in a covered loss, such as a windstorm or a fire in the case of homeowners insurance. Second, human hazards that can increase the risk of loss. For example, there’s moral hazard (such as filing a fraudulent claim to collect on the insurance by setting one’s house on fire) and morale hazard. What’s morale hazard? This definition is a good one:

A term used to describe a subjective hazard that tends to increase the probable frequency or severity of loss due to an insured peril. Morale hazard, as contrasted with moral hazard, does not imply a propensity to cause a loss but implies a certain indifference to loss simply because of the existence of insurance. For example, an insured’s attitude may be indifferent if a loss occurs because they have insurance. (Emphasis added)

The emphasized part is directly applicable to and has major implications for health insurance. In the context of health insurance, a clear example of morale hazard would be the failure to engage in health promoting behaviors and lifestyles. For instance, an individual with a family history and propensity to develop cardiovascular disease eating an unhealthy diet and not regularly exercising. Granted, that individual may not want to have a stroke or heart attack. But if they have the attitude that they can shift the risk of costly medical care should that happen to their health plan, they may be less motivated to adopt a lifestyle to help head off those eventualities.

As one strategy to stem rising costs, health plans must strike a balance between providing people the peace of mind that comes with having coverage for potentially financially ruinous medical costs while also motivating those they cover to take responsibility to avoid them.

This becomes especially critical starting this October, when health plans in the individual market must begin pre-enrolling applicants for coverage beginning January 2014 regardless of medical condition or history. No longer will plans be able to practice risk avoidance to control claims costs, rejecting those deemed too risky to cover or charging small employers higher rates based on the medical condition of their employees.

That leaves mitigation of morale hazard as their only remaining form of risk management. Large employers as well as smaller ones are looking to so-called “workplace wellness” programs as a form of addressing morale hazard, including contingent wellness programs that provide employees economic incentive to engage in health promoting behaviors to reduce the likelihood of their incurring major medical costs. Whether such programs have a meaningful impact remains to be seen given mixed outcomes such as reflected in this 2011 survey and a study published this week in Health Affairs.

With limited financial incentives available to both plans and employers to reduce morale hazard, it will likely take a big shift in societal attitudes to achieve a measurable reduction. For example, viewing both personal health and health coverage as a common social good that should be respected and preserved. If the resources to pay for health care are shared and finite – and they are – we should regard them as a societal asset that should be preserved. That change in outlook will also require us to re-examine our values and strive for balance in our lives that supports preserving our individual and collective health.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

California state building boondoggle squanders millions, presents workshifting opportunity

The Sacramento Bee today has an item on the California State Board of Equalization’s longstanding problems with its high rise building in downtown Sacramento. The state continues to throw good money after bad trying to remedy the problems that according to the Bee story include leaking windows, burst water pipes, toxic mold and faulty elevators. Another $4 million will be allocated for the latest remediation project on top of $65 million spent over the building’s 22-year lifespan.

It’s time to make lemonade from this big lemon. How? By putting the workers assigned to the building into a workshifting program that allows them to work from their homes or other locations in their communities (such as distributed workplaces) where they can be productive. That would save the taxpayers yet more wasted millions while at the same time getting workers out of a less than healthy environment and freeing them up from wasted, stressful commuting time each day. That additional free time can also benefit the state’s finances by giving those workers more time to engage in health promoting behaviors that can lead to better health outcomes and reduced heath care costs.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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