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Thursday, October 30, 2008

Lowering the cost of chronic health conditions

Employee Benefit News

By Leah Carlson Shepherd

September 15, 2008

Employers across the country are struggling with the cost of insuring employees with chronic health conditions, who represent a growing portion of the population. Speaking at a conference in July organized by the Center for Health System Change, experts recommended preventive measures, appropriate behavior incentives, better communication with employees and a variety of other solutions.

Identifying the problem

More than 40% of Americans have one or more chronic conditions, and people with chronic diseases account for 75% of health care spending in this country, according to a recent study published in Health Affairs. ... About 60% of people with chronic diseases are working-age adults.

... The highest cost conditions include heart disease, cancer, mental illness, pulmonary conditions, hypertension and diabetes. Many of these conditions are more common among low-income workers and minorities, noted Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. ...

Employee roadblocks

...Some patients may believe there's nothing they can do that will help their condition. Self-efficacy, or the belief that you can make a difference, "is a huge component of self-management," said Kristin Carman, principal research scientist at the American Institutes for Research.

Another barrier occurs when patients think that the medical guidelines for their condition are biased, too inflexible or just rooted in limiting personal choices, Carman said. ...

Employers step in with messages and programs to promote health and wellness, but employees don't always trust them. Workers "tend to be suspicious because they believe employers are concerned about costs," Carman observed.

To develop trust, "employers need to show what they're doing to support employees and improve health care. When you do that, you begin to break down some of those barriers and the bias," Carman said. ...

Systematic solutions

Each speaker at the event discussed many different remedies to fix the structural, clinical and economic ills of the health care system.

Paul Ginsburg, president of the Center for Studying Health System Change, called for a greater emphasis on prevention. ...

In addition, more research should be done to find the most effective treatments for patients with several chronic conditions, Clancy said. Most research is for one disease at a time, and "where our evidence base is thin is in how to manage people with multiple chronic conditions," especially when one of those conditions is a mental illness, she explained. ...

Eric Finkelstein, the director of the public health economics at the Research Triangle Institute, said better financial incentives could help. "You need to change the environment and make it easier and cheaper [to do healthy behaviors]" and more expensive and harder to do unhealthy behaviors, he explained.

Employers have seen success with environmental changes, such as installing fitness centers, walking trails and healthier snacks in vending machines, according to Ron Goetzel, vice president at Thomson Reuters Healthcare and director of the Institute for Health and Productivity Studies at Emory University.

He also recommended onsite health screenings, health risk assessments, subsidies for gym memberships and holding managers accountable for specific wellness goals.

What doesn't work

..."There's a lot of ignorance out there in terms of what works and what does not, and a lot of what doesn't work is being put in place by employers," Goetzel said.

For example, screenings alone or health risk assessments alone won't work, he said; instead, they should be part of a more comprehensive wellness initiative.

Simply sending workers to a Web site with wellness information, or just relying on awareness-building without follow-through, isn't likely to bring you the results that you want. Likewise, financial incentives that are too high or too low aren't effective, he said.

Beware of implementing changes or limitations that are so sweeping that they leave employees feeling as if they are disempowered or have less control over their health care, Carman suggested.

...Despite the potential pitfalls, you shouldn't dump your wellness program too quickly. The evidence base shows that wellness programs can reduce health risks, lower health costs and prevent disease, Goetzel noted.

"There's a growing body of evidence" that wellness programs can bring a return on investment, if you do things that are evidence-based and well-implemented, he said.