by Bill Bennett, co-founder, TransformHealthRx
Unlike the Paul Harvey stories I have listened to for many years, there is too much to “The Rest of the Story” with health care. Just take a look at the dynamics, and it is enough to make your head spin – even if you are a professional in the health care or benefits business and feel confident in your knowledge.
We finally got a large number of people thinking about what and how they spend medical dollars. We have been able to help curtail the cost of medical plans through CDHC initiatives. There is recognition by employers that healthy employees really are less costly and more productive. And there are programs to help with risk reduction and compliance with treatment regimens for those with elevated risks. Wow, what an improvement over the last decade. Even some in Washington were beginning to “get it.”
Now comes the infinite wisdom of Washington from all of those brilliant individuals who have had so many years of experience in this business and know best what the American public “wants.” And they have been able to discern this without the input of any of those who have spent many decades in the business–although, I guess “they are the problem,” as many have openly suggested. One of the more brilliant of those with their fingers in the pie, Rep. Maxine Waters from California, carefully chose her words when she said, “Anyone who opposes the health care Reform movement being supported by the Obama administration is a “Neanderthal.” Of course, Nancy Pelosi said those people are simply “un-American.”
These are tactics to get us distracted from the fact that we are not looking at health care reform at all, but rather control over a large pot of money and a whole industry–over a trillion dollars of it. There is not one thing I have seen in the bills that address critical issues such as how we treat the chronic issues in this country, five of which are responsible for more than 75% of the total expenditures. Those five are further exacerbated by two critical conditions/habits/addictions–smoking and being overweight.
Today, the growth of patients living with one or more chronic diseases and the cost of maintenance over longer periods of time is staggering. A primary contributor to this problem is the basic business model used to care for these patients. Physicians’ practices and hospitals were initially set up to deal with acute diseases. They make money when people are sick, not by keeping them well. There are more than 9,000 billing codes for individual procedures and modes of care. There is not a single billing code for patient compliance or improvement of a condition or for helping patients stay well!
To aggravate the problem, we have reached a dangerously low number of primary care physicians who can provide a “medical home” for individuals. Nationally we are seeing about 6% of graduates from our medical schools elect to go into primary care. Even those currently in practice are threatening early retirement or refusal of new patients because of the poor reimbursement levels by Medicare with additional cuts threatened.
The July 28th issue of the Wall Street Journal had an article by Clayton Christensen, business professor at the Harvard Business School. In the article he said, “Instead of continuing to outsource employee health to an utterly dysfunctional supplier, the best hope for rebuilding this nation’s health care system is for our companies and business leaders to take a more proactive role.”
Now that we start to see all the moving parts of our dilemma, we need to take a look at what can be done in our own back yard to help employers and employees manage health care costs and stay healthy and productive at the same time. We cannot simply sit and wait to see what comes out of Washington before deciding what the solutions might be for the future. A good dose of common sense is what is needed right now.
A major movement across the nation right now is the on-site medical clinic for employees and dependents. There is a recognition that health care is no different than any other business function in terms of looking at relative value and financial accountability. On the other hand I recognize employers have been the victim of “learned helplessness” and have no idea they can actually control costs, improve outcomes, increase accessibility, and assure compliance.
"There's only one way to avoid paying more and more for the health care system, and that's for corporations to get back into the health care business,“ says John Shiely, CEO, Briggs & Stratton Corp.
Both Christensen and Shiely are suggesting the disruption of traditional health care practices in order to provide enhanced outcomes, greater accessibility, lower costs, and improved accountability. That comes from simply evaluating the issues to see what is causing the very thing Congress says they are going to “fix” with solutions they have yet to explain and financing that is scary. You cannot treat a disease by simply treating the symptom! Such an action is simply irresponsible and makes absolutely no sense. It reminds me of someone driving a 1974 clunker that is hardly running, pulling into a body shop, asking for a paint job and two new bumpers, and thinking everything will be perfect if it just “looks good.” Obviously, the car will look good all the while it is costing more money than ever before (in the case of health care, it may not even look good).
High deductibles and on-site clinics are a natural combination that covers both financial and functional health care issues for sponsors and participants. Frankly, history continues to show that savings from labs, drugs, and reduced emergency room visits alone will pay for the clinic, with other results being “icing on the cake.” Such an initiative will cost far less than employers generally anticipate and will return more than expected. Reduced large claims will translate to reduced costs the following year (If the employer is self-funded, the return is immediate).
It is time to put teeth into a valid program and not accept “wellness-light” without the ability to validate the value of such a program. Face-to-face programs work by developing a relationship between the employee and his medical team rather than having a relationship with the “computer” or simply a voice on the other end of the line. Consumer-driven plans and on-site clinics are unquestionably the right combination in today’s environment.
“The Rest of the Story” should be clear – we just need to tune out the noise and forge ahead for the good of employers and employees.
Bill Bennett began working in employer-sponsored benefits in 1965 and opened one of the early Third Party Administrators in 1971. He has been active in the industry, attending the first meeting of the SPBA and serving as president and chairman of SIIA. He is the co-founder of TransformHealthRx, a management firm that places clinics at the work site and provides health care for jails and prisons. He can be reached at BillBennett[at]transformhealthrx.com.