Where’s the Accountability in Health Care?

It’s time to go to the heart of the problem — too many Americans are obese and the result is far greater claims costs for their employers.

I want to ask every CEO in America: Can you really keep handing out unlimited health insurance benefits like candy with no strings attached? Have you no right to ask employees made sick by their unhealthy lifestyle choices — eating and drinking to excess, smoking, failing to exercise — to change their health-related lifestyles or pay more for health benefits?

Actually, you do have that right. Back on January 8, 2001, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services published proposed regulations on wellness programs that guide employers on how to tie employee insurance benefits to programs that engage them in an effort to improve their own health and wellness. Those proposed regulations became final and effective on February 12, 2007. (Federal Register / Vol. 71, No. 239)

The use of incentives is not new in the field of insurance. Many home and auto insurers, for example, offer discounts to those who take a driver safety class or install a home security system. The regulations allow employers to charge healthy employees — and those willing to work with a health coach on improving their health-related lifestyles — a reduced premium contribution than those with health risks who are not willing to work on them.

This gives employers the tool they have so long and so sorely needed: accountability. Employers demand accountability in every other aspect of their business, so why not also in the third-largest cost of business itself — health benefits?

The lack of accountability is the enormous missing link in the healthcare system. Doctors know that in almost every case encouraging lifestyle change is a much better solution to a health problem than simply giving a prescription. Yet because lifestyle change takes effort, and doctors have no way to hold patients accountable to make those changes, drugs become the easy answer.

Our entire healthcare system is like a hugely expensive ambulance that drives up to the bottom of the cliff and just waits for people to fall off. What an egregious waste of human capital. Why not stop people from falling off the cliff in the first place? Why not use incentives and disincentives to get people to change their unhealthy life habits — just as we use incentives and disincentives in literally every other facet of American life and business?

The federal guidelines also allow employers to engage not just employees in this effort to improve their wellness, but also their employees’ spouses. Change is much more successful when whole families are engaged in the effort.

The process is not difficult. Invite people to participate by offering them a lower premium contribution. Test the biometrics on all who participate. Require those with health risks (which will be the majority) to be accountable to a health coach. Require those working with a coach to:

• set lifestyle goals they’re willing to work on,
• be responsible to track their progress,
• report in regularly to their coach, and
• reach their goals.

Progress comes from gradual steady improvement supported by someone who cares and can provide support and encouragement. By focusing on lifestyle changes, biometrics change naturally.

The amazing part of this whole strategy is that it can be set up where the few who choose not to participate, or stop being compliant, subsidize the cost of the program for those who do participate. For the employer, it is a zero budget proposition.

Over the past eight years, I have seen many companies build accountability into their benefit offerings, and I have never seen one that did not experience an improvement in the overall health and productivity of their plan members.

In fact, a recent study we conducted of accountability-based programs at four mid-size employers (with an average of 800 employees each) found that the total paid claims of program participants dropped to $2,269 compared with $6,187 for non-participants.

The employees felt better and were far more productive. And the company’s financial health materially improved.

What is that, if not the definition of a real “win-win?”

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