The Bridge from Managed Care to Quality Care: Wellness Leads the Way
When you lift the lid on that staggering number, there are some straightforward reasons why America's healthcare costs continue to rise. This trend continues despite efforts to control runaway costs including an array of popular managed care strategies. "The truth is," says Dr. Teresa Bartlett, senior vice president and medical director at Sedgwick, the world's largest independent provider of claims and productivity management services, "a large number of Americans are just not very healthy. And statistically speaking, things are getting worse, not better."
For starters, 40 percent of all adults in America do not exercise. According to the Centers for Disease Control and Prevention (CDC), 45.3 million people or 19.3 percent of adults, ages 18 and older, still smoke cigarettes. The National Institute on Alcohol Abuse and Alcoholism reports that 8 percent of American adults abuse alcohol. And, according to the CDC, 35.7 percent of U.S. adults, or 72 million people, are currently designated as obese versus only 12 percent in 1990.
If you consider big-ticket healthcare risk factors such as lack of exercise, smoking, and obesity that can result in cardiovascular disease or stroke, it's clear that preventable risk factors can be connected to America's hefty $2.5 trillion healthcare bill.
"In fact, research has shown that a staggering 70 percent of all healthcare insurance claims are considered preventable," says Dr. Bartlett. She adds that a 2007 Duke University study found that morbidly obese workers file 45 percent more claims on average than non-obese workers. Obese workers also had eight times the number of lost work days and medical costs that were 5.4 times that of non-obese workers. The National Council on Compensation Insurance (NCCI) research found that work-related injuries are far more costly if the injured worker is obese, and the dramatically higher medical costs suggest that the types and nature of injuries sustained by obese workers, especially the morbidly obese, are more likely to result in permanent disabilities.
"Think about it. Health problems caused by smoking and obesity alone result in 39 million lost work days annually," says Dr. Bartlett. "We are suffering a healthcare crisis in America, but the real issue is not cost, it is wellness. Wellness means a high quality of life, and not just physical and mental, but spiritual and social as well. We need to start focusing on quality care, prevention, and other positive strategies of change."
Dr. Bartlett explains that any discussion about wellness should include the idea of making good healthcare decisions, with participation in health screenings, lifestyle choices, regular exercise, and stress management. It also includes seeking treatment from quality providers who consistently achieve positive medical outcomes and create value for those they treat. Typically, the sooner an illness or injury can be addressed by one of these quality providers, the better the outcome for the claimant and the employer. Only by focusing on those critical factors can Americans, and American businesses, start to reduce the staggering healthcare costs that are saddling employers and, as a result, sapping the nation competitively.
"Employer-funded healthcare costs are increasing every year by five to ten percent," Dr. Bartlett says. "It's to the point where employers can't afford it, and that's a major reason why wellness is such an important topic - especially when it is linked to decisions about lifestyle choices."
What can employers do as a first step in achieving the more positive aspects of quality healthcare rather than the more typical managed healthcare approach? Dr. Bartlett says a good start is to take advantage of an integrated disability and workers' compensation model that uniquely positions large employers to uncover unmet needs and take advantage of offerings that already exist within their group health plans.
By following that strategy, she explains, when an injured worker makes a claim, an integrated approach to holistic, quality healthcare can identify at-risk claimants such as those who smoke, lack exercise, or are overweight. The employer can then both educate and offer these individuals opportunities to participate in wellness-focused programs such as smoking cessation, weight loss, or even basic gym memberships.
"They may not even know their employer offers these types of programs," Dr. Bartlett says, noting that Sedgwick, in its work with clients, often finds itself in that "intermediary" role of directing care. "Each of our clients has a unique set of data for its workforce, and when we can identify chronic conditions, the onus then becomes what we can do with that data."
In essence, Sedgwick's unique position during intake and absence management can serve as an interface to direct injured workers to the appropriate program, specific to their risk factor(s). For example, while many large employers offer a health plan, they may not necessarily practice proactive disease management. Sedgwick, through its intake process, can determine the reasons why people won't be at work. An example may be a child with asthma that leads the employee to learning about the employer's asthma management program for all group health participants, including their family members.
"We cannot continue at the current pace of healthcare spending, but even more importantly, America needs to change its culture so people are healthier," states Dr. Bartlett. "Employers are in a genuine position to take the lead in that change, and to manage to a high-quality standard of healthcare using whatever form of creativity and innovation needed to get there."
Dr. Bartlett points out that Sedgwick is seeing more examples of how integrated disability management can serve as the ideal platform for this needed change. Also, emerging technology developments, such as the advancement of smart phones, allow medical providers to be more connected. Employers also are using gamification, the use of games in shaping behaviors, and social networking to reach out to employees, especially younger ones, as a way to encourage healthier choices and lifestyles.
Another key success component is what Dr. Bartlett calls recognizing "the readiness to change." By that, she means knowing the key scenarios and factors an employee displays when he or she is ready to start losing weight, stop smoking, or make other positive healthcare choices.
"It is so important to determine what phase they are in and if they are contemplating change," she says. "That way, you can help guide them to the next level. Knowing when someone is ready for change by utilizing the right interviewing techniques can really make a difference."
In the end, the focus needs to shift from managed healthcare to quality healthcare -- an achievable objective. If that happens, healthcare costs certainly will begin to level off and eventually go down.
"Yes, it requires us to think and act differently," Dr. Bartlett comments. "Wellness, health education, and medical literacy are all important aspects of this movement. We have to begin to think holistically, rather than just focus on the specific injury or disease."
Dr. Bartlett notes that this cultural change would not be expensive, as it does not require employers to spend additional funds. When an employee suffers a fractured arm, for example, the immediate objective would be to not only treat the injury, but also to determine if there is anything that can be done to improve the overall health of the injured employee or their family members. Dr. Bartlett adds that if you neglect all the other risk factors, you may prolong the recovery from the injury, and that can evolve into another costly mistake.
"Employers are already spending on disability management," she says. "The idea is to work hand-in-hand with their disability management provider and the medical provider community. That way, employers can be more of an advocate for wellness and holistic, quality care within their own workforce. "
For more information, contact Dr. Theresa Bartlett at 248-637-3120 or Teresa.Bartlett@sedgwickcms.com. To learn more about Sedgwick, visit: www.sedgwickcms.com
(The above piece is part of our continuing Insights series designed to highlight key products and services to our readers. This paid-for Insights was written and edited by Risk & Insurance®
on behalf of our marketing partner. Additional Insights can be found on our Web site at www.riskandinsurance.com.)
May 9, 2012
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