Lots More on Fitness as the route to Health Cost Savings

Most of you know that I'm hung up on the problems within the sick care and health insurance agencies ... that are driving our costs up so well. I'm also hung up on the idea that if a person reverses their un-healthy lifestyles (also known as habits) and practices Daily Fitness, that they are on the road to dealing with this personal and national problem.

Recently, I have had an opportunity to listen to several people whom I think are truly on top of this ... people within the industries. Here are the messages that I heard. Please take time to read them. They're important.

Andrew Sykes: More Insights Into Fitness and Health Care ...

The "guru" who has guided much of what we are doing as a Co-op is Andrew Sykes, a TEC Special Interest Meeting on Sept. 15, and came away with these notes:

• Is your objective as an employer simply to lower health insurance costs? If so, DON'T include Wellness thrusts as part of your solution! There are cheaper ways to do that, primarily involving shifting more and more of the responsibility to employees, which is the major national (and appropriate) solution, anyway.

(Side note: Almost everywhere you look, the intrusion "third parties" with their self-interest and not yours primary, has resulted in uncontrollable higher cost trends. Look well beyond health care, even. Yes,you'll hit some political land mines.)

• Health Insurance doesn't make you healthy! You have to have initiatives beyond that, that will ALWAYS primarily focus on nutrition, volume and exercise, not prescription drugs. The latter are the secondary solution because we keep rejecting the uncomfortable primary solution. 5% of the world consumes 50% of prescription drugs ... AND their SIDE EFFECTS.

• Poor health is a result of: The Less-Controllables of Genetics, 20%, and incompetent sick care, 10%. The Controllables of Habits, 50%, and the Environment we pick and allow, 20%. Regarding the Environment, because we don't easily recognize our bad habits because they ARE habits, they are often "mimic-ing" those around us. If our friends and/or family aren't active, we won't be. If they eat badly, so will we.

• Our main culprit is SUGAR! (Bar any sugar drink from your home and your office vending machine!)

• Exercise: There is no better drug to reduce such a wide range of ills. One hour of active exercise gets you two hours more of higher productivity. Your kids? Kids who exercise regularly have higher math scores, for starters!

• Exercise: If you exercise, such critical soft skills as Decision-Making and Managerial Skills are all more effective.

• It's better to be FIT and have a risk factor, than to be UN-FIT (but "Healthy") with no risk factors.

• Education is the LEAST EFFECTIVE contributor to behavior change ... although it's an essential part of a System. A Fitness Mentality will drive all the behavior change you need. It leads to all the other critical factors, such as better eating, sleep, education, etc.

• Generally, Nurses and Teachers are very unhealthy, because they put others ahead of their self ... even though if they were "FIT," they would be even more effective.

• Never allow self-reporting within Health Risk Assessments. If renders them invalid for any comparison or improvement purposes.

• Wellness Incentives: Mostly they are costly ... when you could get the behavior you want for free.

• PS: Never use Cash. It's worth only its face value to the receiver. Instead, give them choices so they can pick something that's even more valuable to them.

Dr. Paul Summerside, CEO of Aurora BayCare, and CMO of BayCare, to a Healthy Lifestyles Co-op Board Meeting on Sept. 26:

Aurora BayCare's Philosophies regarding Fitness and Wellness

• In regard to Fitness/Wellness of their employee group (about 450 at BayCare), they take the position, as the Co-op does but even more forcefully, that "It's All About Nutrition and Fitness." If a person does the right things in those areas, all the other benefits will follow and they will need the medical system services, including prescriptions, at a bare minimum. Thus, they incent for Fitness ... and evaluate QUARTERLY employees on a range of fitness performance elements ... situps, pushups, step test for aerobics, and the like, with performance thresholds adjusted for age. The poorer a person does, the more they will pay for their health insurance plan ... but they have a chance QUARTERLY to show they are more fit, and earn a lower premium.

• "Trying doesn't matter. The only thing that matters is success."

• As an employer, "if you don't change the actuarial metrics of your employees, don't expect any insurance cost improvements."

• As an employer, "we feel the responsibility to put in place programs and incentives that help them achieve success in these areas. But we will reward only on achievement, not 'trying.'"

• "People have to know in advance what they'll be measured on, and the consequences. The tests have to be reasonable and achievable, and easy to understand."

• There are FIVE AREAS you have to impact: OBESITY, EXERCISE, SMOKING, ALCOHOL in moderation, and SEAT BELT USE.

• From a medical cost standpoint, this is what you are dealing with relative to norms:

-- Obesity will cost you about 40% more.

-- Smoking will cost you about 10% more.

-- Exercise will reduce your costs 10%-15%.

• Of interest, even though they are a medical organization, they don't include Health Risk Assessments as part of their program. They feel that the knowledge gained about risk factors in an HRA should be already known and worked on with a physician, and that it drives higher costs through use of drugs to control risks ... rather than a better lifestyle to do it (nutrition, volume, vigorous exercise).

Toussaint of Center for Healthcare Value

Recently, I had the opportunity to hear John Toussaint, former CEO of ThedaCare and now running the ThedaCare Center for Healthcare Value, which fosters research on improvements in medical system processes. Among his points:

• The objective has to be three-fold: Driving Costs Down, and Improving Quality Metrics and Staff Morale.

• We use Lean techniques to achieve the improvement results we need from a system that is both Unreliable and High Cost. Our objective is to Create Value for the Customer, while not Overburdening Staff and Physicians. We will do that through Improved Processes.

• Our current processes are perfectly set up to obtain the poor results that we do.

• Pharmacists are rarely part of the conversation. They're typically in the basement counting pills. Yet, they are usually the second-most trained person on a medical team. So, we are elevating them to full partners in the initial conversation with patients about their continuum of care.

• 60% of our cost is people, so it's about improving productivity. We've improved Operating Room Technician productivity by 30% by reducing their extra activities and distances. In one type of operation, we've reduced the cost to $5800 from $7800.

• Our objective is to create a Single Plan of Care. At a patient's admission, we convene a meeting of the Physician, Nurse and Pharmacist with the Patient to discuss what will happen. Regarding drug therapies, after explaining what each drug will do, we ask the Patient to explain what each is to do to be certain he/she understands and has buy-in.

• He's also involved with the Partnership for Health Care Payment Reform, whose charge is to incent the right behavior by the medical community. (Which means replacing Fee for Service, which incents volume, with a Value-Based method. As an indication of the degree of the problem, he said that for a Knee Joint Repair episode, the highest cost in the state is $55,000 and the lowest for the same episode is $10,000. "Something's wrong!" The Partnership is looking at one Acute Care (Knee Joint Replacement) and one Chronic Care (Diabetes) example to develop a Value-Based approach.

• Major statement: "If you look at the improvements we are seeing from an efficiency standpoint, I think we can potentially work well at Medicare payment levels."