Perhaps the simplest way to reduce healthcare costs is to promote a healthier lifestyle among the U.S. population, experts told the U.S. Senate Committee on Health, Education, Labor and Pensions on Thursday.
The testimony was framed in the context of employer-sponsored health plans, and focused on initiatives employers can take to improve employees' health and mitigate the financial burden to the healthcare system.
Statistics indicate the opportunity for such programs to make a significant difference. According to the Centers for Disease Control and Prevention, healthcare costs represented just 9 percent of gross domestic product in 1980. Flash forward to 2017, and those costs represent about $2.3 trillion and is expected to rise.
Means of improving health for employees, and indeed for all Americans, focus on common-sense approaches such as quitting smoking, maintaining a healthy weight and keeping cholesterol in check. The challenge is in providing incentives for people to do so.
Steve Burd, founder and CEO of Alamo, California-based Burd Health, said his company was able to lower its healthcare costs by about 40 percent, employees' cost by about 10 percent, and improve the level of care they receive by implementing voluntary, company-wide wellness initiatives that provided monetary incentives for maintaining healthy lifestyles.
About 85 percent of Burd Health's employees opted into the program, with 75 percent of spouses opting in as well, and the results were dramatic: Of the people who initially failed the blood pressure standard, 72 percent passed the standard within two years and maintained it through the remainder of the program.
"We needed to provide support tools that allowed people to enhance their state of health," said Burd.
Michael Roizen, MD, chief wellness officer and founding chair of the Wellness Institute at the Cleveland Clinic in Cleveland, Ohio, said that if steps aren't taken to bend the cost curve, the influx of chronic disease -- which is growing at a rate faster than that of the U.S. population -- could well bankrupt the nation's health system. Wellness programs with voluntary participation, he said, could save hundreds of billions of dollars over the next several years.
The Cleveland Clinic has pursued such a program, targeting factors such as BMI, blood pressure, smoking and unmanaged stress, all predictors of chronic disease. By incentivizing employees to improve their health, Roizen said the clinic was able to save $254 million in direct medical costs. There have been substantial reductions in unpaid sick leave, and employees have seen their health costs and premiums decrease. Smoking rates have decreased from 15.4 percent to less than 5 percent, and BMI for all 100,000 employees is decreasing at a rate of 0.5 percent per year. Across the country, that number is climbing at about 0.3 percent annually.
"The program is doable, exportable, and scalable across the country," said Roizen. "It doesn't have to stop with federal programs. Private sector programs can help as well."
David Asch, MD, MBA, a John Morgan professor at the Perelman School of Medicine and the Wharton School, and executive director of the Center for Health Care Innovation at the University of Pennsylvania in Philadelphia, pointed out that Americans spend the majority of their time outside the healthcare system, and that's where determinants of health unfold. And many of those Americans spend a large chunk of their waking time at work.
Asch said that to implement a successful program, it helps to first understand the psychological underpinnings that motivate people to make lasting change. UPenn implemented a program that tested one of those psychological motivators by placing employees into two groups -- those in the first group received an extra $1.40 per day that they walked at least 7,000 steps, while the second group had $1.40 taken away if they failed to walk 7,000 steps. The employees in the second group -- who faced having money taken away -- were 50 percent more likely to succeed.
An economist might not see the difference, said Asch, but a behavioral economist would recognize a central truth: People generally respond more to the potential of loss than of gain.
"Most large companies are using financial incentives to encourage healthy behavior … by adjusting premiums based on healthy behaviors," said Asch. "It doesn't work. There are modest financial benefits to employers and questionable benefits to patients." Success, he said, is more likely "to come from approaches that take the underlying psychology into mind. Those are the ingredients of successful programs."
Jennifer Mathis, director of policy and legal advocacy at the Judge David L. Bazelon Center for Mental Health Law in Washington D.C., stressed that wellness programs should be implemented in a way that takes into mind workplace protections such as the Americans with Disabilities Act.
"People with disabilities need these protections," said Mathis. The ADA, she said, created strict protections that allowed people to keep their health and wellness information private in the workplace.