Health Plans: Removing Costs Can Spark Prevention

Education and incentives are needed to bring about significant cultural health behavior.

Hundreds of thousands of Americans are losing their health insurance coverage every month as employers cut costs by laying off employees or eliminating health benefits. Couple that with businesses transferring more health costs onto individuals through higher copays, deductibles, and coinsurance, and you see why healthcare leaders are worried what they may face once we emerge from the recession.

Americans, because of loss of coverage or finances, are delaying preventive care that could come back to hurt not just them, but employers and the healthcare system at large.

"There is no such thing as a healthy American any more," says Michael D. Parkinson, MD, MPH, FACPM, principal at P3 Health, LLC, which promotes personal and organizational prevention, performance, and productivity improvements. He also is past president of the American College of Preventive Medicine, and former executive vice president and chief health and medical officer at Lumenos, a pioneer consumer-driven health plan.

Parkinson cited the recent National Health and Nutrition Examination Survey that found only 8% of the population eats five fruits and vegetables a day, doesn't smoke, spends 30 minutes on physical activity a day, and is within 5 pounds of their ideal body weight.

Americans are not only unhealthy, but they are also being forced to pick up a bigger percentage of the healthcare tab. Parkinson says he is concerned about cost-shifting solutions.

Instead of arguing who pays for preventive care and how, the healthcare industry should focus on changing individual behaviors, and advocating prevention and better care management. These programs will drive down long-term costs and remove inefficient and ineffective practices, adds Parkinson.

One way to spark a wellness movement is by reducing cost barriers and communicating better with individuals about prevention and wellness. "A lot of barriers, which are real or perceived, can be addressed by health insurance plans working with workers or brokers or consultants beyond who has the cheapest premiums and the best discounts. It's a totally new value proposition. And frankly it's a value proposition that all of these intermediaries must make if they are going to survive," says Parkinson.

One organization trying to help people with health insurance costs is the HealthWell Foundation in Gaithersburg, MD, which provides an "average" $5 million to $7 million to people struggling with healthcare bills each month.

In New Jersey alone, David Knowlton, president and CEO of the New Jersey Health Care Quality Institute and board member of HealthWell, says preventable chronic disease costs $7.5 billion annually. Meanwhile, healthcare reform efforts in New Jersey are priced at $1.1 billion.

"We could do five or six health reforms just with what we waste because people don't treat chronic disease aggressively, and the biggest reason they don't is they are uninsured or underinsured," says Knowlton.