President Obama’s position for health reform has been closely aligned to the nation’s economic health. His argument: healthcare costs consume about 18% of our GDP and until we get health care costs under control our nation’s economic health is greatly impacted.

A recent study by The Robert Wood Johnson Foundation extends the argument beyond health reform and has examined the impact that job loss has on health conditions. The key findings in the study include:

- The likelihood of individuals who lost a job through workplace closure reporting fair or poor health increased by 54%.
- The odds of developing a new health condition rose by 83% among those who had no preexisting health problems.
- Even when individuals found new jobs, they continued to have an increased risk of new stress-related health problems.

David Williams, staff director of the Robert Wood Johnson Foundation added this thought. “Where and how we live, work, learn and play have a greater impact on how healthy we are than the healthcare we receive.” I am not sure that I agree with Mr. Williams completely but I think there is definitely merit to his point. Beyond looking at health reform as the delivery system and a cost containment effort, we also must examine how other environmental factors contribute to our health and therefore, contribute to costs.

Do you know what concerns me when I read articles such as the one in The Wall Street Journal? When individuals are left with no insurance coverage or are underinsured, it opens the door to an increase in catastrophic health occurrences, it impacts our ability to help those most in need practice preventive health and it impacts all of us because healthcare costs sky rocket.

What are your thoughts?

In order to be sustainable and successful, the healthcare system must transform. Industry members have a simple choice to make: to shape this transformation, or to be shaped by it. For those who choose the former, we recommend a whole-brained approach that focuses on rewiring the brain to activate new behaviors and sustain them long term.

Understand why change must happen, and what kind of change is neededAny positive and active change must begin with informed insight. With a layered understanding of the current environment and future expectations, members of the healthcare sector can begin to lay the groundwork for change.Further, as the fundamentals of the healthcare sector begin to take on a consumer-oriented focus, providers, product manufacturers and payers will need to consistently understand the drivers of consumer choice.

Enable the sector with the training and tools to support a new way of doing business
With targeted and effective training and coaching strategies, healthcare providers can be prepared for the coming waves of change. With the right curriculums, they can improve the overall quality of care, reduce inefficiencies and build collaborative practices. The right tools can also be leveraged to educate consumers to make more informed choices regarding health and wellness. Such programs serve every member of the sector and begin a shift from diagnosis-based protocols to preventative health practices.

Motivate the right kind of change through rewards and recognition
In an environment where so many participants have “checked out”, new strategies are needed to drive change. Virtually everyone – providers, product manufacturers, facilities, payers and patients – needs a reason to go through the pain of change. And virtually everyone would benefit from a system where engagement was the norm, because we know that engaged individuals work harder, provide better service and are more willing to go the extra mile. The right motivation can generate engagement, drive new behaviors and help ease the transition into new ways of being.

Taking a broad perspective on the healthcare crisis, one of the most stunning elements of the current situation is that virtually no one is coming out ahead. Individuals are getting less coverage and care and paying higher premiums. In fact, U.S. healthcare spend is the highest in the world, yet we place 14th in mortality rates. Physicians and hospitals are understaffed, over-committed and compensated for activity, not quality outcomes, under the current system. Health insurance providers are struggling against rising expenses. Employers face the one-two punch of a recession and higher rates to cover their employees. Pharmaceutical companies are losing revenue streams, facing public trust issues and astronomical risks from legislation and litigation. Meanwhile, Medicare and Medicaid are tightening the purse strings on reimbursement in an effort to stay solvent, and hospitals are facing truly challenging times with care staff shortages, new competition from smaller surgical centers and ever-dwindling reimbursement funds.

As these interconnected elements of the system are stressed, they in turn put pressure on the other elements. Not only is the system failing to work, the elements of the system are working against each other – a true misalignment of objectives. Unfortunately, the patient is often trapped in the middle with little to no control over their healthcare choices and they are also the ones suffering from the misalignment of incentives.

No matter what your role in today’s healthcare system, it is not difficult to feel boxed in. Health insurance providers frequently dictate where a patient can seek care and which treatments are open to that patient and his or her doctor. Due to the reimbursement model, physicians are being forced to operate from a reactionary model, rather than a consultative one, often preventing patients from taking responsibility for their health. Pharmaceutical companies are being reigned in by a growing array of limitations, regulations and litigations. These reductions in choice can lead to reductions in engagement. Many parts of the system are operating on autopilot. Active decisions, purposeful change and collaborative engagement are hard to come by – and even harder to sustain.

However, one change is undeniable and has already been set in motion. Consumers are gaining more of a voice in their coverage. Workplace innovations like Consumer Driven Health Plans (CDHPs) and Flexible Spending Accounts (FSAs) are expanding consumer options and enabling customization like never before. The cost versus care debate is renewing the focus on ideas such as the medical home, retail health clinics, preventative health and patient rights.

Ironically, while choice for consumers is the wave of the future, the recent past has left many consumers unprepared for this development. As passive recipients of doctors’ orders and fillers out of insurance provider paperwork, individuals have little practice in deciphering or seeking out what information they need. They are inexperienced in screening doctors, selecting hospitals and setting health goals. As an inevitable shift towards consumerism appears, healthcare providers will have to foster discernment and educate consumers. Naturally, as choice grows among healthcare seekers, providers will not only be required to educate consumers; they will also need to attract and keep them – to earn positions as providers of choice in their fields. In an open market, health insurance providers, physicians, pharmaceutical manufacturers and other industry members will need to distinguish themselves and provide stand-out customer service in order to retain a competitive edge.

Whether you are a patient, a physician, or an executive at a health insurance provider, an employer, a pharmaceutical manufacturer, or hospital, you are likely to agree that the healthcare system in the United States is ailing – if not failing – on many levels.

Though it’s true that some Americans still receive excellent and affordable healthcare, incidents of poor care, rapidly increasing costs and inaccessible coverage are on the rise; and those in the business of healthcare aren’t faring any better. Profits are eroding, paralleling the decline of affordable and accessible care. A confluence of intertwined factors is accelerating these issues, including the following:

Unsustainable healthcare costs
The United States already spends more on healthcare than any other country, and under the current system, these healthcare costs can only rise; in fact, they’re expected to double by 2012. Continuous increases in healthcare costs are outpacing inflation, and an economic recession is likely to put even more pressure on the wallets of patients and caregivers like physicians, health insurance providers, pharmaceutical companies and hospitals.

A changing political environment
As healthcare costs escalate, more and more individuals become underinsured or uninsured, and Medicare struggles under a growing burden, we can expect an increasing push for nationalized healthcare. Healthcare is at the center for change in Barack Obama’s political plan, and with Tom Daschle being nominated to head Health and Human Services there is an epic battle about to take place to initiate monumental changes to the current system structure and policies.

Decreasing development and deployment of new drug therapies
For pharmaceutical companies, new drug approval protocols from the Food and Drug Administration are compounding the already high costs of research and development, resulting in a decrease in the development and release of new therapies. Add consumer litigations, drugs going off patent, outsourcing to global markets and the pressure from Medicare and managed care organizations to use generics, and you have a recipe for deceleration.

Uninsured or Underinsured Population
The consequences of a large population of uninsured citizens, economic pressures and exclusions have made healthcare inaccessible to a large percentage of Americans – many with full time jobs and a houseful of dependents. It is far too common for our estimated 44 million uninsured individuals (and the 38 million who are underinsured) to postpone treatments they cannot afford and forego essential preventative care, like screenings, immunizations and check-ups. The result: by the time these individuals seek medical help, they are often suffering from advanced conditions that require more intensive interventions.

Decreasing health across the population
The uninsured and underinsured are not the only ones whose health is in decline. Today, 75% of U.S. healthcare expenses are attributable to chronic conditions that are preventable 80% of the time. A variety of factors – poor loyalty relationships between physicians and patients, disengaged consumers, an aging baby boomer population, increasing rates of obesity, lack of public health education, and a health system focused on treatment rather than prevention – have converged to create rising chronic and morbidity rates among Americans.
© 2008 Maritz All rights reserved
All across the United States, regional coalitions similar to the Ashville project, are taking shape in an effort to address the crisis that our health system faces. As a member of several of these regional coalitions, my observations are that collaboration at a regional level is much easier and realistic than trying to work through a national agenda. Collectively, while these coalitions have differences of opinions, there are several themes that remain constant:

• The need for an interoperable IT backbone for the health system,
• More tightly aligned incentives that focus on a better health outcome,
• More coordinated care to reduce redundancies and unnecessary diagnostics,
• A focus on prevention and wellness instead of treatment,
• Improving comparative data to build better decision models based on what is truly working in the delivery of care

Providers in the healthcare system know that we are facing trends that may eventually cripple the system and that action is what is needed sooner, rather than later