In a recent study published by the New England Journal of Medicine smoking was identified as the top cause of preventable death in the U.S., responsible for killing about 438,000 people each year. Even more astounding was the fact that General Electric spends $50 million annually on healthcare costs for smokers which didn’t include associated costs due to lost productivity.

Interestingly enough, GE ran a study to better understand how incentives influenced smoking cessation programs. The results further validate that incentives, when implemented strategically throughout the progression of behavior change have a significant effect on better health behaviors. Several points highlighted in the study include:

• The trial was designed to see how many of the 836 participants remained non-smokers over a 12 month period.
• Half of the participants were given: $100 for completing the smoking-cessation program, $250 for not smoking within six months after enrolling in the study and $400 for abstinence after six months more, confirmed by saliva or urine tests.
• After an additional six months, 9.4 percent of the paid group still wasn’t smoking though they were no longer receiving cash rewards.

Clearly the investment of $750 per participant to motivate smoking cessation is significantly less than the cost per employee that GE pays for smoking related health issues. And clearly, GE also understood that nicotine addiction is an extremely difficult behavior to break even when an individual wants to change. I believe that GA has seen success in their smoking cessation efforts for two reasons: 1) the use and value of incentives was meaningful enough to motivate participation and meaningful enough to sustain a changed behavior, and 2) GE’s commitment to this program over a longer period of time.

A new report from Trust for America’s Health and Robert Wood Johnson Foundation indicates that obesity rates rose for the second consecutive year in twenty-four (24) states and astoundingly NO states experienced a decrease in their obesity rates.

Here are a few insights to consider:
• More than 25% of adults are obese in 28 states.
• More than 20% of adults are obese in every state except for Colorado.
• In 1980 the national average of obese adults was 15%. Today it is estimated that 66% of American adults are overweight or obese.
• It is estimated that 23 million children are overweight or obese.

These statistics are frightening when you consider the fact that obesity is a trigger for many chronic health issues that plague our health system and continue to contribute to the escalating costs of chronic and multi-disease state care. Even more startling is the fact that the report found that many of the promising policies that have emerged to promote physical activity and good nutrition are not being adopted or implemented for a variety of reasons.

While organizations have typically used a disease management approach to try to manage and control weight of their employees and members, there is a company called Tangerine Wellness , has very compelling success stories about their ability to help people lose weight and keep it off. Recognizing that obesity is an issue that leads to many other health issues, Tangerine Wellness has used some basic principles of social networking, competition and long-term incentives to drive some amazing results for people who are overweight. Their success has been steeped in the understanding that losing weight is hard, but keeping it off over a long period of time can be even more difficult. Through the use of intermittent rewards and effective communication that recognizes participants when they hit key milestones, Tangerine has produced ROI numbers upward of 5% and has achieved participation and engagement rates averaging between 60% to 80%.

When considering programs where the health issue is as pervasive and serious as obesity, corporations may want to consider rewarding on outcomes over a 2 to 3 year period rather than soley on participation in a weight management program. Outcomes-based incentive programs do require more focus on HIPAA criteria however, I believe the ROI that companies like Tangerine have been able to deliver more than justify the investment in a robust outcomes-based incentive strategy.

Marc Siegel wrote an interesting op-ed piece in USA Today regarding the effects the economy is having on overall health and wellbeing. The general point he was making is that the stress levels and anxiety people are feeling right now are beginning to take a toll as individuals lose sleep, eat poorly, fall into depression and increase anxiety levels over job concerns, 401(K) values and general financial health … all of these activities also impact the general health and well being of an individual.

Given the amount of concern over the economy and the general state of morale at most corporations, I am surprised that more organizations are not focusing wellness efforts on stress management and mental health. The USA Today piece offers some relatively simple suggestions for dealing with stress: “The best advice is often the simplest: Eat healthy food, sleep right and avoid obsessing on the doom and gloom. Do yoga, meditate or exercise regularly to combat the growing stress.” It is difficult to imagine that individuals can focus on these measures given what is going on around them. These are extraordinarily challenging times but even under normal conditions, stress is a major contributor to health issues.

Organizations have an opportunity to focus their health efforts on stress management campaigns as a means of helping employees through these tough times. Since stress is a catalyst to many poor health habits, now is an ideal time to focus wellness efforts on managing stress and improving overall mental health. This is an area that has been long neglected in wellness programs, perhaps due to the asymptomatic nature of stress.

I would be interested in hearing your thoughts on USA Today’s piece and what your organization is doing to focus on stress management.

There is some disconcerting news out today that indicates the U.S. is facing not only a shortage of nurse professionals but also primary care physicians. According to an Associated Press article only 2% of graduating medical school students are planning to enter into primary care internal medicine, down 7% from last year.
This troubles me for several reasons:
1) The push towards preventative care (wellness) is going to require a good deal of coaching and guidance to move patients along the continuum of change. Primary care physicians are seen as the most likely candidate to assume the role in quarterbacking and coordinating those wellness efforts. However, coaching, educating and following up with patients in an effort to drive more proactive and preventative behavior takes quite some time. With an aging population (the largest consumers of a PCP’s time) and an expectation that PCPs will quarterback wellness initiatives, the news about a shortage of PCPs is problematic to say the least.
2) The concept of the Medical Home Model that has repeatedly been discussed as the optimal model for coordinated care that can lead to better, healthier outcomes once again rests on the premise that a primary care physician should act as the quarterback for coordinating these care efforts. Without adequate capacity, and a reimbursement model that doesn’t reward PCPs for assuming these additional responsibilities this model will fail before it even begins.
3) The reimbursement model that healthplans have constructed creates a large disparity between primary care physicians and specialists which must be addressed if the U.S. is going to continue to entice med school students into primary care.

Did anyone read the alarming article in the Wall Street Journal last week regarding the toll that the economy is having on consumers’ health care spending? Essentially the article highlighted some trends that the market is seeing in consumers’ reducing their spend on key health services such as: prescription adherence, wellness and preventive screenings and delaying care for minor health issues that carry large catastrophic risk. The article found some very alarming key findings associated with the economic downturn:
• 22% of consumers have cut back on seeing their physicians;
• 11% have scaled back on prescription drugs;
• OB/GYN visits, the sole source of preventive care for many women has dropped 6% versus the same period from last year;
Specific health services being hit are in joint replacement, mammograms and other preventive services. What concerns me is that while consumers are tightening their belt with short-term medical needs what they may be creating is higher risk factors that could then lead to much more expensive outcomes. As more people delay or decide to forego preventive screenings and wellness activities it could lead to minor medical problems becoming major medical problems that result in costly hospital bills and potentially even greater chronic conditions.

Some may argue that the economy is forcing patients to be more responsible consumers of health services. But can that really be the case when the disturbing anectodal evidence suggests that consumers are having to choose between paying for food, gas and things for their children versus spending money on a diabetes blood test that could save their life.

My question is this: if health plans and drug companies are really serious about maintaining the momentum for preventive wellness initiatives why are they not doing a more proactive job of keeping people engaged in being well especially with the economy forcing people to make life-or-death choices? Why are preventive screenings not fully covered? And why are people with chronic diseases having to choose to defer costly tests that could prevent even costlier hospitalization. Health plans and employers must see that this undermines the investment they have made thus far in trying to engage consumers into thinking, acting and doing things that lead to more proactive health.

During this economic crisis, I think it is more important than ever for health plans and employers to ensure that they are using incentives, rewards and communications to actively maintain engagement in preventive wellness programs. The incentives can range from $0 co-pay for prescription drugs to premium deductions and gift cards that offset the costs associated with medical bills. Furthermore, health plans and employers need to continue to communicate the benefits of consumers staying engaged in health focused activities, why it makes sense in both the short and long term. Right now, it appears that consumers see health services and preventive services as an “easy to cut” item in their budget. While this may provide short-term relief, the long-term consequences could have a significant impact on consumers’ wallets and their health.

First it was Disease Management, then it was Case and Utilization Management. Give health insurers credit for initiating various support services to try to help patients manage their health and gain access to the appropriate health services. The problem has been that very few of these methods have actually resulted in better health outcomes and lower costs, primarily because these programs are restricted to relatively small population sizes and because these programs often identify a participant after a catastrophic event has occurred.

Fast forward a decade and you see health insurers and employers alike focusing their efforts on wellness programs. According to a Maritz survey, the number of formal wellness programs have increased from 35 to 42% from 2006 to 2008. Health insurers and employers are hoping that by offering wellness programs, employees will improve their health and become more productive, decrease absenteeism, presenteeism and lower healthcare costs.

The question remains …will wellness be the answer to reducing healthcare costs and improving the overall health and productivity of individuals?