A recent article by the Denver Post highlights the lengths that organizations are going to in order to motivate individuals to become more active owener of their health. It has been evident for quite awhile now that good health is considered a reward in and of itself by a small proportion of the population. In a monumental effort to shift our country’s culture from that of treatment to that of prevention, Health Plans and Employers are placing emphasis on establishing wellness cultures through the use of wellness programs and incentives to motivate healthier decisions and behavior.

The article in The Denver Post highlights the variety of incentives being used in the marketplace to motivate individuals in taking a more active role in their health. Incentives are a necessary tool in motivating individuals because they answer the key question that most participants want to know - “What’s in it for me?”. A good incentive strategy is built off the fundamental principles of motivation and behavioral science elements. A good incentive strategy must also include a strong communication plan that helps to reinforce a wellness culture, remind individuals of their call to action and reinforce how they are doing.

Even when people want to change, it’s hard to learn new behaviors. Shifting passive health behaviors to more active behavior is going to require a commitment from Employers and Health Plans to encourage and reinforce new behaviors, provide positive consequences and realize that change may happen sooner for some than for others.

Several articles from the Wall Street Journal and First Word recently reported that spending for healthcare actually decelerated in 2007. Although health care costs are still exploding at an aggregately unsustainable rate,and at a pace that is higher than economic and wage growth the data does provide support for the notion that generic prescriptions can and will have an impact in containing the cost of medicines.

A summary of the key points of the articles include:

- the pace of prescription-drug spending slowed to its lowest rate in 45 years, climbing 4.9%,
compared with an 8.6% increase in 2006.
- 67% of retail prescription drugs sold in 2007 were generic medications, up from 63% in 2006.
- government also is picking up more of the nation’s health-care tab
- Medicare Part D cost the government $40.5 billion in 2006 and $47.6 billion in 2007.
- Health spending was highest for hospital expenses, which grew 7.3% to $697 billion, and
physician spending, up 6.5% to $479 billion

Given the current economic conditions and the continued focus on reducing the healthcare costs in this country, it is not a surprise to see that generics have assumed a large proportion of filled prescritions this past year. That trend is likely to continue which may leave branded pharmaceutical companies feeling the effects for quite some time.

A recent article in the Chicago Tribune entitled Health Care Reform Talk Goes Local covers one of the many community discussions on health reform that took place over the holidays. One individual summarized the issues facing the health care system in four words: access, quality, cost and prevention while other schools of thought challenged whether the United States actually has a system. The turnout was large and well represented by actual providers of health services as well as consumers.

What I found interesting in reading this article is that there still seems to be a perception that universal coverage and socialized medicine are one in the same. It was also interesting to note that wide ranging perspectives on a market based system. While there was a wide range of opinions on the topic, a prevailing theme that seems to be taking shape is that our nation cannot continue down the current health care path. Change needs to happen and after reading multiple articles on the community sponsored health care reform discussions, I believe there is no doubt that the movement for health care reform has begun. Whether it ends with a decisively different system is anybody’s guess.

I just finished reading Senator Tom Daschelle’s book, Critical - What We Can Do About the Healthcare Crisis. It is a relatively easy read and provides a pretty clear deconstruction about how our health care system has gotten to this point of crisis. He also spends some time articulating a new model that is still based on free markets but with a more robust framework that closely parallels the Federal Reserve Board framework for our financial system. It is an interesting line of thinking and for those of us who work in the health care market, the book provides some interesting insight as to what the future Health and Human Services Secretary may be planning.

Pauline Chen M.D., authored an interesting article in the NY Times, entitled Do Patients Trust Doctors Too Much? It is an interesting question to ask. Dr. Chen’s insight includes the following thoughts:

- In reviewing the physician ratings on Angie’s List there was a strong correlation to high ratings
for physicians based on attentiveness and bedside manner but patients rarely mentioned
medical skills as a criteria of the rating.
- Few patients actually devote any time to researching the medical credentials of a physician.
- Patients spend more time on researching job changes than they do on researching a physician
who is performing surgery on them.
- There are consequences to that type of blind trust.
- A healthy physician/patient relationship requires patients to come to the relationship educated
about their physician, their illness and treatment.

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