Aetna announced the results of a six year study of healthcare claims and utilization for members of its CDHP. Some of the key findings included:

- sustained savings over a five year period, employers saved anywhere between $7-$21 million per 10,000 members over the five year period,
- members of the plans sought increased levels of chronic and preventive care,
- higher utilization of generic drugs, and
- higher utilization on-line tools and information.

These seem to be promising results given the struggle that health plans have experienced in reigning in healthcare costs. It will be interesting to see the strategies that Aetna and other health plans may employ to compress the length of time that it may take for employers to benefit from such savings.

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 study published in Postgraduate Medicine found that automated self-testing health stations in the workplace helped employees improve their management of hypertension and obesity.

Highlights from the study include:
• Over 21% of the employees voluntarily used worksite health stations to measure their blood pressure or weight.
• Worksite health stations identified 27% as hypertensive, 40% as pre-hypertensive, 38% as obese, and 35% as overweight.
• Approximately half of the employees with hypertension and 10% of the employees with obesity successfully reduced their health risks.

I found this study interesting due to the continuing lack of awareness that most individuals have around their health risks. In addition, the convenience that health stations afford employees mitigates the “I don’t have time to leave work and go to the Doctor” excuse that often times delays health risk or condition identification

A rather disconcerting Hewitt & Associates Survey indicates that 19% of respondents plan to drop health care coverage as a benefit over the next 3-5 years. While the survey respondents only numbered 343, the continuing undercurrent to the discussion around healthcare costs leaves little doubt that the impact of escalating costs is forcing companies to make decisions in an effort to protect corporate profitability and global competitiveness.

Health care reform is not an option it is a business imperative. The inefficiency of a massive system coupled with the lack of individual health accountability has created the perfect storm. If employers continue to drop coverage, a single payer system may end up being the only option.

“Promoting employee accountability” was ranked the chief health and prevention component of employers’ health care strategies in 2009. Employers have made significant investments in providing health services to better support healthy behaviors and mitigate acute care episodes. But that alone will not achieve the goal of employee accountability. While Consumer Directed Health Plans may shift a higher cost burden onto employees, I continue to believe that accountability has to be tied to a performance based culture.

Reuters published an article regarding the growing support for a mandate for health insurance as part of the reform effort that are currently being debated. There are 46 million individuals uninsured in this country, the majority have no coverage because they simply can’t afford it. This is an interesting debate to me for several reasons:

- These uninsured individuals usually wait until absolutely necessary (read: really really really sick) before they utilize health services and usually the point of entry into the system is the ER…the most expensive entry point.
- The costs to care for this uninsured population is already being transferred to employers, individuals and the govenment.
- Providing some type of coverage seems to make sense if enables the system to provide more preventive care, thereby reducing the costs of entry.
- Providing some type of coverage should result in less cost shifting to other payers in the system.
- There will and should be trade-offs for providing coverage and health plans need to ensure that the coverage is reasonable and affordable.

Employers are certainly feeling the burden of cost of care for not only their employees but assuming the cost shifting that takes place for care of the un and under-insured. The only way that we are going to truly reduce healthcare costs is if we understand the root causes of what drives those costs up. One of those root causes is the massive number of people who are uninsured. They pay the price in terms of poor healthcare but we all pay the price when it comes time to pay the bill.