In my last article, I talked about how theunsustainability in health care inflation must be addressed withtransformational thinking. What we truly need isrevolutionary thinking. A revolution in the health careindustry is the only way to bend the trend, improve health andcreate a competitive advantage for employers who embrace it. To accomplish this goal, these four challenges must be turned intostrengths:

  • Curbing chronic disease

  • Paying for outcomes and value

  • Leveraging mobile health technology

  • Activating the consumer

In this post, I am focusing on curbing chronic disease andpaying for outcomes and value. Check back for the final partof the series on leveraging mobile health technology and activatingthe consumer.


Curbing chronic diseases

Chronic diseases, such as heart disease, stroke, cancer, type 2diabetes, obesity and arthritis, are the leadingcause of death and disability in the United States. Accordingto the CDC, cancer and heart disease alone account for 48 percentof all adult deaths in the United States. Seventy fivepercent of all health care spending is tied to chronic disease andthis is just the tip of the cost iceberg. Workers’ compensationcosts are two times greater for someone with one or more chronicdiseases, and employers suffer additional burdens from lostproductivity and absenteeism. However, the good news is that50 percent of all chronic disease is preventable orreversible based on lifestyle decisions (diet, exercise, smoking,stress and sleep). The definition of “chronic” implies longlasting, recurring and difficult to eradicate. Thus, thesediseases must be cured with a longer term view of behaviormodification and prevention.


Paying for outcomes

Unfortunately, the majority of financial payments to health careprofessionals today are based on a short-term, fee-for-servicereimbursement model. With only 25 percent of health care spending based on acute(i.e . one-time, short-term) events, we must evolve payment reformto reward a longer term and holistic view of health and healthimprovement. In a value-based reimbursement model, healthcare professionals will be rewarded or penalized for their success(or failure) to deliver certain agreed upon health outcomes. The concept of value over volume, or outcome equals income, is atransformational shift for both insurance companies and health careprofessionals.


Value-based networks

While some of these new partnerships are referred to as “narrownetworks,” I would encourage you to dig deeper and confirm if thesesmaller groups of health care professionals are aligning moreclosely with the insurance company and receiving reimbursementstied to health outcomes. If so, I would argue these networksare “high performing” or “value -based” as opposed to just“narrow.” In a truly aligned health care delivery model,preventive care will skyrocket. Preventive screenings enable early detection and prevention ofdisease to happen sooner and more often. We can reward healthcare professionals for keeping people healthy and productive, asopposed to only paying them once a patient is sick and in theiroffice. This model rewards improved health, rather thanasking employers and employees to spend more of their income onsickness each year. I would encourage all employers tomeasure their chronic condition population today and understand howhealth care professionals and insurance companies in your communityare working together to create these value-based partnerships.


When employers, employees (aka, patients), insurance carriersand health care professionals create a greater degree of alignment,share data and focus on value and outcomes, the result will beimproved health, lower cost, and higher patient satisfaction — thetriple aim!


I look forward to sharing the third and final installment ofthis series with you next month. Be well!

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