By: Mike Merrigan
During President-elect Trump’s campaign, one of his major messages was that he would repeal and replace the Affordable Care Act. He has since softened on this position, but it is likely we will see many changes in health policy over the next few years. A number of unhealthy trends have led to and currently affect our country’s health care situation. Each year, 10 percent of Americans age 47 or older develop a chronic disease. Of those enrolling in Medicare, 97 percent have unmanaged or undermanaged health problems. Of the nation’s $2.5 trillion annual spending, 80 percent goes to pay for chronic disease care. At the top of the list are lifestyle-induced conditions that take the lives of more than 7 in 10 Americans: type 2 diabetes, dementia, cancer, osteoarthritis, heart disease and stroke. If current trends continue, by 2050 the amount of money spent on these six conditions alone will nearly equal the entire gross national product.
To control health care costs, we have seen multiple approaches in government policy and the marketplace during the last decade, ranging from government subsidized health exchanges, capitated payments to providers, Medicare Advantage HMOs, Pioneer and Next Generation ACOs, shared savings programs, private health exchanges, large deductible plans, in-network, out-of-network, narrow-network, tiered pharmacy coverage plans, provider-sponsored health plans, co-branded plans offered by insurers and providers, bundled payments, medical homes, medical centers of excellence and a new reference-pricing trend where a plan caps a benefit amount for certain procedures (e.g. $1,000 for a colonoscopy) and lets the insured choose where to have the procedure done.
Rather than experimenting with how we pay for all of this “sick care,” why not go after preventing it in the first place. The key to doing so is not some new health policy or program from an administration, but by each of us embracing the concept of hitting the “six normals.” Coined by Cleveland Clinic, this involves achieving normal measures in the following key metrics:
- Low-density lipoprotein (LDL) cholesterol at <100
- Blood pressure at <140/90
- Blood sugar at <100
- Waist to height ratio of <0.5
- Nicotine at zero use
- Stress management through regular exercise
According to the research, people who reach the six “normals” — with or without medication — reduce their subsequent chronic disease by 80 to 90 percent over a 10- to 30-year period. Currently, only 3 to 4 percent of people entering the Medicare program each year fall in this range. If only 65 percent of these individuals reached the six normals by the time they entered Medicare, as a nation we would save over $600 billion in health care spending annually.
How do we know this will work? Over the past five years, Cleveland Clinic has substantially reduced its health care costs for its 43,000 employees and 38,000 dependents by targeting these six normals. They found five key steps critical to their success: 1) strong leadership to ingrain a culture of wellness; 2) a shift away from small incentives for behaviors (such as walking 10,000 steps a day), to larger incentives and premium discounts for hitting each of the six normals; 3) removal of fried foods and sugary drinks and candy from their campuses, a smoking ban on their campuses, free smoking-cessation classes and wellness club memberships; 4) partnering with clinical providers to develop better case management and care coordination; and 5) support for staff through health buddies, social media engagement, e-coaching and smartphone apps. Through these efforts, the clinic saw an increase in savings each year, with estimated savings of $60 million in 2015 alone.
As individual members of this community, let’s not wait for more government health care policy that doesn’t work. Instead, let’s tap into the rugged individualism that built this country and strive to make ourselves and America healthy again.
Source: Future Scan 2016-2021, Health Administration Press.
Mike Merrigan, J.D., MBA, is a clinical professor in management at Missouri State University. Merrigan, a former vice president and regional general counsel for St. John’s Health System and Mercy Health, writes on issues related to health care, including the Affordable Care Act. Email: michaelmerrigan@missouristate.edu.
This article appeared in the January 14th, 2017 edition of the News-Leader and can be accessed online here.