Why Healthcare Matters Blog

"Moral Imperative" - Is There a Doctor in the House?

2009-09-07T15:19:00Z

For all the "Moral Imperative" arguments and other hyperbole that President Obama and his like-minded health reformers have put out in their briefings and town hall meetings about the uninsured, we have to ask, has anyone done the math? And not just about the extraordinary cost burden of the various Democratic plans, but about the practicality of driving 47 million uninsured into a health system that is already inefficient and understaffed

Today's New York Times actually addresses the issue and highlights the problem the nation could face in 2013 when all Americans would be required to have health insurance, under the House proposal.

We not only have the demographic boom in the 65+ population contrasted by a leveling off in the growth of the number of physicians, but also the experience of a state that has addressed the problem of the uninsured (chart on right). In Massachusetts, which implemented universal healthcare in 2006, the health system was so taxed that 24% of residents surveyed in 2008 claimed that they had a hard time getting the care they needed, compared to 16% the year before. That's an increase of 50% in just one year. And the state has yet to figure just out how to pay for this plan.

The article also notes that by 2025 (chart on left), the American Medical College projects a shortage of 124,000 physicians without universal coverage, and another 25,000 with it.

Our view is that there are plenty of problems with healthcare in this country. But logic of pushing more people into a system that isn't working is neither moral nor an imperative. We should focus on strategies that build off free-market solutions that have proven effective across other sectors such as financial services, auto insurance, or travel. Use the principles of economic theory that promote choice, price transparency, quality comparisons and other solutions that can allow consumers to flex their market power and drive efficiency into the system.

Part of this also means promoting greater personal responsibility for individual health - which will not come with the Democratic plans. We're moving in the wrong direction if we provide more power to the government to implement change, rather than to the patient who should be in the driver's seat.

Frank Hone
Author, Why Healthcare Matters

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Healthcare Reform: The Good, the Bad and the Ugly

2009-08-11T10:19:00Z

It's telling that the Obama Administration has already rebranded their efforts to socialize medicine in this country. Not that the concept of socialized medicine is explicitly stated anywhere in the 1018 pages of the House bill...but it's in there...They have now taken great pains to talk about "Health Insurance Reform," a not-so-hidden jab at the supposed villains in the healthcare system - that is, if you believe Nancy Pelosi's assessment of the insurance industry.

Interestingly, yesterday's Rasmussen Report conveys that 51% of the American people fear government more than insurance companies.   And there is much more to come. Despite being one of the traditionally quieter news periods of the year, the next few weeks should prove to provide a much richer and more colorful storyline of the government's plan. This is good, because most of the voting public were lulled into disinterest in the earlier days of congressional discussion on addressing healthcare change. People need to be engaged and involved, and their voices need to be heard in the many forums now available for discourse. The national media will pick up on the events where anger and confrontation occur, but this will only fuel more rational expression about the direction of the debate.

We need to understand the "why" of all this. What is the ultimate outcome? Lawmakers seem to be long on tactics and short on strategy. Their goal is, or was, to provide health insurance for the majority of the uninsured, but a key question is, to what end?

Many in the industry would agree that a central outcome should be to improve the health of American citizens. Is broader insurance coverage the answer to that? Or do we need to do more work addressing the root cause of poor health in this country?

In a nation that is, generally speaking, out of shape, noncompliant, happy for a handout and "living in the moment", are we really going to expect health behavior change just because more of the population have health insurance? This is simply going to add health costs to a system that needs fundamental restructuring.

The real opportunity is to put more attention toward the demand side of the equation.   Despite the recent vocal public outcry against the government plan, consumer power in healthcare has been extraordinarily weak and disorganized. Oh, there has been activism around breast cancer, HIV/AIDS and some other diseases, but when it comes to being market-driven, healthcare is at the bottom of the list.  National advocacy efforts would do well to first address personal responsibility and behavior change on the demand side before we put additional untold billions into the dysfunctional supply side.

Frank Hone
Author, Why Healthcare Matters
Naples, FL

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Healthcare Reform: Dead on Arrival

2009-07-18T11:29:00Z

It seem like the more President Obama defiantly insists that a transformational, budget-neutral, good-for-everyone health reform bill will pass this year, the longer the odds become. Yesterday, he again chided those that , "those who are betting against us on getting this done are badly mistaken" in a clip played often last evening.

So there was a certain satisfaction this morning to open the leftist New York Times to see the headline, Democrats Grow Wary as Health Bill Advances. Somehow, he feels that the more he claims the "historic opportunity" facing the nation, the more important the populace will feel about the valor of passing legislation, regardless of the damage will create.

"This is what the debate in Congress is all about: whether we'll keep talking and tinkering and letting this problem fester as more families and businesses go under and more Americans lose their coverage," Obama said Saturday in his weekly radio and Internet address. "Or whether we'll seize this opportunity — one we might not have again for generations — and finally pass health insurance reform this year, in 2009."

A major problem with the proposal is that the main intention is to provide universal coverage. That didn't work in Massachusetts, and it won't work on a national level. But, perhaps even more concerning, is the desire to push more people into a system that is already dysfunctional. It would sure be a lot more logical, from a strategic management standpoint, to fix the many systemic problems first, then encourage more access.

And with regard to the public health option, why not encourage private health insurers more ability to better compete, like by eliminating the state-level controls and allowing them to provide coverage in all states?

Finally, we must give more attention to the demand side of the healthcare equation, rather then focusing solely on the supply side. By effectively driving health behavor change and personal responsibility at the consumer level, the nation's healthcare system could be relieved much of the burden of lifestyle-related conditions and diseases.

So, despite the president's defiant urging, sentiment and support for this massive reform bill seems to be eroding as more and more legislators and voters gain perspective that it is not the right solution. Change is needed, but it must come from market-oriented approaches, not socialist measures.

Frank Hone
Author
Why Healthcare Matters

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Frank Hone Joins Healthways

2009-07-01T09:45:00Z

Effective this week, Frank Hone has joined Healthways, the Nashville-based provider of specialized, comprehensive disease management and wellness solutions. Healthways is a fast-growing company on the cutting edge of health improvement for thousands of clients and millions of consumers in the US, with an expanding presence in overseas markets.

His role will be to serve as Sustainable Engagement Leader in their Innovations group, with a mission to advance the state-of-the-art in participant enrollment and ongoing use of Healthways services. This includes identifying the best ways to attract participants, sustain their involvement, and use physical, mental, and sociological programming to create deep and on-going engagement that lead to positive health outcomes.

This is an exciting opportunity and will allow him to leverage his experience in healthcare consumerism, direct-to-consumer advertising, new product development, consumer insights, strategic planning and global marketing to help advance and improve the company’s already outstanding service offerings. He'll be based in Naples, FL, with frequent travel to Nashville and many other points around the country.

He expects to maintain an active industry presence, advocating for prevention and wellness, greater consumer involvement and personal responsibility, and increased emphasis toward demand side solutions in addressing our nation’s healthcare challenges.

Frank Hone
SVP – Sustainable Engagement Leader
Healthways, Inc.
frank.hone@healthways.com
www.healthways.com
7865 Hawthorne Drive, #401
Naples, FL 34113
917 375-7716
Author, Why Healthcare Matters

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Congress Debates Health Reform as Proacitve Businesses Take Actions: Safeway CEO, Steve Burd in WSJ

2009-06-19T16:13:00Z

As Congress debates the massive efforts to reform healthcare in this country, many of the concerns relate to the growing cost of effectively delivering quality service to the broadest number of Americans in need.

But while this is going on, and most of the populace have little or no real input in the process, there is a lot happening on the other side of the equation – the demand side.

Many leading-edge employers have begun to create a culture of health in their workplace and have developed programs and incentives to help improve health behavior of their people.

Last Friday’s Wall Street Journal featured an opinion piece called How Safeway is Cutting Healthcare Costs, by Steve Burd, CEO of Safeway. Burd has long been an advocate of market-based solutions for the nation’s health crisis, and he summed up the problem in simple terms:

Safeway's plan capitalizes on two key insights gained in 2005. The first is that 70% of all health-care costs are the direct result of behavior. The second insight, which is well understood by the providers of health care, is that 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes and obesity).

He further noted that majority of people at risk for these four disease states can actually prevent them. Safeway has developed a health insurance model that rewards good behavior and penalizes bad behavior – not unlike the auto insurance industry – and it’s working. They’ve been able to keep costs down and improve health outcomes and productivity. We wholeheartedly agree with this approach, and believe that Business holds far more weight in addressing healthcare than Washington gives them credit for. I sent the following note to the Journal which was published online:

Steve Burd is a hero to all proactive and pragmatic business leaders that want to do what is within their power to address the cost and productivity issues of healthcare. His thesis is clear and cogent and leverages the principles of healthcare consumerism. The stale and regressive arguments from the left in the current health reform debate pale in comparison to this refreshing and effective views of a CEO who has first-hand experience of stimulating behavior change in middle-class and often transient workforce of supermarket employees. Let's hope that Congress takes a close look at his piece and listens to his sage advice.

Business has a lot to offer in building appropriate interventions, incentives and support programs to improve the health of our people. Congress needs to learn more about all that is happening in this area in corporations across the country, and they should encourage deeper involvement of corporations in healthcare reform initiatives.

Frank Hone
Author, Why Healthcare Matters

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Why Health Reform and Rationing May or May Not Be Linked: NY Times

2009-06-17T12:01:00Z

Today's NY Times featured a piece by Economic Scene writer David Leonhardt on the issue of rationing relative to health reform. He argues that rationing is part of life in these United States, whether we are talking about healthcare, vacation spots, or prime steaks. He notes that the key is to "ration well", as opposed to simply rationing.

That, I would agree, does make good sense, but to achieve this, we must have a system that is more market-based than government-run. The government certainly hasn't proven itself an rationing arbiter extraordinaire, whereas effective markets do self-regulate in a way that should lead to economic fairness.

Perhaps I expected more from an economist on the topic of rationing, as it does not stand alone, but rather is one part of an extremely complex economic puzzle. So from a bigger picture perspective, I offered the following in my letter to the NY Times, published this morning:

Author David Leonhardt makes some good points about rationing in his piece on health reform. As the rhetoric and position-building in Washington grow in intensity, we should actually hope to hear a whole lot more in the way of rational economic perspectives about health reform. A few thoughts:

• A basic tenet of economics is the law of supply and demand. But why then, is there so little discussion of the demand side? Nearly all the storyline we hear out of Washington relates to ways of adjusting, expanding or re-pricing the supply side. We know that some 70% of healthcare costs are behavior-related, yet there is very little emphasis on the role of individuals to take greater personal responsibility for their own health.

• A basic lever in economic theory is incentives. But why then, are so many of the incentives based on tests and procedures the physician performs, and not related to the outcomes they achieve with proper care? We do not pay accountants, auto mechanics, butchers or barbers for the steps they take in their work, we pay them for results. And to the point of the demand side of the equation, where are the consumer incentives that can actually drive better behavior?

• Critics continually cite the amount spent on healthcare in the US versus other counties, but fail to note that this spending is actually a powerful economic engine. Not that it’s all well spent, but that it does support a variety of industry subgroups and thousands of companies. The US is more of a market-driven economy than any other nation on the planet, which by the way, suggests that the way to improve on the inefficiencies of the health system is with market-based strategies.

• Mr. Leonhardt makes the point about employers having to pay higher insurance premiums which often lead to minimal pay raises. This is true for corporations that are not proactive in addressing health in the workplace. On the other hand, there is substantial documentation about the return on investment for companies that have made employee health a priority, instituted disease management and wellness programs, provided incentives for health behavior change and focused on individual personal responsibility.

He’s correct that we will continue to hear about “rationing” as a key issue from critics of socialized medicine. That concern can be set right with more effective use of demand-side approaches and incentives, attention to improving health behavior, and allowing the market to work by promoting price transparency, greater choice and broader access.

Frank Hone
Author, Why Healthcare Matters
Naples, FL

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Why Healthcare Matters: New Book Support Free-Market Approach to Health Reform

2009-06-12T09:30:00Z

Now that the healthcare debate in Washington is getting the attention of both common citizens and influential business leaders outside the Beltway, it is coming clear that a lot of what's being proposed is just wrong for this country.

While complex and inefficient, our nation's current healthcare system is still far better than the socialized medicine offering of European countries or Canada. The Obama Administration would do well to more closely examine the efficiencies of systems where medical care is rationed in order to manage demand.

The United States is the freest country on the planet - why would we stoop to the sort of government-run program that deprive citizens of freedom of choice? More importantly, why are we not using the power of healthcare consumerism to drive better efficiencies from our current system? This is achievable, and is one of the main theses of a new book, Why Healthcare Matters: How Business Leaders Can Drive Tranformational Change.

Why Healthcare Matters offers a big picture perspective on what’s wrong with healthcare in the US, and provides a set of practical, market-based strategies and solutions.

The book explores an array of contributing factors and competing interests that have fed the decline in the healthcare system and led to out-of-control health insurance costs, higher disease incidence and sub-optimal medical care. This includes discussions around medical errors, medical malpractice, healthcare quality, administrative costs, and the uninsured along with a complete evaluation of the Medical Model and its inbred biases

Why Healthcare Matters offers an insider’s view on the nation’s growing healthcare crisis with ideas for substantive change. It calls on corporate leaders to more actively participate in the transformation of healthcare in the United States by devising C-level strategies to approach employee health within their own organizations.

Today 60% of the US population (over 170 million American adults) is covered by such plans. For too long, the employee health benefit has been farmed out to a third party. Companies now need to regain control of this increasingly important and costly investment in human capital.

Why Healthcare Matters is a business guide. It helps corporate leaders clearly understand the range and depth of the crisis from a business perspective, providing best practice and lessons learned from progressive companies whose actions are leading the transformation. Specific and detailed recommendations illustrate how they can latch on to the promising trend of healthcare consumerism and implement powerful new concepts strategies to lower overall costs and improve health outcomes at their companies.

The book’s core idea is that the essence of the solution lies in personal responsibility, that the main catalyst for change is healthcare consumerism, and that the main engine for popularizing this is the business community acting as employers.

Why Healthcare Matters is a practical guide for employers to help address one of the great macroeconomic challenges of our time: the US healthcare crisis. Employers have leverage to initiate real market change by encouraging greater personal responsibility from their workforce. Healthcare consumerism can influence the markets toward greater economic efficiency, better quality of care, and improved outcomes overall.

The heart of Why Healthcare Matters is the Seven Step Guide to Transformational Change for Employers. This strategic template has recommendations that can lead to substantial positive change for healthcare in their company. Collectively, American business can lead the nation to substantial improvements in the cost, quality and outcomes of the US healthcare system.

Corporate executives are an audience primed to do something about this problem with the power to make a difference. Essential to this solution is to shift the emphasis from the supply side to the demand side, to put the power in the hands of the people. Why Healthcare Matters is a manifesto for change and provides the information, insight and ideas for how corporate leaders can make this happen.

Order it now from Amazon, and read how free-market solutions can really drive effective change for healthcare.

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Good News: Obama is Focused on Employee Health and Wellness in Health Reform Thinking

2009-05-13T00:31:00Z

For the second day in a row this week, President Obama spent time at The White House with key stakeholders in healthcare. During today's meeting, the focus was on company leaders who have been early adopting employers of healthcare consumerism as a way to address employee health.

Yesterday, he got everyone's attention by getting executives that represent three-quarters of the Medical Marketing Model (Pharma, healthcare professionals and insurers - the FDA did not attend) to pledge to lower their costs over the next several years. This was a big win for the administration because out-of-control costs have a chokehold on reform efforts.

But the real excitement for advocates of free-market strategies and demand-driven solutions came today when the main topic related to behavior change. By meeting with employers who have had the direct experience of reducing their healthcare costs, and improving their worker productivity and company profitability through employee health initiatives, the president has signaled the importance of encouraging wellness and prevention through appropriate employer interventions.

With representatives from Johnson& Johnson, Pitney-Bowes, Safeway, Microsoft, REI, as well as the State of Ohio and the Hotel and Restaurant Employees International Union, President Obama listened to their stories and came through with a clear message to the nation:

"So what we've done here today is to gather together some of these stories and best practices to make sure that they are going to be informing the health care reform discussions that take place here in Washington. There's no quick fix, there's no silver bullet. When you hear what Safeway or Johnson & Johnson or any of these other companies have done, what you've seen is sustained experimentation over many years and a shift in incentive structures so that employees see concrete benefits as a consequence of them stopping smoking or losing weight or getting exercise, working with providers -- the provider incentives are aligned with the employee incentives as well, and changing the culture of a company."

This is precisely the sort of thinking that we need to be focused on as the Congress works through health reform planning. Employers must be centrally involved, healthcare consumerism and consumer power needs to be recognized, personal responsibility should be leveraged, and in the end, a better between supply-side refinements and demand-side efforts can bring about new efficiencies and a healthier nation.

Frank Hone
Author, Why Healthcare Matters

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Health Reform Takes a Right Turn with Wellness Programs for Employee Health

2009-05-11T17:34:00Z

With the news on health reform starting to pick up, it was certainly encouraging to open the Sunday newspaper and read that Congress has taken up a position reflecting demand-side solutions for employee health.

The article in the NY Times says the plan is to give employers more of a say in helping to drive health behavior change through efforts delivered at the workplace. Senator Tom Harkin, a Democratic voice of reason when it comes to healthcare, notes that “prevention and wellness should be a centerpiece of health reform.” His advocacy in this area is long and well-documented. But he seems to have gotten others from his party to come around as well.

What’s refreshing about this view is that it is giving focus to driving health behavior change among consumers so that they can delay or avoid accessing the healthcare system about lifestyle-related diseases or problems.

This concept is similar to the strategy of Nixon’s “War on Drugs”, which was designed to tackle the problem at the source of drug importation. By emphasizing consumer interventions with health improvement incentives and rewards, there is a fantastic opportunity to drive more “health” into the culture and begin to reduce the reliance on “sickness treatment” that exemplifies our healthcare system.

Wellness has unfortunately been on the fringes of the healthcare system for far too long. It had been viewed as soft and fuzzy and unscientific, but over the years the data have shown positive outoomes, and today many companies are already committed to using as way to address employee health.

Look for even more innovations from companies like Healthways, SHPS, Alere, Health Dialog, Meritain and others that have proven programs in this space. They have been given a golden opportunity to be at the center of health reform, and allow healthcare consumerism to really deliver effective solutions with measurable results for employee health.

Frank Hone
Author, Why Healthcare Matters

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WEBINAR TODAY (Thursday, May 7) Help Your Employees Get Healthy, While Reducing Costs and Increasing Profits: Employee Health Strategies That Impact Your Bottom Line

2009-05-07T11:44:00Z

In the course of working with clients and talking with other experts in employee health, we continue to experience a wide variation in knowledge, experience and motivation toward health behavior change in the workplace. Most believe that working to develop strategies that improve employee health and reduce overall cost is a good thing, but many aren't sure where to start.

For that reason, were excited to announce of a new webinar on the topic, entitled Help Your Employees Get Healthy, While Reducing Costs and Increasing Profits:Employee Health Strategies That Impact Your Bottom Line. effective strategies to address employee health as a means of reducing costs and increasing productivity and profits. The webinar will take place on Thursday, May 7 at 1pm, hosted by Business Expert Webinars. Frank Hone will be the featured presenter of this educational and insightful one hour event.

"There must be something I can do to address the rise in healthcare costs…" Like all business owners and leaders, you’re searching for solutions to help rescue your company from the economic crunch. But you can only cut staff and spending so far. In the end, a healthier workforce will actually save money and deliver better results. To truly grow the bottom line, you must do something to improve employee health as a way to lower costs.

Frank Hone, author of Why Healthcare Matters: How Business Leaders Can Drive Transformational Change, teaches business leaders how to reduce company healthcare costs by improving employee health. You’ll learn a process for creating a culture of health among your employees so they willingly take personal responsibility and action to improve their health. As a result of their active participation, you’ll not only reduce health care costs, you’ll also increase productivity and reduce absenteeism. You can learn more and register for the event by clicking here.

In this webinar, you will learn how to:

• Design a culture of health founded on employee accountability
• Develop a communication strategy to fully engage your workforce
• Create strategies to address lifestyle-related conditions and diseases
• Employ health screenings and interventions for positive change
• Formulate strategies and tactics to promote personal responsibility for health

About the Presenter:

Frank Hone is a consultant, author and advocate for free-market healthcare solutions. His book, Why Healthcare Matters: How Business Leaders Can Drive Transformational Change, offers perspectives on the US healthcare crisis, proposes that business has a major role to play in transforming consumer health attitudes and behavior, and provides a blueprint for change that incorporates creating a culture of health, fostering personal responsibility and leveraging healthcare consumerism. As Founder and CEO of Healthcentric Partners, he leads engagements supportive of employer ambitions to promote better health in the workplace as a way to lower cost and increase productivity.

Go to Business Expert Webinars to register.

Frank Hone
Author, Why Healthcare Matters

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Horses Lining up for the Health Reform Derby

2009-05-03T14:21:00Z

It won’t be long now before the handicapping fever on the Health Reform Derby picks up in a big way. The date for the race hasn’t been set, but the horses, trainers, owners and spectators are all jockeying for position.

Much is happening behind the scenes, and some aspects of reform have already occurred. As Rick Scott of Conservatives for Patients Rights noted in his letter to The Hill last month, about $1.1 billion of stimulus money has already gone into “comparative effectiveness research,” and the public assistance programs of Medicare, Medicaid and the State Children’s Health Insurance Program have already received increase funding and have had their eligibility expanded. He labels these quiet and deliberate steps toward socialized medicine “Stealthcare.”

We know that the goal of the Democrats is to provide universal coverage to all citizens, but there are innumerable complicating barriers to that becoming a reality. One is the extraordinary cost. We are already nearly out of money for the healthcare entitlement programs – how will the government pay for universal coverage that includes the 45 or 47 million Americans that don’t have insurance? But even if a plan is concocted that makes financing possible, is there sufficient medical capacity to handle the need for care?

Last week the NY Times ran a page one article on the shortage of primary care physicians in this country. This has been a “stealth” problem on its own for the past few years, as the reimbursement schemes and income opportunities have favored specialist doctors. But one only needs to look to Massachusetts to see the enormous strain on the primary care system caused by universal coverage.

The lessons from that experience should be clear, that the system needs to be in place before filling it with newly insured consumers.

All this reinforces the notion that good health is not about a medical system that is newly available to all. It is about educating and motivating all individuals to take on more personal responsibility for their own health – personal health reform.

This and free-market solutions that focus on building market-oriented strategies to deal with health issues will be a far better approach than driving more consumers into an inefficient healthcare system that is ill-prepared to handle more patients.

So as the gates open, and the horses take off down the track, be prepared for any number of obstacles in a long and muddy race for health reform, but keep your expectations in check – real reform will happen when consumers get fully engaged in their own health and take charge of managing the system.

Frank Hone
Author, Why Healthcare Matters

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Health Reform: Five Factors Supporting Healthcare Consumerism

2009-05-01T22:56:00Z

With so many in the media talking up the government health reform plan, it sometimes seems as thought the train has already left the station. It would be wise then for the station masters to take a good look forward at the destination before too it gets too far down the track.

If more government involvement is truly inevitable, then we urge further and better incorporation of Healthcare Consumerism principles and platforms into the mix.

With much of the health reform debate fixed on adjustments to the supply side, the patient – or consumer – is too often left out of the discussion, when in fact, they should be more fully integrated into the reform and restructuring of the system. Aren’t “they” the reason we are working to fix it anyway?

My sense is that Healthcare Consumerism is an enigma to those with their hands on the throttle. It is not well understood or appreciated, so it is being left out. Admittedly, the scope of “what it is” does continue to evolve with the times. Here are the views of two leading experts:

Ron Bachman, Senior Fellow of Newt Gingrich’s Center for Health Transformation says that “Healthcare Consumerism is about transforming an employer’s health benefit plan into one that puts economic purchasing power—and decision-making—in the hands of participants. It’s about supplying the information and decision support tools they need, along with financial incentives, rewards, and other benefits that encourage personal involvement in altering health and healthcare purchasing behaviors.”

Ron Loeppke, MD, Co-Chairman of US Preventive Medicine says that “Healthcare Consumerism is one of the hottest topics in the industry. Although definitions vary, the term is generally used to describe a partnership between employees and employers regarding how needed healthcare services are used and paid for. The new alliance takes beneficiaries beyond the role of passive patient and allows them to assume new responsibility as knowledgeable and active consumers of health and healthcare.”

These views focus rightly on the employer role as a primary provider of health insurance, but can and should be extended to the broader market as well. There is a massive untapped healthcare market in the consumer sector that can be activated and better engaged for the advantage of all.

We see five key and interrelated areas that can be effectively implemented and create greater system efficiency and better outcomes:

1. Smarter Health Insurance Plans. Our current model of providing health insurance for such a broad gamut of services has created a false reality of the cost of care. Consumers want to put down co-pays, physicians need to game the system, and no one knows the true price of services. Consumer-driven health plans offer hope to a more reasonable approach, but they have yet to reach critical mass in the market. We should revisit health insurance as a risk-management vehicle, not as a pre-paid medical expense.

2. Price Transparency. In order to achieve a smarter health insurance system, we need to know what services cost. Hospitals and physicians must begin to post their rates, not unlike the way retail health clinics such as Solantic here in Florida are doing. This will at least create some ability to price shop for certain medical needs.

3. Incentives. Consumers could benefit from some of the incentives that are being offered to physicians. A current initiative, known as “Pay for Performance” provides physicians a bonus if they follow proper procedures! One analyst recently noted that it really is “Pay for Process” with no regard for outcomes. In other markets, economic incentives are used to effect behavior change – why not healthcare where behavior change would go a long way to cutting costs.

4. Disease Prevention and Wellness. Besides diagnostic exams and screenings, this area is out of the physicians’ sphere of influence. President Obama rightly wants to do more with prevention – a good place to start is by providing consumer incentives to participate and stay engaged.

5. Personal Responsibility. It all does come down to the individual wanting to do more for his or her own health and being given the information, resources and access to appropriate health professionals to help them. If provided with this and with incentives, consumer can and will change healthcare from the ground up.

And so, we ask President Obama and the legislators in Washington, as you continue to look at reform, please be sure that you open the train doors wide and let consumers aboard. They may just be able to lead us to a better destination than you are currently envisioning.

Frank Hone
Author, Why Healthcare Matters
Founder and CEO, Healthcentric Partners, Inc.

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The Universal Coverage Debate: What Do The Uninsured Want?

2009-04-16T13:32:00Z

Watching the health reform debate continue to unfold in the pages of The New York Times provides an interesting and occasionally enlightening (though not enlightened) perspective. Last week, we wrote about their tentative and uncertain endorsement of a public health plan that is being talked up by the Democrats in Washington. Then, a couple days later (on April 9), they bravely printed an Op-Ed by National Review's Ramesh Ponnuru titled, The Misguided Quest for Universal Coverage. It was a good piece, offering a reasonably balanced view of the practical, moral and political considerations of universal coverage.

Universal coverage in and of itself, can be a good idea. For some countries. Where people are compliant. Where doctors work for the state. Where socialism is revered. It just isn't a good idea for the United States. We are a marked-driven economy fueled by largely by consumer buying power and choice And yes, healthcare is big business. More government money already goes to healthcare than to national defense.  But that doesn't suggest that our system would be any better if we shifted more budget and control to the federal government.

But the idea of a "public health plan" to complement private health insurance as the route to universal coverage has such a groundswell of support that there is a good likelihood the Democrats will push it through as part of health reform this summer.

With the fervor to pass this aspect of health reform growing, it would be instructional to just step back a moment and ask a few questions:

What do the uninsured think about universal coverage? Do they understand it? Do they want it?
What about the responsibility of the uninsured (as well as the rest of the American public) to take greater control over their health? Why is that not an essential part of "health reform?"
And most importantly, how on earth will we be able to pay for it? The Massachusetts experience shows that there are ways to reduce the number of uninsured (not close to zero, though), but they haven't figured how to pay for it. Shouldn't a thorough analysis of that case be developed and shared first, with advocates on both side of the argument?

Back to the Times, the enlightening aspect of their position came yesterday in the five letters they printed under the heading Health Care For All: A Moral Obligation . Each of the writers commented on Mr. Ponnuru's Op-Ed, with statements including these:

"Health insurance in a civilized society is a collective moral obligation"
"America does not have any real long-term choice but to turn to a single-payer plan"
"Healthcare should be a right, not a 'benefit'"

These kind of exchanges suggest that there is a good deal of opining going around, but where are the data? Where is the research that provides some validity to the arguments for universal coverage as a viable option for healthcare in the United States?

We need to be sure that if the political agenda is going to take us down a path toward more government, that we are able to accomplish some measurable and meaningful goals. Universal coverage is a tactic, not a strategy. There is much more that can be achieved through health improvement initiatives that include nutrition, fitness, disease prevention, personal responsibility, health education, etc., than by simply ensuring that everyone has health insurance.

Frank Hone
Why Healthcare Matters

universal coverage, uninsured, health reform, personal responsibility, health policy, ny times

NY Times: A Public Plan for Health Insurance?

2009-04-08T23:18:00Z

The NY Times took a curious step yesterday with their tepid endorsement of a government-run healthcare plan.

Even the headline of their editorial featured a question mark. In their waffling and feeble attempt to support socialist medicine from the Obama Administration, it seems as though they hired a junior economist to craft their message.

Their opening argument toward building their case bravely states, "A new public plan — to offer consumers greater choice, keep the private plans honest and, one can hope, restrain the relentless growth in health care premiums and underlying medical costs — seems worth trying."

It's like saying, "Well if doctors can't really do their jobs as well as we'd like, let's try veterinarians."

They go on hopefully, "Many reformers suggest that a public plan be modeled on Medicare. If crafted correctly, it would provide a valuable option for people who don’t trust private insurers to have a patient’s interest at heart and would offer a safe haven should private plans abandon a market, leaving their subscribers stranded. It would also serve as a competitive yardstick for measuring the performance of private plans."

Maybe they should have a look at the headlines in other newspapers about the growing trend of physicians and pharmacies that are opting out of Medicare, and by the way, since when do patients believe that the government has patients interests at heart any more than private insurers?

Their conclusion provides an even stronger representation of the left's muddled thinking on health reform:

'A new public plan is neither the cornerstone of health care reform nor the death knell of private insurance. It should be tried as one element of comprehensive reform. If, over time, a vast majority decides the government plan is superior, so be it."

The way to go is to take steps to empower the consumer, and leverage the untapped market strength that can occur when individuals have the resources, motivation and tools to take greater personal responsibility for their own health. In the end, we must all take control of our own destiny, and not hold out to see if a grand socialist experiment on healthcare might work in a market-driven economy.

Frank Hone
Author
Why Healthcare Matters

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Walgreens Workplace Health Centers: Bringing New Meaning to Employee Health

2009-04-05T21:52:00Z

As retail health continue its slow but steady upward climb with ventures like Rick Scott's Solantic in Florida, CVS's MinuteClinic and RediClinic, one major retailer has turned their attention to the workplace.

Walgreens last month announced the establishment of their Health and Wellness division that will include two pending acquisitions of companies that operate worksite health centers, I-trax, parent company of CHD Meridian Healthcare, LLC, and Whole Health Management. When these deals close, Walgreens will have over 500 worksite and retail health center including their existing Take Care Health Clinics.This is a smart move by Walgreens, the nation's largest pharmacy chain, as it has clearly identified that employer health is getting increased attention and investment by progressive corporations that have adopted aspects of healthcare consumerism. In their press release, Walgreens notes that "the current potential market for worksite health centers and pharmacies includes more than 7,600 corporate campuses of 1,000 employees or more."

Leading the effort as president is Hal Rosenbluth, a relative newcomer to healthcare, having spent an earlier career as the head of a major global travel agency, Rosenbluth International, which had a stellar reputation for customer service - precisely what the healthcare industry needs in order to drive efficiencies throughout the system. Rosenbluth's book, The Customer Comes Second, was widely applauded by management experts when it was published in 2002.

This week Walgreens ran a full page ad in the Wall Street Journal announcing their venture, and promising "a holistic solution that reduces soaring healthcare costs and improves employee health."

Look for continuing and rapid evolution in this sector, and more importantly, data that proves improvement in productivity and profitability for those corporations that buy in to workplace health centers.

Frank Hone
Why Healthcare Matters

employee health walgreens take care health systems healthcare consumerism retail health solantic Turbo Tagger

Democrats Agree on a Health Plan: Where is the Money???

2009-04-03T01:47:18Z

Yesterday's NY Times proclaimed that the Democrats had come to an agreement on a health plan for America. It apparently includes the idea that everyone must have health insurance and that employers should help pay for it.

April Fools Day!! Unfortunately, not...

It's great that they figured out a plan to appeal to the left, I guess thinking that they can push anything through now using that ill-named concept of "reconciliation."   The major problem, identified in paragraph three, is that they haven't figure out how to pay for the plan! Small detail while we all struggle in the throes of a recession.

The article did stress that the legislative leaders took great pains to include stakeholder groups that could well derail efforts to push through a plan that didn't address at least some of their concerns. And so, the five main heroes of this effort, Representatives George Miller, Henry Waxman, and Charlie Rangel, along with Senators Max Baucus and Ted Kennedy, have constructed a Taj Majal on a Bombay budget.

And while they may have strong armed some of the stakeholders, the Republicans have yet to have their say. A lot of the conceptual framework of this plan requires that there be universal coverage - many a wise policy thinker has spoken about the fallacy of actually compelling all Americans to have coverage, including The Cato Institute's Michael Cannon.   It is just a fantasy.

The other of the two legs that this plan stands on is the idea that the nation could cut spending if physicians cut back on procedures and tests that cost money (read: "earn them money"), but do nothing to improve the quality of care. That will be very difficult to legislate, and will also require a real change in behavior, which has become ingrained in doctors looking to make money in an increasingly difficult profession with an absurd payment structure.

The big problem is that this approach will diminish the rights and the power of the patient, which should be a central theme in health reform, not an afterthought.

Frank Hone
Author: Why Healthcare Matters

Liberty Mutual Personal Responsibility TV Campaign Misses Mark

2009-03-31T20:23:00Z

It's too bad that Liberty Mutual doesn't market health insurance. If they did, the theme of their just-released advertising campaign might be more relevant. "The Responsibility Project" is part of $50 million investment by Liberty Mutual from my former agency (30 years ago!) Hill, Holliday, Connors, Cosmopulos in Boston., designed to stimulate discussions about personal responsibility.

Their latest effort features a fictional family called the Marlowes who have an array of issues in their household that include economic woes, child discipline dilemmas, cross-generational conflict, and misuse of cellphone cameras. I suppose that this intertwined storyline built on a "real-life commercial" concept is ultimately aimed to drive more auto, home and life insurance policies to the sponsor. It's a departure from their previous effort what was about strangers helping others in whimsical ways, somehow sprinkling responsibility dust across the population.

It's a stretch.

Unless they sold health insurance. Because that is where personal responsibility is paramount. In a nation that's casting its eyes toward Washington DC for magic entitlement solutions to today's healthcare woes, most Americans would do well to look in the mirror and take some proactive, healthy steps toward.

I'd love to see Aetna, United Healthcare, Wellpoint Humana, RedBrick Health or others CDHP plan providers talk about personal responsibility as a centerpiece of their marketing efforts for their consumer driven health plans. These plans need more attention in today's market, and would truly benefit from an emphasis on personal responsibility. Consumers don't need more health insurance, they need more health in their lives.

Frank Hone
Author: Why Healthcare Matters personal responsibility health insurance CDHP TV Campaign Liberty Mutual Why Healthcare Matters Turbo Tagger

Is There a Patient in the House???

2009-03-27T19:49:00Z

Remember the old movie scene where a suddenly grief-stricken wife looks up at the camera as she kneels over her fallen husband and cries “Is there a doctor in the house?” Within moments, the local physician arrives, revives the victim and provides a magic serum to speed the recovery. Before long, calm is restored and the happy couple walks off together smiling – a crisis averted.

Yes, it’s a Hollywood story, but right now we need that same protagonist in Washington, stirring things up and asking the legislators about why patients aren’t being represented in the current healthcare debate.

Three of the major healthcare stories in the press this week related to digital patient records, government-run healthcare and the insurers’ gambit on pulling back from tiered pricing based on health status (all from the Obama-supportive NY Times). Each of these is part of a continuing and interrelated story about “healthcare reform,” an ambiguous but hopeful term that comes with many varied definitions.

With so many moving parts and conflicting constituencies it seems impossible to make real headway on reform without some major comprises, unless the Democrats move forward with their threat to push through a plan through “reconciliation,” which would lead to a national disaster.

The real question is who is standing up for the rights for the patient?

We live in a capitalist nation that has grown and thrived with a market-based economy driven by consumer buying power. Healthcare is one of the very few industries where that power is largely dormant, though some breakthroughs are now evident. Retail health, medical tourism, concierge medicine, consumer-driven health plans, and individually-controlled personal health records are all helping to bring consumerism into the mix.

But this is not enough.

The consumer needs to participate, and in some areas, take the lead in transforming health in the United States. Think about these points…

1. Why is there such a media-fueled furor to ensure that every citizen have health insurance? Not every citizen necessarily wants or needs health insurance, certainly not government-issued. Susanne Lomatch of Boise, Idaho, for instance, provides a sane approach in her opinion letter at wsj.com today (in response to their excellent editorial on National Health – more below):

“Mandated insurance is the best way to get to universal health coverage but the insurance has to be the individual's responsibility rather than the government's or the employer's. Require a bare bones insurance policy with free well visits, a savings component and high deductibles and also require that employers' hand off their policies to their employees. With the exception of financial assistance to the poor and unemployed, government would have no role whatsoever. “

2. Why does the emphasis on prevention go to the physician and not to the patient when some 70% of the cost of healthcare in this country is driven by lifestyle-related diseases? Since when have physicians had good solutions for addressing health behavior change? Patients can and should be motivated to take on more personal responsibility for their own health, and they will do that if they are given more of a role. But to pay doctors to focus on prevention is not a good use of incentive dollars. There are far better ways to drive healthy behavior.

3. Will the federal government pay attention to the Massachusetts experience with universal care? As mentioned, today’s Wall Street Journal featured a lead editorial, “National Health Preview” that predict that universal coverage will bring “runaway costs followed by price controls and bureaucratic rationing.” We must learn from this experience, before making a huge mistake.

The insurance industry made headlines this week by promising to end pricing on premiums based on health status, if there was an “effective, enforceable requirement that all Americans….obtain and maintain health insurance.” This was a safe bet on their part, because universal coverage based on their definition can never happen in the US.

That’s not just my view – it is shared by many, but Devon Herrick of the National Center for Policy Analysis said it well this week during a talk at Susquehanna University. He says that President Obama's proposal for mandated health insurance will not be achieved because mandated insurance is difficult to enforce and will drive up the cost of coverage and encourage special-interest groups while reducing consumer choice. Also, mandated acceptance by health insurance providers would encourage Americans to wait to obtain insurance until it is needed, and mandated benefits would increase the cost for each person, even though the person may not need specific coverage.

Rick Scott and his Conservatives for Patients Rights have a simple and effective view in their four pillars for health reform: Choice, Competition, Accountability and Responsibility. His campaign got some interesting added credibility from the left when Matthew Holt included a piece from Rick in The Healthcare Blog titled "Patient-based Health Reform or "Fannie Med?"

Let’s put the patient in the driver’s seat on health reform and remember that consumer power has the ability to create and turbo-charge markets. Healthcare consumerism is the right choice for reform.

Frank Hone
Author
Why Healthcare Matters

health reform universal coverage health plan personal responsibility consumerism national health Turbo Tagger

Madison Avenue Methods Can Drive Health Behavior Change

2009-03-25T12:50:00Z

If you asked the typical HR leader how the flashy glitz of Madison Avenue and the world of consumer advertising fit into their job function, you’d probably get more than a few raised eyebrows. But there is much that HR can learn from advertising, especially as it relates to addressing health-behavior change in the workforce.

With the costs of health insurance continuing to rise far faster than the cost of living, the ability of HR departments to communicate effectively about health improvements has become more challenging. And it’s not just communicating information about services; it’s about driving participation and measuring results.

Unfortunately, most Americans are doing a fairly poor job at caring for their health and well-being, as evidenced by the rising rates of obesity, diabetes, cardiovascular risk, stress, anxiety and other lifestyle-related conditions. Their inability to do what is “right” about their health — whether by improving nutrition, engaging in exercise, taking preventive measures or dealing with acute or chronic health issues — impacts negatively not just on themselves, but also on the efficiency and profitability of their organizations.

But while this is a national issue, addressing it effectively must happen at the “local” level — that is, in your own company.

Changing health behavior can be daunting. It is a process that requires a fundamental understanding of the employees' mindset and how they make decisions about health choices. Not all employees are the same; each has an array of rational and emotional barriers that stand in the way of appropriate actions and beneficial behaviors.

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Rational and emotional barriers stand in the way
of appropriate actions and beneficial behaviors.
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'Direct-to-Consumer' Messaging

To improve communications targeting health issues, a bit of perspective from Madison Avenue can help. Consider, for example, lessons learned from the experience of direct-to-consumer (DTC) advertising of prescription drugs.

The era of DTC began in the 1980s, and intensified in the late 1990s when the U.S. Food and Drug Administration relaxed regulations on broadcast advertising. About a decade ago, there was an upsurge in TV commercials for brands you didn’t know, with side effects that seemed horrible, treating conditions you never knew you had.

Many of these commercials are good examples of bad communications. Despite the millions of dollars that were invested, most ads fell on deaf ears, and some even hurt brand sales. But the lessons learned from this early experience of televised drug advertising can provide a helpful guide to improving behavior with relevant messages in the right media. Here is a four-step process to good communications strategy from the advertising world:

1. Input

Before you can plan an ambitious move forward, you need to know where you are starting from. The first step for advertisers is a Situation Analysis. This involves a complete understanding of the current market dynamics, target-audience demographics and "psychographics" (i.e., mindset), an analysis of the competitive situation and an assessment of market forces that can impact the brand being advertised. Objectives for the advertising should be set at this early stage.

Employers must develop a baseline understanding of their workforce and its health status. This is best done with an array of data—aggregate insurance claims, health-risk assessments, biometrics, surveys and other elements that can help profile the workforce and identify current and future health risks.

An audit of employee perceptions, issues and ideas can help, as can a thorough analysis on future market trends in the area. Employers need to create a realistic set of goals for the coming year or other relevant periods.

2. Intent

The ad agency planners and strategists then write a Creative Brief, which serves as a work plan for the creative team. The art directors and copywriters who think up unique and stimulating hooks and storylines prepare advertising ideas for review by the client team. This is generally followed by market research with target consumers, revisions and then full production, ready to be shipped to media outlets.

In crafting the messages for the workforce, there should be a similar amount of creative collaboration, not just between art and copy, but among the various departments and groups that will be providing the key health messages over the course of the year. Communications designed to stimulate employee action need to be planned, integrated and coordinated to generate maximum effect.

The actual content should be a combination of broad-based messages applicable to all, plus targeted information for specific demographic populations or disease-diagnosed individuals. Some of this can be made available “on-demand” as an online resource from your intranet. But whenever possible, create a series of sequenced communications to allow learning and actions to effectively build toward full behavior change.

3. Implementation

Once an ad campaign is produced, there is usually a “pre-launch” period, to prepare key stakeholders for the coming campaign launch and rollout followed by the Campaign Launch. This is often an event in itself with public relations plans to get news coverage and synchronized media rollouts in the selected print, broadcast and online vehicles. Usually the advertising is intended to reach not only the consumer target but also retailers, wholesalers and others associated with the brand’s distribution.

Employers need to consider media options and timing similarly. Most employees are focused on their jobs and might not react to a health-oriented message. Messages about health improvement or disease-management initiatives should be given the same consideration as an ad campaign. Assess the various media options that can be leveraged online and offline and incorporate them all into the thinking about where, when and how to deliver the campaign—and the follow-up communications.

A launch that involves the CEO or top managers is the best way to show that the company is fully invested in the initiative. A town hall meeting or video announcement, or even a Health Day, are all good ways to start getting everyone’s attention and to create interest and commitment to forward action.

4. Impact

While there are still myths about whether advertising works, the actual measurement of Campaign Effectiveness has become sophisticated. Most advertisers conduct consumer surveys about awareness, interest and intent; they monitor brand shipments and sales closely to gauge effectiveness. Mid-course corrections are not uncommon, and at the end of the campaign there is typically a measurable return on investment for the effort—if the advertising and brand meet consumer expectations effectively.

Similar principles apply to employer-behavior-change initiatives. Be very clear at the beginning about goals and about what can be measured and how often. If there’s an expense to capture data or survey employees, be sure that it is in the budget. Be realistic about what can be achieved, and be sure to have metrics at least once a quarter. Employee feedback is part of the mix. The outcomes need to include improved health and continuous improvement in the communications and intervention process.

Beyond the management reports, let all your people know how its going and where improvements need to be made. That way, they'll feel they're a part of the effort and that it's not just for a select few. This takes some additional work, but the results can be rewarding for employees and profitable for the company.

So the next time you think about Madison Avenue, remember that its tactics can be part of your world as a health benefits manager, too.

This article appeared in SHRM Online on March 9, 2009

Frank Hone is the author of Why Healthcare Matters: How Business Leaders Can Drive Transformational Change, and the founder and CEO of Healthcentric Partners Inc., a health care consumerism strategy and consulting company.

Madison Avenue DTC health behavior change employee health healthcare consumerism hr Turbo Tagger

WSJ Op-Ed "Health 'Reformers' Ignore Facts": Counterpoint Perspectives

2009-03-07T12:56:00Z

Obama's health reform approach has people talking. And we'll be hearing a lot from all sides as the discussion continues. It will take a lot of vocal opposition and cogent arguements to diminish the amount of government intervention that is being considered. Government can play a positive role, but it must allow for market forces and consumer power to contribute to transformational change of a dysfunctional healthcare system.

Sally Pipes of the Pacific Research Institute, who speaks from a free-market perspective, wrote an op-ed in yesterday's Wall Street Journal, entitled Health 'Reformers' Ignore Facts that didn't quite hit the mark for me. I responded with the following letter that was published on wsj.com:

While those of us who advocate free-market solutions in healthcare will readily agree with Sally Pipes that the Democrats are aiming to take the country down a treacherous path with their version of healthcare reform, some of her arguments in this piece deserve a closer look.

She makes four main points in her op-ed commentary:

1. She complains that the Democrats are incorrect when they use statements such as Waxman’s “The costly failure of our healthcare system affects the financial health of our businesses.” Her view is that the healthcare industry employs 13 million Americans and says that the cost of providing health insurance does not in fact cripple American corporations in the global economy.

The first response to this is blindingly clear: GM. Beyond their current sad state, they and the other US automakers have been dogged by this for years in a story that has been all too well documented. But the other fact is that America is losing and will continue to lose our edge in global competitive advantage until we get a handle on improving the health of our people. This is not an insurance issue; this is an issue of personal responsibility for improving one’s own health. Our rates of obesity, diabetes, tobacco use, cardiovascular risk, and respiratory disease are alarming, and business can and will play an increasing large role in addressing these area – outside of the health insurance plan.

2. Ms. Pipes then seeks to debunk the myth that more government insurance is needed because private payers are already shouldering the burden of the uninsured, and notes that universal coverage will raise the prices for everyone, citing a couple of sources.

This of course is true. Universal coverage will cost both the government and the private sector, which is why it should not be an entitlement. Consumers must have some “skin in the game” and play their role. Some basic coverage should probably be included for all, but it is an exercise in insanity to hand out coverage without incorporating some level responsibility for individuals to engage in healthy behaviors.

3. She notes that preventative care, disease management and electronic medical records, which are often listed as cost-savers, are just hypotheses, because they aren’t proven.

Perhaps not, as some studies on prevention and disease management have not been overly positive, but have the data sources been fully interrogated? How can preventative care and disease management not pay out? The logic is too strong to think otherwise. And where is wellness? That is too often left out of the mix, because it doesn’t treat sickness. It simply creates a healthful way of being that keeps practitioners out of the health system. On the EMR point, I do agree that savings – at least for a national system - are probably overrated. The cost and effort may not be worth it.

4. Her fourth point is that Americans like their current healthcare system.

This I find hard to believe, despite her citation of a Gallup Poll. Polls can be deceptive and are often used to create the illusion of public support around an issue. Around the same time as the Gallup survey, Deloitte asked Americans to rate the US healthcare system. A total of 2% gave it an A, and 18% a B – that’s four out of five giving it a C or worse (38% gave it a D or F) – hardly a good endorsement

Her final point is that the government wants to take away the very things that Americans like about their healthcare system. Well one thing is clear about healthcare in this country and that is that our nation’s health would in fact be better off if someone took away the very things Americans like so much – fatty foods, sugared beverages, sedentary lifestyles and little attention for health issues until an acute condition or chronic disease strikes.

It’s time to shape up, America. And it’s time for the lawmakers to focus not only on the financing but on relevant incentives to focus on individual personal responsibility and health behavior change as core elements of the health system for tomorrow.

In my book, Why Healthcare Matters: How Business Leaders Can Drive Transformational Change, I talk about the need for free-market approaches and demand-side solutions. Healthcare consumerism is a trend that needs to be fostered, not squashed by any additional government involvement with healthcare.

Frank Hone
Healthcentric Partners

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