Managed Care - March 2009 - (Page 23) 1976. Edington is an international speaker and consultant, and he has authored or co-authored more than 500 articles and several books, including Biology of Physical Activity, Biological Awareness, Frontiers of Exercise Biology, and The One Minute Manager Balances Work and Life. In addition, Edington has contributed to such national efforts as creating a model wellness program for NASA. He spoke recently with Managed Care Editor John Marcille about his latest publishing effort and corporations’ growing demand for health management services from health plans. MANAGED CARE: You’ve been studying health management for a long time. What have been the milestones? Where does the new book come in? EDINGTON: We have spent a lot of time asking, “How do Americans move through their lives?” We found that people naturally flow to high risk, and they naturally flow to high cost. So we established what we call the natural flow. If a company does nothing, what will happen to their employee population in terms of risk and cost? That’s what we measure everything against — the natural flow. If you change risk, costs will change in the same direction. We thought the next step would be pretty simple. All we had to do was get people to reduce their risks. But that isn’t so easy. Wellness programs have been focusing on behavior change, and I’ve come to the conclusion that that’s been a waste of time. Because even if you do get somebody to change, you put them back in the same environment and they go right back to doing what they were doing before. That led us to think about the overall environment of the workplace and the possibility of creating a culture of health in corporations and communities. So we took our research and the best practices of our clients, and we did a lot of modeling to see what would happen if the successes we did have could be multiplied throughout a population. We’ve now come up with a solution. We’ve outlined the five pillars of a culture of health, identifying important roles for CEOs, managers, employees, incentives, and measurement. Almost half of the book is about what to do going forward. MC: So not everything we’re doing has been wrong? We just have to reach more people? EDINGTON: You are absolutely correct and that has been one of our major learnings. One of the limitations of interventions is that they reach one person at a time. It’s almost impossible to get to everyone involved without a change in the culture of an organization. Interventions have typically been done for 10 or 15 percent of the population, so by the time you did get someone to change, someone else had gone to high risk. The best you can do in that case is break even. You’ve got to get to a point where you have total population engagement. My suggestion is that we bring health into the conversation as energy, vitality, well-being and high-level performance rather than the absence of disease as it is often thought about presently. MC: How do you differentiate between programs for individuals and programs for populations? EDINGTON: We like to start with cultural or environmental interventions. We ask senior leaders, “Do you have a healthy environment?” Then we talk to the employees and say, “What do you think the environment is like in terms of health and productivity?” And then we look at the differences and do a gap analysis. An example would be stairwells. The company says, “We have these stairwells but nobody uses them.” The employees say, “The stairwells are locked.” So a workplace intervention would be to clean up the stairwells. Put carpet in there, add music, paint some murals on the walls. And then maybe people will use them. That’s a cultural intervention. I don’t mean to come across with the idea that we are going to get rid of individual interventions. We have to have balance. MC: But don’t companies still operate under the silo principle, where keeping the benefits costs low is the goal? EDINGTON: That’s exactly right. When you shift costs to employees, you haven’t changed the cost of disease, you’ve just shifted the cost to somebody else. Companies have to approach this in a comprehensive way. MC: Do high-deductible, consumer-directed health plans have the potential to improve the situation? EDINGTON: Consumer-directed health plans could be the solution if you approach it right. That’s a huge if. You have to spend a lot of time on education on the front end. You have to cover preventive services and a bunch of things around MARCH 2009 / MANAGED CARE 23
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