Managed Care - March 2009 - (Page 27) a law that gives tax credits to companies that are MC: In your book, you talk about not letting your doing wellness programs. health status get worse being a good approach. MC: We will be embarking on an incredible debate EDINGTON: The American lifestyle leads to high at the federal level about how we are going to orrisk and high cost, and people are getting a little ganize health care. What do you see the role of the worse every day. You don’t exercise enough and federal and state governments in health promoyou eat another Twinkie, and every day you get tion and wellness efforts? And should we be lookworse. And then one day you are diagnosed with ing for a certain ratio of expenditures for sickness diabetes, and you can’t come back. So if you have and wellness? diabetes, we are going to take care of you. But if you don’t have diabetes, just stop getting worse. EDINGTON: From my biased point of view, we This simple idea takes the pressure off people. should spend 20 percent of our health care dolNow, if people don’t get worse, then maybe they lars on the wellness and prevention side, because will start to get better. And they do. We have data sick people come from a pool of well people. I estimate that we spend between 1 percent that show if an employee population and 3 percent on wellness, though some doesn’t get worse and maybe gets a litestimates are slightly higher. Healthy tle better, the company can get to zero people are our champions. Everyplace trend in their health care cost increases, else, we honor our champions. Not in which means health care costs will not health care. We wait until they aren’t rise higher than the rate of inflation. champions anymore before we pay atMC: The psychological side is very intertention to them. I haven’t been encouresting. So many of us have bad health aged by the debate so far. People talking behaviors that intellectually we know about health care reform are still focuswe should change, but we don’t. ing on access and affordability, and the EDINGTON: You’re right. Why do people only thing that is going to do is drive up Zero Trends: continue bad habits when they know costs. Medical professionals are not Health as a Serious they are bad? That’s a huge line of regoing to work for any less money. I think Economic Strategy search that someone should spend a Dee Edington, PhD, the only solution is higher health status, writes about the lot of time on. We are starting to think and that’s why I’m so passionate about problems of rising costs about that now because we are going to this. Treating wellness is much cheaper and low productivity. be changing our research direction than treating sickness. somewhat. One of the reasons we are changing is because we know the precursors to MC: Would this result in rationing care away from disease. We’ve been studying that for a long time. the very sick? But one of the interesting questions going forEDINGTON: I don’t think so. Even if the cost of ward is, “What are the precursors to wellness? treating sick people remains the same, we’ll have Who is it that stays well or gets well and stays fewer of them to treat. They may even be able to well?” That ties in with your question, and it get better care in a real sense because we would would be good to understand that better. You have less sickness. know, I end all of my presentations, and the MC: Are wellness programs viable for Medicare book, by asking, “What’s the point? Why are we and Medicaid populations? doing this?” The point is not about economics or EDINGTON: Medicaid is a huge challenge because about productivity. The point is people helping you sometimes can’t even get to the people to people. We’re all in charge of our own lives, of communicate with them. But we are doing a lot course, but we have responsibilities to the peowith the Medicare population. We have a half ple we live with and work with. How do we help million people at General Motors on Medicare, each other have a better place to work? How do and we have been able to make a difference in we help each other have a better community in their health status. It’s better if they get started bewhich we can raise our children? How do we fore they hit the age of 65. So Medicare should help people avoid unnecessary pain and sufferbe thinking about helping companies turn over ing? That’s the point. MC healthy people. MARCH 2009 / MANAGED CARE 27
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