Our ‘Sick Care’ System Isn’t the American Dream
This is a post by Newtopia CEO Jeff Ruby, originally posted on Medika.
The spread of the COVID-19 virus continues. The infection itself is a risk, but it masks two critical health care challenges Americans face: the continued rise of chronic non-communicable diseases and escalating health care costs. One feeds the other.
Both are rising at an unsustainable rate, with nearly half of the U.S. population suffering from an expensive chronic condition. COVID-19 has demonstrated the importance of prevention and how vulnerable we all are. It also sets the stage for a further uptick in noncommunicable diseases such as diabetes and heart disease due to unhealthy habits that have become worse during the pandemic.
Health insurers are footing much of that ticket when it comes to covering the costs.
This will have tragic consequences. According to the World Health Organization, noncommunicable diseases kill 41 million people each year, accounting for 71% of all deaths globally.
Despite all our medical advances, our “sick care” system will not be able to handle the waves of noncommunicable disease set to wash over America. Americans are at risk. So are employers and insurers who believe that they can solve the ills of their members by plugging holes in the boat. COVID-19 is the tip of the public health iceberg that could sink the boat entirely.
Offering ‘sick care’ doesn’t do the trick
The current system waits until we become ill before it kicks into action — instead of inspiring us to stay healthy and preventing us from becoming sick. There’s a missed opportunity to address potential issues with preventive care, with people often receiving diagnostic treatment from providers after their health problems emerge.
To some degree, this is a product of market dynamics; after all, the most lucrative medical treatments are delivered when health problems are most pressing. But this approach jeopardizes individuals’ well-being and places the cost on health insurers — many of whom are employers.
Chronic disease in particular is costly for employers, in terms of direct physical, mental and emotional health costs and lost productivity. For U.S. payers, the average annual health care cost per member is $3,400 for a healthy employee; that figure rises to $15,000 to $20,000 for an employee with diabetes or heart disease, according to an Aetna study.
Health care spending is projected to rise more than 5% annually over the next decade and accounts for about one-fifth of the U.S. economy — and much of that spending can be attributed to chronic conditions that could be managed by helping people make healthier lifestyle choices.
Preventive care today
The medical community recognizes that the costs of late-stage care is best addressed sooner to create a more sustainable health system. That’s why everyone from providers to insurers must reconsider preventive care.
Preventive care matters because it can lower health care costs by preventing, reversing, or slowing a disease before it becomes urgent. There are already many public health campaigns encouraging everything from quitting smoking to routine checkups to the importance of mental well-being.
Despite these efforts, a 2019 report by the CDC’s Behavioral Risk Factor Surveillance System found that much work is still needed to encourage preventive action in the U.S.
Even though four in five Americans have health insurance, one in four didn’t get a routine checkup last year. Nearly 3.31 million people reported that they have never had a checkup in their life. These alarming statistics were captured before COVID-19 discouraged many from going to the doctor, so we can expect both 2020 and 2021 numbers to be significantly worse, leading to further substantial increases in chronic sickness and costs for an already overburdened health system.
But preventive care means much more than just annual checkups, vaccinations, and screenings to catch disease at an early stage. More importantly, it means working with individuals proactively to help them establish healthy lifestyle habits that will reduce their risk of developing chronic disease in the first place.
The health that corporate America pays for today is backward. The focus on footing the bill for sick care for employees (or members) — instead of offering primary lifestyle prevention to keep our people healthy — costs individuals, businesses, and society a fortune and is completely unsustainable. It’s the equivalent of working to restore loyalty to an unhappy customer instead of focusing on delivering a world-class experience from the first touchpoint and keeping customers happy and loyal along the entire customer lifecycle.
In a savvy world, preserving the best aspects of our current pharmaceutical-and-surgery-based crisis intervention and disease care system while refocusing our public health systems on primary prevention is a smarter investment for companies that offer employees health benefits. Programs and solutions would address an individual’s health needs well before they reached the most damaging and threatening stages. The experience would be inspiring, convenient, and personalized for each individual, while health care providers would be compensated for positive outcomes for their patients. Everyone would win.
That sounds an awful lot more like ‘health’ care.
There have certainly been efforts to explore this possibility. Decades ago, President Nixon warned that the U.S. health care system was unsustainable and would, without prompt administrative and legislative action, break down. Every successive administration has promised similar revolutionary changes, but we still face many of the same challenges.
Corporate employers and both private and public payers need to take the initiative in moving us toward a health system that works for everyone to keep healthy people healthy. After all, 49% of the population get their insurance from an employer.
Employers have the ability to offer preventive health programs that help employees avoid disease and embrace healthy lifestyle choices. Benefits should go beyond generic gym membership discounts and proactively encourage behaviors that prevent disease and foster health.
Forward-looking companies have long sought to demonstrate their commitment to employee health and resilience, using their benefit and incentive programs to assist in recruitment and retention efforts as well as lower health costs. Today, that commitment is more important than ever.
As the long-term health outlook for the general population grows more serious, employers can deliver the preventive health care measures that the current system hasn’t been able to sufficiently provide. They can bring together the best of human and digital technology to promote healthy habits among at-risk employees, drive more sustainable outcomes, and lower costs.
Business leaders need to take action and put employees’ well-being first. Maybe it’s not the ‘system’ that should heal itself; rather, the corporations that are the paying customers. Health and care aren’t just two words. They need to be the guiding principles that accelerate the transformative changes our country needs.