Have You Ever Been Experienced?

"That Case is A Dog With Fleas." This is what an underwriter will say just before issuing a decline to quote letter or a bid 20% over your renewal rates. Over the years I have heard the phrase and used it myself while working on the carrier side to discuss a group with appallingly bad loss experience. A carriers underwriting methodology is designed to account for the results whatever the cause of poor experience. In other words the carrier does not care why the experience is bad only that they are accurately pricing the bad experience. So what makes a dog a dog when it comes to group claims experience. Is it bad hring practices or a poor corporate culture? Some insights are available froma respected source.

It Seems that Tom Rath and Jim Harter  of The Gallup Company have coauthored a bestselling Book, Wellbeing:The Five Essential Elements.

Career Wellbeing: how you occupy your time and liking what you do each day.


Social Wellbeing: having strong relationships and love in your life.

Financial Wellbeing: effectively managing your economic life to reduce stress and increase security.

Physical Wellbeing: having good health and enough energy to get things done on a daily basis.

Community Wellbeing: the sense of engagement and involvement you have with the area where you live.

These five elements of wellbeing are measured by Gallup’s Wellbeing Finder, an assessment with scores that range from 0-100. When Gallup compared overall wellbeing indexs for those employees who were struggling (defined as 50-59th Percentile) they found an average annual cost associated with sickdays of  $6,168 based on a median wage of $200/sickday. Comparably, those employees who were thriving (defined as 70-79th percentile) had an average annual cost associated with sickdays of  $2,784. For those keeping score that is a difference of $3,384 per employee per year which for a company with 1000 employees would translate into $3,384,000 annually. If one were to drop down to the 40th-49th percentile the average annual cost associated with sickdays is $7,560 which is a differential of $4,776 or $4,776,000 for the fictitious 1000 life company.
 
Traditional wellness targets physical wellbeing like diagnoses of hypertension, high cholesterol, back pain, diabetes, depression, sleep apnea and insomnia. Looking at the the employees who with such diagnoses were struggling(50-59th) incurred an average of  $6,763 in disease burden annually just based on these diagnoses which compared to $4,929 (70-79th) a per person differential of $1,834 or $1,834,000 for our fictitious 1000 life company. For those keeping score the combined we are now up to an annual cost of $5,218,000 just for sick days and disease burden associated with chronic conditions.
 
Gallup then took the disease burden a step further in order to pinpoint the annual increase in disease burden costs just year over year. Based on new cases of disease burden only (and adjusting for demographic differences), the average annual new disease burden cost for people who are thriving is $723, compared with $1,488 for those who are struggling/suffering — a per-person difference of $765. Based on these figures, those who are struggling/suffering realize two times higher new medical costs due to disease burden (2008-2009). For those keeping score the combined we are now up to an annual cost of $5,983,000 annually just for sick days, legacy and new disease burden associated with chronic conditions.
 
If you are not completely depressed yet do read on. Among randomly selected U.S. workers, a mere 28% are engaged in their jobs. People in disengaged workgroups are nearly twice as likely to be diagnosed with depression, have higher stress levels, and are at greater risk for heart disease.
 
There are many employers who will no doubt believe ardently that their employees social wellbeing has no connection with their job. Gallup results bear out this opinion.
 
Just 5% of workers strongly agree when asked if their organization helps them build stronger personal relationships, while most employees disagree with this statement.  



People in disengaged workgroups are nearly twice as likely to be diagnosed with depression, have higher stress levels, and are at greater risk for heart disease.
Gallup has extensively studied the impact of friendships on an organization’s productivity. By asking more than 15 million workers if they have a “best friend at work,” we discovered that people who have high-quality friendships on the job are seven times as likely to be engaged in their work. Without a best friend, work can be a very lonely place: Those without a best friend in the workplace have just a 1 in 12 chance of being engaged. Social relationships at work have also been shown to boost employee retention, safety, work quality, and customer engagement. It seems that like it or not management has a strong need to assure all employees are encouraged to thrive. Good managers know this but why on earth would a smart company not institutionalize the expectation that the integration of all employees into the social fabric of the company is the expected standard for those managing people?

Like most Gallup research the book is painstakingly footnoted and the data is statistically significant.

If you are an employer that has taken a massive rate increase on your group Health or Group Disability due to poor losses you have been "experienced." The underwriters do not care why your experience is so bad they just want no part of your risk and they price accordingly. While that may be bad news the ability to implement sound human resource countermeasures along with coordinated employee benefit design plan changes and strategies to hire and  assist more employees in thriving in the 5 areas of wellbeing just might pay enormous dividends in stabilzing benefit costs and boosting productivity and profitability. Or you could just do nothing while complaining your insurer is ripping you off and all those large claims will not happen again next year .

We all laugh when R. Lee Ermey impersonates a therapist in the Geico Commercial. There are without question many executives who will view the Gallup research on wellbeing and conclude its just another voyage to namby pamby land. Many of these executives will will have invested in health insurance, wellness, EAP's, short and long term disability. How could just 8% of those surveyed agree their organization helps them improve their physical health as the Gallup research shows? Easy. They are not engaged. Some executives are eyeing 2014 when they can dump their employee population into the Obamacare Exchange and take the savings to the bottom line. One might ask whether it makes more sense to craft a strategy now that can lower health costs in order to gain a profound human capital advantage over competitors planning to dump their populations into the exchanges. The hard reality employers must face is that the issues this Gallup survey brings into focus on wellbeing persist whether your employees are in the exchange or not. It will certainly be impossible to access disease management data in aggregate for an employers population in an exchange in the era of HIPAA.

Wellness Revisited

I read an interesting article in the New York Times about a company targeting Health Care savings for employers through subsidized healthy meals at the workplace as well as discounts on health foods purchased at the grocery store. These paragraph caught my eye;

A study in the January-February 2009 issue of the journal Health Affairs concluded that 75 percent of the country’s $2.5 trillion in health care spending has to do with four increasingly prevalent chronic diseases: obesity, Type 2 diabetes, heart disease and cancer. Most cases of these diseases, the report stated, are preventable because they are caused by behaviors like poor diets, inadequate exercise and smoking.



Obesity alone threatens to overwhelm the system. In a recent study, Kenneth Thorpe, chairman of the department of health policy and management at the Rollins School of Public Health at Emory University, found that if trends continued, annual health care costs related to obesity would total $344 billion by 2018, or more than 20 percent of total health care spending. (It now accounts for 9 percent.)

Dr. Thorpe also said that if the incidence of obesity fell to its 1987 level, it would free enough money to cover the nation’s uninsured population.

Of course the New York Times would never think of pointing out such an obvious fact during the health care debate on its editorial page.

For the record I made the same point about the cost of unhealthy behavior on this blog in April 2007.

And The Abysmal Timing Award Goes To...

The U.S. Preventive Services Task Force has issued new guidelines suggesting women should wait until 50 to begin routine mammograms for breast cancer early detection in a front page story in today's Houston Comical. It seems that false positives are very expensive you see and the costs outweigh the benefits involved unless it happens to be you or your mother, wife, daughter, aunt, girlfriend or sister.

The task force also recommends against teaching breast self-examination because no data exists to show it reduces deaths. That would be news to many women including my best friends wife who recently detected a lump which turned out to be malignant breast cancer. I suppose if you are a professional athlete wearing pink the last few weeks you were duped and 25 years of messaging to raise awareness was pointless?

The timing of such an announcement during breast cancer awareness month is suspect and at a time when healthcare reform awaits a senate vote is simply outright stupid. Yet it does foretell what we can expect under Obamacare  when clinical guidelines rooted in data supplant physician judgement. I thought the American Cancer Society's chief medical officer succinctly summarized the core issue;

Dr. Otis Brawley, the American Cancer Society's chief medical officer...said the statistics suggest the task force is “essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.”

Brawley added that the task force is saying screening 1,339 women in their 50s to save one life makes it worthwhile in that age group, but that screening 1,904 women in their 40s to save one life isn't.

The American Cancer Society, he said, believes the benefit outweighs the harm in both cases.

And this is precisely why The US survival rates for breast cancer surpass nations worldwide with socialized medicine. Women's groups should be rightly up in arms over this edict. Watch it hit the fan over the next few days.

The American Risk Pool & Heart Disease

Excellent summary of the challenges our nation faces in bending the health care cost curve down.

Fewer and fewer Americans are at low risk for cardiovascular disease, according to an important and frightening new report on long term trends from the National Health and Nutrition Examination Surveys (NHANES) of adults 25-74 years of age.




In the most recent survey (1999-2004) only about 8% of US adults had a low risk profile, despite favorable trends in reducing smoking and cutting cholesterol. The overall increase in risk was due to the increased prevalence of diabetes, obesity, and hypertension, said the CDC’s Earl Ford, and his colleagues, in their report in Circulation.
Of major concern, the long term trend observed by the study was troubling. Following the early 1970s, when very few people had low risk factor profiles, progress appeared to be made, as the survey found substantial increases in the proportion of people with low risk profiles in the late 1980s and early 1990s. But then the hopeful trend reversed in the mid 1990s, apparently in accord with the increase in obesity and diabetes
Low risk was defined as;
•not currently smoking

•total cholesterol <200 mg/dL and not using cholesterol-lowering drugs

•blood pressure <120/80 mm Hg and not using antihypertensive drugs

•BMI <25 kg/m²

•no previous diagnosis of diabetese

Prescription Drug Non-compliance

WSJ Health Blog has an interesting piece up on just how prevalent non compliance for prescription medicines is today that will be of interest to those benchmarking pharmaceutical compliance. This is a coachable moment for wellness advocates as 1/3 of americans do not adhere to their prescription routine.

An ounce of prevention

I was visiting a client yesterday when several employees stopped to visit with me in the lobby. One employee in his early 50's said hello and shared he had just scheduled his annual physical. He told me of one cousin who had recently been diagnosed with early stages of cancer caught during a physical. Another cousin was admitted directly to the ER following a routine physical where after checking his highly elevated blood pressure the nurse called an ambulance. The nurse was amazed the man had been able to walk into the appointment his blood pressure was so high.

Whenever I conduct enrollment meetings I try to emphasize the importance of annual wellness physicals. I suppose my appearance in the lobby yesterday was a reminder to this employee to schedule his own physical. I wonder how many adults in the US could benefit by treating themselves as they treat their children--you know scheduling a checkup around every birthday and getting a full physical? How hard is that?

On Monday one of my clients, lets call him John, called to thank me for prodding him into getting his physical for additional life insurance. His PSA was elevated and his Dr had ignored it but the life insurance company did not and refused coverage until he was examined. MRI showed a tumor and the biopsy revealed prostate cancer. He starts radiation next week and due to being caught early the odds are in his favor.

Last week another client called to tell me his partner and he had decided to go ahead with life insurance to address a business buy-sell problem identified over two years ago. His 51 year old brother in law had died unexpectedly and he found himself scrambling trying to run his own business while taking on responsibility for his in-laws business.

What is it about our nature that requires us to experience a hurricane before we buy flood insurance or a death in the family before we buy life insurance?

Wellness Plans For Free

www.fitday.com is a great and free site where employees can track the impact of calories they consume along with what they burn

Practicing What We Preach

Later today during an enrollment meeting I will without question be approached by a morbidly obese employee inquring about bariatric surgery. It happens every time I visit this company.
In fact it happens today at a lot of company's. My experience in speaking with employees about wellness shows they are interested in avoiding illness but many have simply not made the connection between their behavior and its inherent risks aside from smoking. So when I explain that 70% of health care costs are linked directly to lifestyle choices--what we eat, how much exercise we get, or do not get--I will observe lightbulbs going off in the room.

Personally I am down 23 lbs for the year and have a ways to go on my own goal. My hope is to be able to deliver my wellness message with a before and after picture that encourages behavioral change.

The Cenek Report has an interesting post today on obesity and wellness.

The Cost of Unhealthy Behavior: Got Wellness?

Here is an interview of Dr Steven Aldana conducted by WELCOA president Dr David Hunnicut.

Some of the key points are;

1. Sedentary Lifestyles account for 15% OF ALL HEALTHCARE COSTS and only 20-25% of the population achieves the recommended 30 minutes of daily physical activity
   
2. The total healthcare costs associated with a male 24 year old tobacco user are $220,000 which breaks down to a healthcare cost of $40 per pack of cigarettes of paid for by someone besides the smoker. 23% OF AMERICANS USE TOBACCO.
   
3. Obesity accounts for 12% of healthcare costs and 67% of the US population is either overweight or obese today.
4. Factoring in preventable health conditions aside from smoking you have an additional 40% of healthcare costs.
5. For those without an actuarial background we now have 70% of healthcare costs tied directly to lifestyle decisions. Physical Inactivity, Diet, Tobacco Use and preventable disease.
   
6. 70% OF deaths in America are attributable to strokes, heart attacks, diabetes and cancer which are all influenced very significantly by diet.

This week the media is reporting Consumer Driven Healthplans are getting a lukewarm reception from employees provided with alternative plans. What a shocker. Lets see, 80% do not get enough exercise, 23% smoke, 67% are overweight and or obese.

We have seen the enemy and its us.