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health accountability

Insist on employee
health accountability

New York employers in 1994 spent more on health care–$3,631 per worker–than those in all but three states, according to the most recent figures available. Health care spending in the nine-county Finger Lakes region hit $3.7 billion in 1993, increasing nearly 10 percent annually for more than a decade, far outpacing the Consumer Price Index.
Most businesses have attempted to control costs by taking a fiscal approach. Increasingly, employees are expected to pay part of their own or their families’ premiums. Nationwide, 89 percent of employers offer managed care, which has squeezed out the easiest savings.
But as the Wall Street Journal reported in February, “As managed care becomes more pervasive, it’s getting harder for companies to cut health costs further. … Now the only way to find additional savings is to make your employees more healthy.”
Roughly 80 percent of health care bills can be traced back to 20 percent of employees, the Journal continues, citing studies by a Nashville health consulting firm. Often, those 20 percent smoke, are overweight or otherwise neglect their health. Nationwide, 70 percent of illness is preventable, according to the Wisconsin Network for Health Policy Research.
It’s hard to ignore the staggering data linking individual habits with excessive costs. A study of 6,000 workers at Chrysler Corp. showed that overweight employees had 142 percent more inpatient days than did low-risk employees, the Wisconsin Network reports. United Technologies Corp. claims that smokers cost the company $5,000 more a year each in medical care than their non-smoking co-workers. And the Wisconsin group reports that male heavy smokers will cost the system 47 percent more than non-smokers, or $100,000 over their lifetimes–two-thirds of which will be financed by private health insurance.
But financial costs are only part of the story. This year, the National Institutes of Health estimate, unhealthy behavior–tobacco use, poor diet, physical inactivity and alcohol abuse–will account for 1 million deaths, nearly half of all U.S. deaths.
Clearly, it’s incumbent upon responsible employers to directly address the financial and human toll that such poor choices take, and to partner with employees who assume personal responsibility for their health habits and their use of the system.
Some two decades ago, hopeful employers began offering on-site workout centers, educational materials and other health promotions, encouraging employees to get into shape, reduce their use of the health care system and save the employers money. Achieving those goals has been time-consuming and often difficult to measure.
At HCR, we’ve been refining our health assessment and intervention strategies, enabling employers to focus their resources on health-improvement programs that are most likely to show results.
HCR recently concluded a five-year project with NASA to identify employee health risks and to enable NASA to support employees in improving their health habits–and in becoming more productive. We surveyed some 2,000 employees, developed a profile of their risk factors and compared them with the goals in the Healthy People 2000 initiative. We then recommended interventions–smoking cessation, nutrition counseling and stress management, for example– focused on reducing the most significant risk factors. NASA is measuring the impact of those interventions with such benchmarks as number of smokers, number of overweight employees and number of days lost to illness.
Locally, managing the state of employees’ health has become particularly relevant. Until recently, Rochester employers have had little fiscal incentive to field a healthier work force. Under the community-rated system, every Rochester-area employer paid the same premiums. As Eastman Kodak Co. has moved to pull its own employees out of the community pool, however, other companies should be scrambling to improve their employees’ health–and avoid paying the highest premiums.
I believe that spiraling health costs can be reined in–but only if everyone takes responsibility. Health care providers need to offer more comparative information about their outcomes. Individuals need to know how much their habits are costing themselves, their co-workers and their employers. And informed employers need the courage to create workplace climates where employees are prodded and supported to reduce their health risks.
It isn’t easy. Employers squirm at the prospect of playing Big Brother with their employees’ personal lives. Many companies fear that disgruntled employees will take legal action for having their lifestyle choices singled out.
The most courageous business leaders, however, will weather the naysaying and work to improve the system by insisting on employee health accountability. With a healthier and more responsible work force, we all win.
(Louise Woerner is president and CEO of HCR, a health care management firm with offices in Rochester, Washington and Atlanta.)

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