EVENT HIGHLIGHTS: Comments from the Panelists
Andy Hines, moderator: It’s time now to turn to our panel and get their perspective on some of these issues that we’re thinking about. If I could start with Senator Barker, you get the first question.
Question: From your perspective as a legislator, how do you see the current state of health insurance, and what do you worry about if that current state doesn’t change?
Virginia Senator George Barker: The current state of health insurance is one we’re going to be struggling with and certainly one that is a huge challenge at this particular time. I think there’s sort of two major issues to focus on as we look at what’s happened with health insurance.
One is the cost and to a large extent, upon the types of things that our keynote speaker Steve Aldana has already alluded to. What is driving those costs? And secondly, at the substantial number of people that we have uninsured, and what are the trends as it relates to that?
We have situations both in Virginia and also nationally where there’s some very distinct trends that have occurred at different periods of time. To some extent during the ‘80s, and particularly during much of the ‘90s, health insurance costs went up actually less than the rate of inflation for a period of time.
We did not have what we had had previously with healthcare costs far outpacing the cost – the general cost of expenditures of the GDP and the general inflation rates. However, that’s changed dramatically. In the last several years costs have again begun escalating very, very rapidly, much more rapidly than GDP.
Between ’99 and 2007 health insurance costs went up 114 percent; average wages and income went up 20 percent. That is a huge differential there. What that does is that puts extraordinary pressures on both employers and employees. And it’s part of what is leading now to a decrease in the number of employers providing health insurance coverage, and the number of employees accessing that health insurance coverage partly because of the higher co-pays and deductibles and things that make it – and the larger share that they’re paying of their health insurance premiums.
In Virginia we’ve had a decrease in the last seven years from 64 percent of employers providing health insurance coverage to 56 percent. That may not sound large, but you look at that type of trend, and it is very significant.
Now, the proportion of total employees covered by private insurance is much higher than that because it’s mostly the small insurers who don’t have health insurance coverage. Large employers, about 97 percent provide health insurance coverage. Those employers with less than 12 employees, it’s a very small minority that provide health insurance coverage now.
So what we’re seeing is a trend where fewer and fewer employers are providing health insurance coverage. Accompanying that, however, is a trend where even if those provide health insurance coverage, fewer employees are accessing that coverage. You have many low-income employees who have access to healthcare coverage but don’t top to take it because of the contribution that they have to make to that.
And of those who do take it, in many instances, they take it for themselves, but they are not able to afford the cost to take it for their family members. So you have many employees, even in companies that provide health insurance coverage, that don’t have the coverage for themselves, and it’s the low- to moderate-income employee wages – wage earners that are in that category. As well as in many instances where you have family members who don’t have that coverage, even if the employee does.
That’s part of what is contributing to the fact that we’ve had a stubbornly high uninsurance rate, both in Virginia and nationally, and Virginia’s rate is pretty much comparable to the national average even though our income is much higher than the national average at about 14, 15 percent.
One of the other things that’s striking about what we’re seeing right now is that we have this high rate of number of people who are uninsured, despite the fact that we have significant number – increases in the numbers of people who are covered through public programs.
The SCHIP program is a perfect example. We’ve had an extraordinary number of children who have gotten health insurance coverage through SCHIP programs all across the country. We have increases in the Medicare enrollees just because the aging population and other factors, disability.
But despite the fact that there are far more people now covered through public programs, we still have that 14 to 15 percent of uninsured. What’s happening is the number of people who are covered through public programs is steadily increasing. The percent of the population that’s covered through private insurance is steadily decreasing.
That is something that’s very significant because particularly as those of us who are – as you saw me standing over there, I have sciatica. I’m happy to be between two physicians here right now. One of them’s a neurosurgeon I found out and two miles from my district, so I may access services here by the time the dinner is finished.
But those of us who are nearing the age when we will qualify for Medicare, there’s going to be a significant shift in the proportion of healthcare expenditures and costs that are covered by public programs. It’s already happening, but it’s going to escalate dramatically. And it will change the dynamics in terms of who controls the systems and what happens long term there. So I think those are things that are critical to think about.
I’m on the Small Business Commission with the Virginia General Assembly right now. This year we are dealing with one issue and one issue only. Not surprisingly, that issue is health insurance. And we’re dealing with that issue because when we talk with the businesses, the National Federation of Independent Businesses, the chamber of commerce and others, that is the issue that is most concerning them.
What they say is that the vast majority of businesses want to provide health insurance coverage. They want to do the right things for their employees, but many – what they’re seeing is rapidly escalating costs.
One of the things I think that Steve talked about, if you saw his chart there, through wellness programs and those types of things, we can make dent in that cost. But what you saw was that large gap that he said his wellness programs, even if they were fully implemented, weren’t going to deal with. We have to tackle that as well.
What’s driving that is not insurance companies just charging whatever they can charge to be able to drive that up. It’s the underlying utilization of services and the underlying expenditures that are driving that. The insurance companies, in effect, are just passing along what those experiences are.
Unless we tackle utilization of services and the underlying expenditures, we will not substantively address the cost problem. We can do some things through wellness and other things, but unless we address the fundamentals of that, that won’t happen.
Now, during the ‘90s when we had those – that period of time when costs were not increasing – healthcare costs were not increasing faster than general inflation or the GDP, what was happening? We did not increases – significant increases in utilization. That was stabilized and many anticipated it going down.
Hospital utilization in Northern Virginia went down between 1981 and 1997. The population went up 50 percent. The use of hospital beds went down 33 percent. One’s going up 50 percent; the other is down 33 percent.
What’s happening there was a change in culture, a change in delivery of services. There my have been a little bit of it that was related to health status and wellness and those types of things, but most of it was how we practice medicine and the types of things we did. There were fundamental changes that happened there that produced those cost savings so that we all benefited. And we did not have those increasing costs that then were leading us to by 22, 26, having 100 percent of our GDP go to medical care.
What we have though is a situation in the last few years where that utilization has gone up. Expenditures go up. A lot of more capacity has been brought online, many of which is questionable as to whether it’s needed.
What happens? Those get passed on – those costs get passed on to the insurers; the insurers pass those on to the employers who are providing the health insurance coverage; and we all pay for it. If we don’t start addressing those things, we’re not going to address our fundamental cost issue.
The final thing I wanted to say is that it’s not simply a matter of being able to do things that we can’t do. References made in Steve’s presentation to 16 percent of our GDP going to healthcare. If you look at other developed countries around the world, most of them are spending between 6 and 10 percent of their GDP. It’s an extraordinary difference.
But it’s not simply that we say, well, we have to go to the types of system they have, or to do things that may delay care or do some rationing or other types of things that we find objectionable here. All you have to do is look at differences just within the United States.
In Virginia, you simply have to compare Northern Virginia to the Richmond area. Roughly the same size of population, close to 2 million in Northern Virginia; less than 2 million in the Richmond area – about 1.5 million there.
There are extraordinary differences. If you’re in Richmond you’re about three times as likely to get an MRI procedure as if you’re in Northern Virginia. You’re far more likely to get a cardiac catheterization procedure; twice as likely to get that. You’re far more likely to be in the hospital. The cost – the expenditures are much higher in the Richmond area than they are in Northern Virginia.
Now, being from Northern Virginia I’m happy to go down to Richmond in the general assembly and talk about how we’re healthier and smarter and everything else. But in reality the fundamental differences in the population aren’t that great. It’s differences in terms of how we provide care.
Now, Northern Virginia, Fairfax, Loudon, Prince William County, places like that, we have about the highest education, highest income population in the entire country. So it’s not as if we have a population that’s not accepting – that is willing to accept inferior medical care. We have good medical care. We’re providing good care, and it’s producing good results. And it’s without the high utilization of services and the high costs that go with that.
You compare even Massachusetts and Connecticut, it’s the same type of thing. Costs are far higher in Massachusetts than they are in Connecticut. Are there big differences in the population? No. It’s difference is in the utilization of those services. And as part of them, what drives – what was talked about earlier – the costs that are affecting what’s happening in Massachusetts.
In Massachusetts they’ve done a great job of providing health insurance coverage, so they’re down to about 4 or 5 percent of the population that’s uninsured now. But it’s costs that are choking them, and part of the reason is because – well, there are two major reasons for that.
One is when you have people that are uninsured and you first bring them on, a lot of them have chronic conditions that have not been treated. And so you do have a period of time to deal with that. Some of that will go away over time once you’ve done that.
But the second thing is you have a high cost structure and high utilization of services that’s part of that medical culture there, and so that’s part of what’s affecting it there. If we don’t type the rest of those issues, we’re not going to address the fundamental cost problems we have.
Andy Hines, moderator: Thank you, Senator. The next question is for Dr. Compton Phillips. We’ve been talking about wellness. In your experience, are you seeing a correlation between wellness and rates? How is that being measured? Do you see that as a useful remedy for controlling costs?
Kaiser Permanente’s Dr. Amy Compton-Phillips: Well, if you look at commercial weights, the healthier the population the lower the rates, right. Because rates are just determined by the cost of care, plus the cost of the administrative services, divided by the number of people you cover. So the healthier the population eventually the lower the rates go.
What that doesn’t translate into though is lifetime costs. So what you saw on your graph that you put there Steve is that people live longer. And as they live longer they accumulate costs. So one of the quickest things you can do to stay healthy is quit smoking. Your chance of being hospitalized goes down almost immediately.
And in the short term, your employer, for example, would pay a significantly less amount, or the insurance that you would have would pay a significantly less amount for coverage in the immediate term. But your lifetime costs, if you quit smoking, is actually higher because smokers die faster.
So you live to utilize, which is a good thing. That’s a good outcome, right? We want people to live longer. We want people to live healthier so they can die in a snowboarding accident at 94. That would be the ideal. In the long run, that’s not the answer to healthcare costs because we’re going to be living longer, so we’ll be spending more.
So I think absolutely to the point that you both brought up that controlling costs in that bottom portion of the graph, the part below the area, is where we have to go to control healthcare costs. Addressing variation and care.
If you look at Jack Wennberg’s Dartmouth Atlas data, variation in care accounts for a huge percentage of Medicare expenditures particularly.
We also have an incredible dearth of primary care in this country. And we know that primary care, taking care of the same condition, tends to cost significantly less and provide higher quality than seeing a specialist for the same condition. But right now only 2 percent of medical graduates are going into primary care.
So what are we going to do in a few years when we’re sick and we want to go see a doctor? You have to choose your organ and go see the doctor – you know, the specialist of the organ of choice. So there are a lot of ways to control cost. And I think that wellness is a great way for us to live longer and healthier, but I don’t think it’s the ultimate answer to controlling costs.
Moderator Andy Hines: Great answer. Dr. Cohen, the next question’s for you. Based on the current of state and federal regulations and mandates, how do you think workplace wellness programs might be implemented in a way that could reduce rates?
*United Healthcare’s Chief Medical Officer Dr. Sanford Cohen”: Thank you for the question. I echo what Dr. Aldana said. If you look at the American Heart Association, for example, they estimate that one out of every three people in this country have cardiovascular disease; for example, stroke and heart disease. And I agree that our culture has driven this.
The obesity epidemic driving diabetes. Diabetes, in and of itself, mandates that you treat a diabetic as high risk as someone that’s already had a heart attack in terms of cardiovascular risk reduction. You look at high blood pressure, you look at smoking. And if you actually look at the number of deaths in this country from cardiovascular disease, that equals cancer, trauma, respiratory, all combined.
And just using that as an example and getting back to the question, will wellness help. If we just pick cardiovascular disease as one example, I totally agree with the comment that by changing culture and by changing lifestyle and changing risks that are changeable, we can definitely decrease healthcare trends by working with employers, physicians and certainly setting up wellness culture at employer groups, setting up onsite wellness workshops, biometric screening. First creating awareness at an employer level opens up the door to allow that awareness, start a culture change, start people thinking about it.
Hopefully down the road that can lead to education, whether it’s through coaching programs or personal health records, to allow that. And then ultimately, if that will lead to behavior changes: smoking cessation, weight loss, hypertension control, we can definitely impact, as one example, cardiovascular disease and a resulting decrease in trends.
Moderator Andy Hines: Thank you, Dr. Cohen. Dr. James Melisi, the next question is for you. First of all, we’re glad to add to your patient list today. Second, in your experience as a surgeon, what do you see being done in terms of workplace wellness? Is it showing up amongst your patients?
Neurosurgeon and Johns Hopkins MBA candidate Dr. James Melisi: Well, first of all, thank you for inviting me to be on the panel. I’m really grateful to be here. I did not come here to look for patients, although I will say that I’ve already seen at least one of them here today, and HIPAA laws keep me from telling you who that is, but it seems everywhere I go I run into patients.
The answer to that question is really not an easy one. The programs that have shown the greatest return on investment, for example, include health assessment activities that determine employee health and identify their risks; health screenings for early detection and treatment of problems; self-help materials; self-care programs like nurse advice lines; incentives to reward people for healthy behavior.
But the truth is, is that while those things are being implemented by some employers, in my practice and in the vast majority of my colleagues, we don’t see that. I just don’t see that in the vast majority of the patients that come through my door.
Thankfully, as a neurosurgeon, I treat spinal diseases and certainly diseases of the brain and spinal cord. More people have back pain, thankfully, than brain tumors, so it makes up the vast majority of my practice.
But 80% of the healthcare costs are really instigated by only about 5 to 20 percent of the American population, as Dr. Aldana did point out. But that 80 percent of those healthcare costs are really, as he said, chronic and severe illnesses that, in my opinion, are really not amenable to wellness programs.
And when I was first asked to be on this panel, I was concerned because I thought I’d be the only one to suggest that the bottom half of that curve that you showed was really the place to contain healthcare costs. But I’m so thankful to hear that I’m not the only one that obviously thinks that.
These chronic and severe illnesses may not be amenable. So while wellness programs are a step in the right direction, it’s only really the tip of the iceberg in identifying the places to cut healthcare costs and provide quality care for everyone.
And if I could just add – go off topic just for a moment, I just wanted to make it clear that while there are indeed greater than 40 million people in America that do not have health insurance, every man, woman and child in this country is not denied healthcare ever. If a patient goes to the emergency room, they will get the same doctors, myself included, to take care of them. These are the best-trained people in the world that have the best technology.
So even though it is true that many people do not have healthcare insurance, everyone gets treated and they get treated with the best healthcare that I think we have available to us.
With respect to everyone in the room, the difficulty is that the policy is being made with very little input from those of us who are in the trenches. And I would like to see, frankly, whoever gets elected next week that they include the healthcare providers, the hospital administrators, the physicians, the nurses, the people that are there everyday taking care of these people because we need to be involved.
I would encourage those who are involved, and I’d be happy to hear from the insurance executives such as Dr. Compton-Phillips and Dr. Cohen about how they plan including those of us who are providers. And to that end, I would say that part of the reason for me being here is that I am not the only physician or nurse that feels that way. We would love to be involved. And if there’s any way that we could get involved we would love to talk to you either later or any other time. And I have a list of people that would love to be involved as well.
The last thing I would comment on is like Steve said, most of the cost opportunities for saving in healthcare costs was on the bottom part of that curve. I don’t discount wellness programs. I think they’re wonderful. The problem is that most of the people will not take advantage of them.
We have to be realistic in this room. I’m looking around the room and none of you look like most of my patients. The vast majority of patients are overweight. I have to lift them up onto the operating table to operate on them. I’m a marathon runner. I run 158 pounds. I can barely do that. But that’s who we’re taking care of these days.
But part of the healthcare costs noted in that – in your slide – and I’ll finish in a second – malpractice insurance costs, for example. And just to reiterate what you said, that cost alone is forcing good doctors out of business. I will tell you that OB/GYN doctors and neurosurgeons and cardiac surgeons that have never had a lawsuit in their practice are paying between $100,000.00 and $200,000.00 a year. It is unaffordable for liability insurance. It is more money than my father made in a lifetime to pay in a year.
My new partner, who I just signed on, after five years, after – and owing over $200,000.00 in medical school and college debt, is going to be at that same rate in a few years. There has to be tort reform, otherwise it’s going to force good doctors and healthcare providers out of business, and you will not get the healthcare that we’re used to getting at this time. Americans will not stand for it.
Moderator Andy Hines: Thank you, Dr. Melisi. You mentioned the issue of would people take advantage of it. I understand we have one of our participants today. Priscilla O’Donnell is a small business owner who has implemented a wellness program at her company. And the joke she has is that in the six months her employees have lost a total of 700 pounds, the equivalent of four or five full-time employees. Could you share with us a little bit about your story?
Audience member Priscilla O’Donnell, vp of human resources at a Northern Virginia firm: I’ve been in the HR business for 28 years, and we started this program in April as sort of the last frontier of ways to contain medical costs. We have 400 employees at my company, and had tweaked the plan design and shifted cost as much as we humanly could and still maintain a competitive healthcare program.
So we entered this wellness initiative in April with a $10,000.00 budget; $5,000.00 from our healthcare provider, which we were very thankful for. In April we gave out pedometers to everybody. We started a 10,000 step program. In May we added onsite Weight Watchers, and we have actually lost more than 700 pounds since May. And that is amongst 25 employees.
Now, I would say the vast majority, probably 35 percent of our employee population has taken part of some form of wellness initiative. We’ve had stress reduction month. We have had — we will be having health screenings next month. Passport to Wellness is what we call it.
Ultimately, what we have found out so far is that we’ve had at least one employee who has quit smoking. We’ve had one employee who has backed away from a pre-diabetes diagnosis, so they are no longer considered in pre-diabetes. We’ve had somebody who has gone off maintenance blood pressure medication. And this was a long-term prospect for us. We didn’t expect short-term results, but we’ve gotten them.
We obviously have to keep it up. But I would say the one other benefit that we didn’t expect has been that we’ve also been supporting an employee engagement initiative at our company. And I would say that one – the biggest drivers of employee engagement has been this wellness initiative.
This translates to employees as their employer caring about them as individuals. It’s not something that’s going to make them more productive, even though it will make them more productive. But they feel like we care about them. And we have gotten tremendously positive response from this. I can’t stress it enough. And it didn’t cost a lot of money. So it just takes effort and leadership.
Moderator Andy Hines: Thank you for sharing that story. Next question is for Al Redmore, and it’s really a two-part question. First is how many years do you think it would take to put something like a universal wellness plan into place? And given the obvious time and money questions, why aren’t companies being more proactive in making wellness programs part of their routine?
Former Maryland Insurance Commissioner Al Redemer: Well, I don’t think we’ll see anything that’s universal any time in the short term. I think employers have too many varying interests and objectives to see a consensus in something that’s universal.
The reason we don’t have more employers, like Priscilla, doing this is a variety of reasons. Some just don’t – they don’t get it. They don’t understand the value and the benefit.
Also, as the doctor mentioned earlier, most employees really don’t have a strong motivation or desire to change their lifestyles. So if the employee isn’t interested, why should the employer be interested, especially if they don’t recognize that return on investment.
And typically what you find if you have an employer, as an example, that’s going to offer memberships to the local healthcare club, they end up subsidizing those employees that are going to the healthcare club anyway. You’re not necessarily attracting new participants.
The other thing is on the employer level and also the insurance carrier level, as is always the case, you have to follow the money. Are there financial incentives to participate? In a lot of areas, Maryland specifically, if you’re a small employer, there’s absolutely no financial incentive to participate at all other than attendance and those types of things.
But if you have employees that have poor experience and high costs with adjusted community rates and so on, you don’t pay the costs. So there’s no incentive to encourage that type of thing.
And on the carrier level, while there may be long-term cost savings from wellness programs, if you look at the typical relationship between an employer and a health insurance company, if you’re a health insurance company and you’re going to make a capital investment into wellness programs, it’s going to take a little bit of time to see the return on that investment.
More often than not, the employer group, by the time there’s a return on the investment, they’ve changed carriers, and somebody else is going to benefit from the investment that has been made.
Moderator Andy Hines: Thank you, sir. This next question is for Dr. Paul Rao of the National Rehabilitation Hospital. It relates to some – a trend we’ve been tracking in our futures practice around transparency of the person. And we have a little brief that we’ve given you in the bag that describes that issue. And we’re looking at the issues surrounding genomics and genetic predispositions and how that interacts with lifestyle choices.
How will preexisting conditions be defined or redefined in the future? And how might health insurers in the healthcare system handle the insurability of preventive treatments that could impact the rate and adoption of genomic-based medicine.
National Rehabilitation Hospital’s vp vice president of Clinical Services and Quality Improvement Dr. Paul Rao: That is a huge question. Before I answer it I would like to first thank Josh Basil, a person with spinal cord injury who had this vision and is here today.
Josh came to me about six months ago and said, look, I’m spinal cord injured, but I want to be well forever, and he really has advocated for persons with disability.
I think the first answer I’d like to give is to choose your parents well because that is getting at the DNA point. But I think if you go back to Mr. Clinton’s HIPAA, it started out as the Health Insurance Portability Accountability Act. We focused on security. We focused on privacy.
But truly, one of the issues was portability. If somebody left an employer they were going to carry their insurance, etc. Now, the thing is if we get through the DNA markings and mappings, how well are we going to be able to be portable and safe and transparent?
Transparency is really touted as something that’s very big. But I was just chatting with Amy that Kaiser did a study. Thirty-one percent of healthcare consumers use data to make medical decisions. I mean, they just trust, and they don’t just go onto the web, etc. So that issue of folks trying to be empowered, we say knowledge is power and we try to empower folks. We all, I think, heard about the young woman who had a double mastectomy know that she, her mother, her aunt, etc., and she had the markers, so she prophylactically took action.
Now, I think the insurers will have to partner at a table, at a summit like this where we’re kind of saying, look, in the long run, everybody is going to save with respect to wellness. And people do not want to carry the marker. They want to carry the wellness attitude.
I have a few low-hanging fruit that I’d like to speak to. Steve, you did a terrific job, but my glass up here is half full. Look at healthcare literacy as an issue. And I know that Northern Virginia, a lot of bright people, etc. But it’s incredible. Twenty-five percent of our patients have no idea what we say to them when we say do this.
They listen. Anybody who has had a medical illness. They smile. They listen. They have no idea what the hell you’re talking about, and it’s scary. That’s 25 percent.
If we can reduce the lack of compliance with – and the recidivism, folks not complying with their medication and going back in the hospital, huge – Melinda – huge savings on healthcare costs, number one. Healthcare literacy has not been talked about. It’s huge.
If you look at the website of the Agency for Healthcare Research and Quality, www.ahrq.gov, and really study the healthcare disparities out there, huge number of folks who are underserved, but they don’t know what to ask. They don’t know where to go.
The second savings that we’re going to start seeing effective October 1st of this year, is we’re not going to get paid for medical errors. If you cut the wrong leg off you’re not going to get paid. In the past you got paid for medical errors. That’s a huge chunk of change that’s going to go out of the system. We are going to benefit from a safer environment, and we are going to advocate for just wash your hands. Make sure I’m the right patient that you’re giving this blue pill to.
So on a take, I’d like for folks to really be aware of how important their partnership is in healthcare design-making.
I just want to summarize very briefly, Rand did a study in 2008. This gentleman referred to the study in D.C. It’s a microcosm. Twenty-five percent of persons in D.C. have high blood pressure; 10 percent asthma; 8 percent diabetes; 5 percent cardiovascular; 2 percent cerebral vascular disease; 50 percent of us are overweight; 25 percent of us are obese.
If we can get folks to begin to do the wellness thing, look at the savings that D.C. is going to see. Thanks.
Moderator Andy Hines: Thank you Dr. Rao. Can we have a round of applause for our panel? Thank you. I have more questions that I could ask, but I think this is a good point to turn the mic over to you and from the audience. If you’d like to ask questions of our panelists I think this a great time to do that. I think we have a roving microphone that’s ready for you.
And here we have a question upfront. This is the table with questions up here.
Question: I’m an internal medicine physician just finishing off time in Boston at Harvard, and now I’m here in Washington full time. One of the things I’m also doing is working with the Center for Disease Control Office of Emerging Research, looking at the issue of social determinace of health. Beyond you should stop smoking but also produce should be in that supermarket and that the hours of the clinic need to be open longer. So the social determinace beyond the victims – blaming the victim issue.
But the other side of this is that I’m working on the corporate side and looking at something, and I have this really big question, and I’ve created this huge curriculum because I am confused about where the medical directors are in these corporations.
I sat with a medical director of a huge, international corporation. His priorities were I have to make sure these people get immunized before they go over there. I have to make sure these people get the right plane. She got sick on the plane, so she can’t come home.
And I said to him how many obese people do you have working for this corporation, and he said very few; it’s not really an issue. I said please bring in somebody who knows better than that. And another person came in and he said 60 percent of our people are obese.
So I started making and designing this program for medical directors who have, by nature, other priorities in their corporate agenda to bring in beyond the human resources. Because we know the Washington Business Group on Health did a study on issues for human resources. And they found there were lots of questions.
You’re not a medical person. And your medical person has got a different agenda than you have. So I really want that question answered. Where are the medical directors, and what are they think about? About – not what are they thinking. What are they thinking about?
Dr. Amy Compton Phillips: I think you know different medical directors than I do. I know that in a lot of our work we’re working with some very forward-thinking medical directors of large corporations that are very much attuned to the health and wellness of the population that they work with, their employee base.
One of the reasons being because of the directly attributable cost of absenteeism but also with presenteeism. You know, the fact that healthy people tend to focus more at work and actually are more productive.
And at least with a lot of the large corporations, particularly those linked in through the National Business Coalition on Health, are very focused on wellness right now and making sure that we’re providing care in a way that focuses on keeping their people healthy. And that’s including making sure they have appropriate information to know how to take care of themselves, done in the right health literacy environment, and really focusing on that work.
I think it’s really a different field than most of us were trained for in medical school. We were trained to find the problem, fix the problem and go on to the next problem. We weren’t trained to prevent the problem from occurring in the first place. So it’s a different world, but at least in a lot of the sophisticated companies I think they’re there. It’s as we move into the smaller groups that it’s a bit more challenging.
Question: As another medical director I’ll add a comment. I could see your point, when are we going to move from being reactionary to proactive. And at least in the discussions that I have, I do see that culture changing. We have pilots now, for example, where we will meet with employer groups. If they have that clinical leadership, great; sometimes not.
But to change that culture in regard to wellness, working with employee leadership, doing onsite evaluations; biometric screenings, for example; heightening awareness; partnering with them to allow those referrals for education and behavior change.
So at least in some of my discussions I do see that changing, moving from flu shots, screening, but all proactive, how can we move to a more preventative landscape.
Question: Just this year eight hospitals in MedStar Health have, again, given every team member and their family members the opportunity to go online, complete a health status questionnaire. If they complete it they get $50.00 in their paycheck for each person in the family that completes it.
And the second thing is I’m getting every month now a newsletter from the health status telling me what I need to do after I completed the survey.November 20th is the Great Smoke Out, and all hospitals in MedStar will not have any smoking on campus, on your person, no smell, no parking lot, no nothing. Zero. And it’s going to be tough on our CEO, who is trying to quit.
Question: My name is Pamela Thomas. I’m the coordinator of the health center at Prince George’s Community College. I see the students who are 19 to 24. They’re too old now to be on their parents’ insurance, yet they don’t have a job and they don’t have health insurance. I heard you say that they can go anywhere and get treated.
Consider that my daughter had Crohn’s disease. She was a sophomore at the University of Maryland College Park. She had to drop out so her insurance coverage went away. I sent her to social services. They said she couldn’t get coverage because she didn’t have any children. She was a student.
She wracked up over $80,000.00 in one year from Crohn’s disease, being treated at the hospital. She didn’t want to go to the hospital, so she always waited till things got real bad because she didn’t have health insurance.
I told her to go anyway. I’ve taken care of so many other people’s sick children. I’ve been in the healthcare field for 36 years. And we’re talking about students at this age that need to be treated.
Syphilis is in the rise; gonorrhea; Chlamydia; HIV. And these students – these teenagers are sexually active. That’s running our healthcare costs up. So when you say that they can go and be treated, yeah, they can go and be treated but they’re running up healthcare costs. And they, like you, don’t want to run up the healthcare costs, so they’re not going to get treated. What are we going to do to impact these things?
Question: In Maryland, there is nobody that doesn’t have access to health insurance. If you can’t get it through work, if you can’t qualify for individual coverage, you go to the state; you get the Maryland Health Insurance Program. It’s partially subsidized by the state. Not saying you can afford it, but everybody in Maryland has access to individual health insurance.
Dr. James Melisi: I have a 19-year-old son who is in college and another daughter who is on the way, and while I sympathize with you because I understand that is a problem, again, we will not deny coverage – we will not deny care to anyone. And in terms of the cost, I am here to tell everyone here that we do not allow costs to figure in to who we will treat and how we will treat them. And frankly, to be perfectly honest, a lot of that ends up getting written off anyway.
But my son, for example, who is out in college in California, could not attend the school without healthcare coverage. And we got a letter before he attended school that said if we don’t cover him on our health insurance plan, they would provide one at a small cost. So I know that there are things out there.
And again, even if they have no coverage, there are ways of getting treated.
Senator George Barker: I think there are a couple of things that are important. One is we have to create the expectation that people will have health insurance coverage and have it be something that’s a priority for them.
One of the things – both of our children turned 22 while they were still in college. They went off our health plan. What we did is we got them enrolled in individual plans for a period of time until they had health insurance coverage through their jobs.
Our daughter just finished three years of teaching, and in her last year, decided to go skiing and tore her ACL. She was certainly glad she had health insurance coverage. And so she exercised her COBRA option there. We have to create the expectation that people want that.
One of the issues that we have, and it’s part of the reason why we have a substantial number of people uninsured in Northern Virginia right now, even though our unemployment rate is virtually nil, our income levels are very high, but we have about 11 percent uninsured just in Northern Virginia.
Another thing that’s driving that is the very high rate of uninsured – of the lack of insurance coverage among ethnic minority populations, many of whom have moved here from other countries. And in their own countries there’s not that same history for private coverage – private health insurance coverage.
So whether it’s them looking for a job and health insurance not being a critical factor in terms of a decision about taking a job, or whether it’s them setting up their own small business, which many of them have done, health insurance is not necessarily the top priority even for themselves as well as their employees. We have to, in effect, create an expectation among people that they will seek and get health insurance coverage.
Dr. Amy Compton Phillips: I think that you actually hit the nail on the head identifying one of the major drivers for huge healthcare costs. Crohn’s is one of those diseases that can be controlled with – it’s not preventive treatment, but maintenance kinds of treatment, that you can prevent bad outcomes from happening.
But when you’re one of the 48 million Americans that don’t have insurance, what happens is you wait until things get horrible and the bad outcomes happen before you seek care. So with an ounce of prevention.
I feel for you and your daughter because hopefully the course of her care might have been dramatically better had she been insured. So it really highlights driving up care costs as well as healthcare disparities.
Question: I’m Dr. Mary Ellen Rose, a teacher at American University. And first I just wanted to say I used to sell health insurance programs to small businesses back in the ’80s, and actually it was before HMOs and PPOs and all that. And the frustration that I felt with trying to serve my client but understanding the position of the health insurance saying we are in business to make money.
And now as a teacher and as the mom of two teenagers, I look at the full spectrum. I went back to school at 40 to get my PhD to reenter the workforce, and I’ve always been in the health field. And how little we’ve come in regard to academically what we know, and that we are still pushing eat right, exercise and all your problems will be solved is frightening to me.
I have a number of close friends that are physicians that have walked away from their practices because of the bureaucracy of the insurers. And I understand their position, but their frustration is simply the debt that they accrued during medical school, and the lack of time that they have with patients.
It would seem to me if we’re going to throw government dollars anyway, it would be toward the medical professionals who take the time to go to school, who take the time to get educated, who take the time to treat the population of this country, and then enter an industry where they can’t survive, can’t spend the time, and they no longer love what they spent all those years doing. That is the crime of this government spending right now.
We have CDC and HHS and every – I mean, you’re in Washington. You know the money we spend in this government on healthcare, and we’re not moving forward, so there’s got to be something wrong.
And I applaud every doctor that stays in this field, just like I applaud every teacher that stays in this field. Because you think they make a lot of money, but you’ve got to look at what their costs are. And it is phenomenal when you get inside their heads and start to talk about how much it hurts to put out all of this money into something that they loved and spent all that time doing. I guess that was a pointless point. I’m sorry.
Dr. Sanford Cohen: I hear your thoughts. I just wanted to empathize and say we do believe in helping people live healthier lives and getting back to wellness.
I agree, this is going to be – we all own this, physicians, payers, and I think more meetings like this, multi-stakeholder where we can come with thoughts and collaborate will hopefully move and get us there.
We have done things in working with employers and subsidizing biometrics, coaching, to try to move this culture change. That is one piece, in addition to the other areas we’ve seen in terms of waste and having more maintenance therapy and things of that nature. So thank you for your comments.
Andy Hines: It feels like we just got started, but we’re actually approaching our two-hour mark and want to get you back to your offices on time. Although there is so much more that we can talk about, but we want to respect the time permitted. So Stephanie, could you come up here and say some closing remarks?
Event host Stephanie Cohen, CEO Golden & Cohen: STEPHANIE: Hello, and thank you for attending the first annual DC Health Summit. I hope that our speakers engaged you today, and now have given you food for thought.
The 2008 DC Health Summit is the first step we are taking in setting up a national coalition that will include some of the largest health insurance companies, cutting-edge physicians, hospital administrators, pharmaceutical firms, and politicians. Our plan is to put together a consortium of leaders who will come together quarterly to investigate effective ways all of the parties can work together to lower the cost of health insurance for all Americans.
We’ll be posting our findings in a report, which we’ll submit to the next President of the United States as a suggestion for how to lower health insurance rates.
We’d like you to be part of our team. In the coming months, we’ll send out information about our progress and invite you to participate in an online dialog via the blog we are setting up on our website, www.dchealthsummit.com.
In the meantime, let me take this opportunity to offer a special thanks to the following people who made today’s event possible:
• Our sponsors — UnitedHealthcare, Kaiser Permanente, Coventry Health Care, and LifeWork Strategies, Pfizer Pharmaceuticals, and Lifetime Fitness, whose generation donations made this event possible.
• I’d also like to give a round of applause to our panelists — Kaiser Permanente’s Director of Population Care Dr. Amy Compton-Phillips, Neurosurgeon Dr. James Melisi, the National Rehabilitation Hospital’s VP Dr. Paul Rao, Maryland’s former Insurance Commissioner Al Redmer, and UnitedHealthcare Northeast regional Chief Medical Officer for United Healthcare Dr. Sanford Cohen.
• Thanks also go our keynote speaker — Dr. Steven Aldana, CEO of the wellness company, Wellsteps.
• And the event wouldn’t have moved as smoothly without our moderator — Futurist Andy Hines, director of custom projects at the global futurist research and consulting firm Social Technologies.
• And hats off to my team at Golden & Cohen, including my right hand Lisa Garlena, sales executive Jon Read, and my director of communication, Hope Katz Gibbs, the founder and principal of Inkandescent Public Relations. And of course thanks to my partners, Scott Golden and Jack Cohen.
Here’s to having you be part of a national movement to lessen the ballooning cost of health care. If we work together and increase and encourage workplace wellness, I am confident that we will find a way to make Americans — and the system — stronger and healthier. We’ll look forward to working with you on this important initiative. Have a great day.
END