EVENT HIGHLIGHTS: Keynote Speech from Dr. Steven Aldana

I have to admit I’m a little bit worried about this meeting. I bet I do 100 meetings a year, maybe 150. I do a lot. I see all kinds of organizations, carriers, providers, TPAs. I see everybody in this field, and I have gained a perspective that I never had before.

Having said that, I’m – frankly, I’m a little anxious about this meeting. I rarely get all the players together in one room. So that is a little bit intimidating. But more importantly is the charge that we’ve been given here today, and that is we’ve got to change this system. And what I don’t want to be is Henny Penny. I don’t want to say the sky is falling, the sky is falling. I don’t want to be a harbinger or doom.

But to be perfectly honest with you, when we look at this whole healthcare cost issue, I’ve got a solution for part of it. I don’t have the solution for the other part of it. I’m going to have that solution come from your panel over here because I have no idea how to do this. And I’ll be really impressed if they tell us how to do this. too.

We’ve been doing a lot of research in a lot of areas. Let me just show you one little piece of this pie. I want to connect the dots for you. We took a whole bunch of people in Rockford, Illinois, middle-aged adults. I ran a _____ clinical trial with 700 people. We just wanted them to change behaviors. We would like you to start eating better, exercising more, stop smoking. We put them through the CHIP Program. It’s part of the Swedish American Health System with Dr. Hans Diehl.

This is what we got. The people with overweight, their BMIs – by the way, this is eight weeks. This is two months. We went two months, six months, one year, a year and a half and two years in our clinical trial. This is eight weeks. This is the overweight group dropped the BMI 1.3 points; the obese group dropped 1.6 points. This is their blood pressure drops.

If I was a high – if I had blood pressure at baseline, eight weeks later I’m down 13 points. That’s 13 millimeters of mercury. That’s a big drop. For dangerously high, they dropped 30 points in eight weeks. We had 380 people in this part of it, in this arm of the trial. This is eight weeks, and these cholesterol and blood pressure drops are larger than you’re going to get with the medication.

Here’s diastolic blood pressure. Fourteen point drop for dangerous high; ten point drop for medium. What changed? They changed what they were eating. They changed whether or not they were physically active, and this was eight weeks. Cholesterol, this is a 50-point average drop. This is the average 50 points, versus 30 for borderline high. And even the normal weight cholesterols dropped.

We’ve been doing these studies for a long time. The connections between our behaviors and risks are pretty solid, and we know this to be true. Then we go the very next step. We take some data from somebody like Dr. Caldwell Esselstyn at the Cleveland Clinic. Dr. Esselstyn has been treating cardiovascular disease with healthy lifestyle.

You see this image right here? This is the left anterior descending coronary artery. This is a 55-year-old male. You see this very opaque, occluded, blocked-up artery right here? That is that same artery six months later after lifestyle change. There’s no stent. There’s no medication. The only thing that changed for this 55-year-old male was lifestyle change. This is what we actually consider reversal. This is reversal of disease.

Here’s a 65-year-old female. Very tight bend in that artery right there. That is that same artery after lifestyle change six months later. I think these are exceptional cases. I don’t think the average American can change lifestyles and get this dramatic of reversal. Now, I think it’s possible, but you’ve got to work hard. Most Americans aren’t willing to work hard.

So we’ve been doing these studies, and a lot of other researchers have been doing these studies. In fact, when we take a look at the clinical trial datas, it’s pretty good. But when we open it up to the epidemiological data it’s even more compelling.

I would like you to think of anybody you know in your family, your neighborhood, your work, who has cancer. Let’s ask a very simple question. Of all the people in the United States who have cancer, what percentage of those cancers are lifestyle related? In other words, what percentage of those cancers are due to poor physical activity, tobacco use or an unhealthy diet? Very simple question. What percentage of those cancers were there because these people chose poorly?

Based on the epidemiologic data, and this data continues to grow every single day, it’s 61 percent of – 71 percent of all cancers. Seventy-one percent of every cancer in the United States can be explained by those factors. Seventy percent of every stroke can be explained by those three factors. Eighty-two percent of every heart disease factors can be explained by those three factors. And ninety-one percent of all Type II diabetes can be explained.

Wait a minute. Surely there must be a genetic component to this somewhere. I mean, genes, genes everything. We’ve got the human genome project, and we’ve got the NIH that spends a whole bunch of money in this area. Oh, that’s right. Genes are here. Genes are this top piece. It’s the piece that’s missing. It’s this segment at the very top of this chart that is genetic or un-modifiable environmental factors.

I think this chart right here is the most telling part of this presentation because what it says is the majority of chronic diseases that we’re treating in this country – and by the way, I can add to this list. We’ll let Dr. Malici talk about the data on Parkinson’s and Alzheimers, and we can put that on this list now. They very much appear to be lifestyle related.

We can put COPD, chronic obstructive pulmonary disorder, up here. We can put erectile dysfunction in males up here. Most of it appears to be lifestyle related.

Okay. Let’s connect the dots a little further. Unhealthy behaviors in the United States leading directly to health risks, those health risks leading directly to chronic disease, and you know what’s next. This is where all the cost is. The healthcare cost burden, the majority of that burden is being spent right here on chronic diseases. And the basis for most of those diseases is here with behavior.

So I just want to take you on a quick little journey today, and I just want to share this data with you and show you these results. Now, in all of my travels I came across an amazing organization. I’m going to have a little quiz with you this morning. I want you to tell me who you think this is.

This organization, since you’re in the healthcare area you should be able to figure this out, this organization delivers basic medical care very inexpensively. This organization delivers it to the masses, not via house calls, but they still get it to the masses. This organization doesn’t allow for insurance billing or TPAs, third-party administrators.

There’s no reimbursement for this group. This group developed and used disease identification tools and methodologies. This group has substantial clinical lab work expertise, and this group delivers health content to 130,000 lives every single day.

Any guess as to who this organization is? This is Lowe’s. You know, the home improvement company, Lowe’s? Look at it. Here’s the data. Here’s what they’re doing. And these top three right here, they’ve got onsite clinics. To heck with you and your clinic and your hospital, we’re going to do it ourselves. We’re going to hire a physician’s assistant or a nurse or a doctor to come on site and we’re going to have these onsite clinics.

And we’ve got a health risk appraisal that also has biometric screening on it. And that’s where their lab work comes from. They’re doing HDL and LDL cholesterol at Lowe’s. In addition to drywall and nails, you can get your HDL cholesterol checked if you’re an employee at Lowe’s. And then lastly they’ve got a web portal where they’re delivering their wellness.

Isn’t it strange that a company that produces home improvement materials is doing this? I mean, don’t they have other things that they should be spending their time on, like sales and service and customer support? And yet, they’re measuring hemoglobin A1C at Lowe’s. Isn’t that – if you think about it, isn’t that weird? Lowe’s has other things to do, and yet they are providing these services for their employees.

There is an enormous disconnect between our current healthcare system and the real world. Now, Lowe’s and a variety of companies out there, have to deliver behavior change programs to their employees, and here’s the reason why. And this is why I get anxious speaking to this group. Lowe’s and all the companies like Lowe’s, are the only players, for the most part, the only major players in this whole landscape that stand to make money with behavior change and prevention programs. And it’s not that they’re going to make money at Lowe’s. It’s that they’re going to lose less realistically.

Now, an insurance company that is very serious about employee behavior change could stand to continue to bring in their premiums and save money by spending less. That’s true. I’m not sure they’re fully engaged in that yet. We’re talking about it. But worksites are the only group that is serious about this.

So we’ve taken this data from Lowe’s. And we’ve taken data from all of the published studies that have looked at the return on investment for these wellness programs. And I’m going to use that as my gold standard because, frankly, I don’t believe your marketing and sales data. I know how sometimes it works, and I want to believe you, but the best evidence we have says take your data, turn it over to some peers and let’s see what the peers can do, the peer evaluation process can do to this data.

So we did this little study. By the way, this right here, this is our current healthcare system. Now, you joke, but it’s true. I checked the data for the D.C. metro area. I looked at the mortality data for this area for the last 23 years. The death rate in the D.C. metropolitan area hasn’t changed 20 years. It’s still one per person, right? Everybody in the room is going over the falls. Everybody. The only thing that’s up for debate is when and how.

Our current healthcare system is here. Has anyone in this room got a postcard or a phone call from their dentist recently? Anybody? In the far back, gentleman in the blue shirt, what does your dentist want from you? It’s true; she does want your money.

“Hi, how you doing?” Maybe it’s your birthday or whatever. “Come see us. Let’s do a cleaning. Let’s do a fluoride treatment. Let’s take care of this. Oh, if you do have a problem, we can take care of that too.” That’s not the healthcare system; that’s the dental system. The two are not the same.

This system is not a healthcare system. This is a disease care system, and it is the best disease care system on the planet. If you have disease this is the place to be because we have the best treatment in the world. But it’s not a disease prevention system. If it really were a disease prevention system, you’d get a postcard from your doctor saying, “Sally, did you know that the safe, recommended amount of trans fats is zero? Come see me and let’s talk about how to help get trans fats out of your diet.”

If that’s what the system was designed to do, that’s not the same system. There is no money in prevention unless you’re an employer, and then there’s some money available in this.

We took all the published data in this area, and we came up with this calculator. It’s called the ROI calculator. It’s at WellSteps.com. It’s free.

We basically said put in your healthcare spend, annual healthcare spend. Give me your annual healthcare cost increase in percentage and the number of benefited employees. Now, I don’t want anyone to get upset. This is Blue Cross/Blue Shield of North Carolina. I’m going to be there tomorrow. They spent $41 million for their 4,500 employees.

So the insurance group, Blue Cross/Blue Shield of North Carolina, has 4,500 employees, and they spent $41 million last year for their employees, and it went up 11 percent per yet. I think it’s great that our insurance carriers are struggling under the burden of increased healthcare costs because I thought they were part of the problem.

So this is Blue Cross/Blue Shield North Carolina, and look what happens. The red line on the calculator is if you do nothing this is your healthcare spend going forward. You spent $41 million last year; it’s going to be $45 million; then $50 million; then $61 million. We know where it’s going.

If you put together an effective employee wellness program, look what happens. This is the green line. The green line is a high-impact employee wellness program. The difference between those two trend lines is really what this discussion is about today. This piece right there.

Now, here’s my anxiety. I am totally confident in that right there, and I’ve got 37 papers to back it up, very well-designed academic papers that say companies that do this well can bend that trend down about that far. That’s how much of a healthcare cost we can really, dramatically impact with wellness.

It’s this part right here that worries me because all the healthy living in the world, all the exercise, all the seatbelt usage, all the flu shots, all of that combined will do nothing to change that increase. Where is that increase? Well, that’s pharma and malpractice lawsuits. And it’s high-tech equipment. There’s professional salaries in here. And there’s an administrative layer in here.

And by the way, it’s you. It’s the people in this room that are this piece right here. Somebody in this group is paying me to be here today. I too am part of the problem. This piece right here, I don’t know what to do about that. Massachusetts has opened up their healthcare system to just about everybody, everybody but about 4 percent of the population. And that 4 percent doesn’t want healthcare anyway.

I think the fact that they’ve got greatly distributed coverage is wonderful. Anybody know what their problem is up there? They’ve got a problem. What’s hampering the big experiment in Massachusetts in their universal coverage? Cost. Cost is killing them. Cost is this piece right here. Well, that’s the wellness piece too. Theirs is the whole piece.

So even though they’ve expanded coverage, they’ve done very little to control cost. I’m going to challenge Melinda – is it Melinda? I don’t know how we do this. I don’t know how you expand coverage and you don’t address these. Because all the wellness in the world is not going to make this problem go away. They’re going to continue to go up.

So I’m at Lowe’s. I’m at whatever company, and my costs are going up and I’m in trouble. And this is what Alan referred to earlier. This is the percentage of the gross domestic product that is for healthcare. Right now we’re at 16 percent. It used to be 5. Don’t you wish your 401(k) plan looked like that? Wouldn’t that be great?

So we have some evidence now, and Alan alluded to this, that in nine years from now – the paper just came out – in nine years we expect that number to be 20 percent of the GDP will be for healthcare. Twenty percent. All right. That don’t mean anything to me. That number, that’s a crazy number.

This means something to me. You see this right here? This green line right here, this is the average salary for a bunch of employees at a manufacturing plant in Franklin, Kentucky. I was there. I worked with them. This is payroll. The average employee makes $26,000.00 a year. And going forward, that green line is what we project payroll to be per person at this plant.

Then we plotted their healthcare costs. This is the red line. The red line is their healthcare costs going forward. And right there, 12 years from now, those two lines cross. What does that mean? It means 12 years from now this company will pay more for healthcare cost than they do for payroll per person per year.

Now, I know for a fact that’s never going to happen, but this discussion that we’re going to have right now is happening at companies and organizations all over the United States. I know that’s never going to happen.

So what can they do about this? Anybody? What’s this company going to do? They can stop insuring them. “We love you. We care about you and your families. You’re on your own. We can’t afford to do this anymore.” That number goes up by 47,000 lives every single month. “I’m employed but I’m not longer covered.”

Okay. That’s an option. Give me another option. The Lowe’s model is let’s get serious about wellness and changing the behaviors. That’s what they’re focusing on right now because they don’t like any of the other options. The other option is let’s just shift costs. It’s cost shifting. You employees are going to pay a greater and greater portion.

We’re going to take a piece – we’re going to continue to play that game. I have a high-deductible plan myself, a high-deductible has. It is the ultimate form of cost shifting. They have taken almost the entire cost and given it to me because if I go to the doctor, the first $5,000.00 comes out of my pocket. Frankly, I love it. It’s great for us, but I don’t know if it’s going to work for everybody else. It’s cost shifting and it works perfect for us because I’m self-employed, or a small group anyway.

They can send their manufacturing south of the border. This is a – they make torsion bars for the front of cars. You can do this in Tijuana a lot cheaper than you can do this in Franklin, Kentucky, and they don’t have to pay for healthcare costs.

It’s not that NAFTA, the North American Free-Trade Agreement, has opened our borders and they’re pulling these jobs out of the U.S. It is that we’re pushing jobs out of the U.S. because we can’t afford to do this anymore.

In November of last year, almost a year ago, I was in St. Louis with the Federal Reserve Bank. What would the Federal Reserve Bank want to do with a wellness guy? This is what’s happening. And I – this is part of angst in this discussion.

What’s happening now is that we have a large number of organizations in the U.S. who are shipping their employees overseas or their services and manufacturing overseas or south of the border. Why? Because it’s so much cheaper to do it outside the U.S. than inside the U.S.

And as we continue to push jobs, not pull them out, push jobs out because of this, it is going to affect the very economy in which we live. It is going to be a constant drag. I call it an insidious cancer that is going to eat away at our very core economy until something changes. And I don’t think it’s – I’m just talking about that bottom piece of that curve. I’m not talking about the wellness piece. I’m talking about that other part of this cost that I don’t have an answer for. But it is going to continue to drain.

I suggest you do this. Go home. Do nothing. Forget this meeting even happened. You’ll be back because your cost as an individual, as an employee, is going to go up. It’s going to go up every single year at a rate much higher than your salary is going to go up. The pain will continue.

I wish it would just implode like our financial system. I wish it would just go boom, and the sky is falling, and someone like Henry Paulson would show up and say, “Oh man, we’ve got to fix this. Here’s $700 billion.” Wow. It’s over. We fixed it.

This is going to eat away at our economy for a long time. So I’m thinking 16 percent now of the GDP, if we go forward – I did this little analysis. Now, I’ve got my PhD, and I’ve been doing a lot of this statistical work. I said let’s project this trend forward. We’re at 16 percent now. How bad is it going to get?

So I projected this trend way out into the future. And right here on this day, January 1, 2226, right there, 200 years from now, 100 percent of the GDP is for healthcare. Ah, there’s something wrong with my numbers. That can’t work.

And I thought about it, and I thought about it. How can it be 100 percent of the GDP? And the more I thought about it, I figured out that on that day, 200 years from now, every man, woman and child in the United States will be a doctor, and we will take turns treating and billing each other. That’s it. No more insurance. No more brokers. No more employers. It’s all healthcare.

Now, we’re not going to get to that point. That’s obviously going to change. But it’s bad, and it’s going to get worse. Twenty percent of the GDP, that’s 20 percent of every dollar in the United States is connected to the system. It’s going to get worse.

The part that I know for a fact we have a control over is this piece right here. This is the one piece that I know you can – it’s your destiny to control this. It’s because behaviors are driving risk. Risk is driving disease, and disease is driving cost.

As the cost of healthcare continues to go up, we’re going to marry that with the changes in health risks in the U.S. population. Our behaviors in the U.S. have never been worse. We have had wonderful, lifesaving advances, but the overall prevalence and incidence of the major chronic diseases hasn’t gone down much. In the last ten years it hasn’t changed. We still get the diseases; we just live longer with them. That’s expensive.

Let me just, a little quick whirlwind tour. You’ve seen the obesity maps. I know you’ve seen these. This is – these four – these states in 1985, 10 to 14 percent of the adults were obese in 1985. Nineteen ninety, 1995, 2000, 2005, and the most recent data you haven’t seen, 2007. Now we’ve got Tennessee, Mississippi, Alabama, greater than 30 percent of the adult population is obese.

It would appear from this data that gravy has become a beverage. It starts right here. It’s bottled in this part of the country and it’s shipped all over the United States. It’s made it as far as Alaska.

It’s getting worse. There is a paper in public health six months ago that said of this increase in healthcare cost, what are the players? What are the causes for the increase? The biggest single factor, 29 percent of the increase, is due to increasing body weight. Obesity. Obesity is explaining 29 percent of the increase in the total cost. And obesity is going to continue to go up.

So I went a little further. I said this is just obese. Let’s just take overweight. This is a BMI of 25 or greater. Look at that chart. This is a percentage of the United States with a BMI of 25 or greater. It’s now at 67 percent of the adult of population.

Once again, don’t you wish your 401(k) looked like that? It just keeps going up.

Obesity Research, two weeks ago, said if we just take these trends and project, how far is this thing going? I mean, what’s the ultimate outcome? Their data suggests that in the near future, the percentage of the United States population adults that are obese or overweight will equal 86 percent.

Now, that’s been revised twice by two different groups. That’s their estimate of where this is going. Oh, but it goes much deeper than this. The obesity epidemic is tied directly to the Type II diabetes epidemic, and the CD has maps for those. You probably haven’t seen these. This is diabetes, and this is 1990. These four states, 6 to 8 percent of the adults; 1992, 1995, 1996, 1997, 1998, 1999, 2000, 2001. The maps for obesity and the maps for Type II diabetes are very closely correlated.

So now we have Florida, Mississippi, Alabama, greater than 10 percent of the adult population is Type II diabetic. We’ve known this is coming. And you remember the Healthy People 2000, Healthy People 2010 reports? Here’s some strategic goals; we’ll aim for those.

Okay. Here’s where it started right here. Here’s where – this is the obesity per 1,000 – excuse me, diabetes. In the ‘80s we knew that this thing was increasing. And the federal government said let’s set some goals and standards to do this. So we got an increase, and we said, okay, boom, right here, Healthy People 2000 was at that point right there. This is the goal. We don’t want to exceed this for Type II diabetes.

And look what happened the next five years? Boom. We blew through that, and we went a little higher. And then the 2010 Healthy People goal came out and said, okay, let’s just raise it up and say we’re not going to cross this line. This is far as we’re going. So we set the line right there in 2002 in Healthy People. And we blew through that.

And now, we go ahead, and this is what we estimate our three scenarios going forward. It’s going to get way worse before it gets better. I don’t see much to change this at all, very little to change this. It’s what we have become.

We, as Americans, are part of our culture. The culture in which we have created has created nutrition and physical activity behaviors that are not conducive to good health. So my question that I always like to ask is how did we get this way? I mean, what’s brought us to this point? Well, I can tell you what’s brought us to this point.

[Plays song sung to tune of “Big Rock Candy Mountains]

So we buy. We purchase, right. Do you recognize these characters? You do because you’ve seen it over and over and over. Do you see the waist-to-hip ratio on the captain? Do you see that waist-to-hip ratio? That’s cardiovascular risk right there. We know these characters. We know what they stand for. We know their names.

And you know the tagline that goes along with these. It goes something like this. “These cereals are all part of a balanced, nutritious breakfast.” You have bought the message hook, line and sinker. You’re part of the system that we have created, and it is contributing to this.

It’s not the sole source of this problem. It goes much deeper. In Texas the K through sixth – K through sixth grade, they don’t have recess. Did you hear that? Can you imagine grade school without – they have quiet, study time because recess cuts into valuable learning time. Are you crazy? Our culture has changed, and we have changed with it.

A few have been able to create an alternate culture, like myself. I exercise regularly. I eat a diet consistent of foods very close to their natural form. That ain’t what most people are eating. I’ve created an alternate culture for myself and my family, and we live in this little subculture within a culture. But our culture is heading in the wrong direction very, very quickly.

Now, I’m not going to have time to elaborate on some things I wanted to show you, but I am going to jump ahead to this one right here again and just make a few more comments.

We have some great data on all these different things that wellness programs do. By the way, we’ve got great data on wellness programs and preventative screenings, but as far as what I would consider very good published data on the rest of these pieces, nurse hotlines, case management, disease management, I’m saying the jury is still out.

They may work, but the studies that we’ve been doing and the academics have been doing, I’m not convinced, except for those two pieces right there. Because the return on investment for healthcare cost is a dollar in and three and a half out and a dollar in and six and a half out on absenteeism.

We’ve got great studies to publish this. And I showed you the calculator, and I showed you this piece right here. The discussion from here forward is focusing on that piece right there. That’s the only piece of all of this that we’re going to have any impact on today.

The argument is really this. I don’t care if it’s the McCain plan or the Obama plan or whatever that plan is, it’s going to have to address cost. And cost boils down to this very question. Who in the room today is willing to make less money? Am I right? Who in the room is going to make less money? I don’t care if you’re a provider or a carrier or a broker or a lawyer. I don’t care if you’re a pharmaceutical company.

If this really works, first off, this piece is going to make – you’re going to make less money here. At its core – and we can have debate. We can do discussions, and the panel is going to give you their opinions. In my opinion, somebody is going to have to make less money. How you package that, whether you ration services or you cut back or you negotiate or whatever it is you do, unless you do that, this part of this discussion is over.

And I’m just going to speak my last frank words here. I don’t think it’s going to change. I don’t think we have enough willpower to get together as a group and say, all right, we’re going to solve this. I see it being like every other aspect of our economy where people will drive it into the ground and make as much money as they can for as long as they can. And then something will rise out of the dust. I don’t know what that is, but that’s my opinion.

I wish there was another option. I can’t think of one. I only know of that piece right there, and that piece right there has great data, and I can tell you hundreds of companies who do this really, really well.

Let me end with this last note right here. Do you see this? This is the average lifespan in the United States. We make it to 76 years of age. And through our life we get sick and better and sick and better. And right here we have a critical event. Our health gets worse and worse, and then we pass away. This is about a seven-year period of poor health.

If you’re willing to change behaviors, look what happens to this timeline. You still live – you live much longer. You still have illness that ebbs and flows throughout your life. You still have end-of-life illness. But when you compare the two, the top group is where we are. The bottom group is the timeline that you can be on if you want to make behavior change.

Both scenarios end in death. This one has one-third end-of-life illness than this one. But best of all is this piece right here. This is 10 to 20 years of high-quality life that you can enjoy that’s not on this timeline. Beyond all the financial costs and all the healthcare data costs, there’s a 10 to 20-year gain in high-quality life for individuals and companies who want to make behavior change.

For me, I personally, I don’t like this. I still don’t like that end-of-life thing. I don’t like that illness that’s towards the end of life. I want to be 94 years old. I’m going to be snowboarding with my great grandchildren. I’m going to hit a tree. Boom. Right there and it’s over. So I’m going to compress my illness into about four seconds. That’s kind of – that’s personally why I’m in it. That’s what I’m in it for. It changes my life.

All the slides that I’ve presented here are up on the website with the ROI calculator. They’re at WellSteps. You’re free to download any of those you like.

Thank you, and good health.