The Importance of Prevention in 2010

Against a backdrop of upheaval and debate in the health care industry, a paradigm shift is quietly taking place—the transformation from a reactive, treatment-centric health care system to a proactive approach focused on prevention. Regardless of the outcome of any legislative debate, the American ingenuity that brought us airplanes and artificial hearts is steadily uncovering ways to help people live longer, healthier lives.

The global preventive health care movement is based on a simple premise—saving lives and money by keeping people healthy and treating chronic illnesses before they progress. It represents an entirely new way of thinking, centered on preserving health rather than merely treating disease. Today’s preventive health care programs strive to reconnect patients with health care providers for advice and encouragement at every stage of the prevention continuum—not just when they are sick. Based on the clinical science of preventive medicine, these health management programs move beyond simple wellness to identify an individual’s top health risks and recommend specific actions to avert those risks; detect diseases in the earliest stages when treatments are more effective; and slow or reverse the progression of disease.

Why Prevention?Like most innovation, the preventive health care movement is driven by necessity. The United States can no longer afford a system where 70 percent of deaths and nearly 80 percent of health care costs stem from the same preventable chronic conditions. Employing our collective brainpower and creativity to solve one of our nation’s toughest problems is a natural progression of an American entrepreneurial tradition.

Prevention Matters to PeopleMore than 1.7 million Americans die each year from chronic diseases. Five diseases cause the majority of all U.S. deaths annually—heart disease, cancer, stroke, chronic obstructive pulmonary disease (bronchitis, emphysema) and diabetes. The good news is, although chronic diseases are among the most common and costly of health problems, they are also the most preventable. People can choose to live longer, happier lives by understanding their risks and making lifestyle changes to reduce those risks.

Prevention Matters to BusinessesChronic illness is a growing and costly threat to business in the United States. Health care costs are the second largest expense beyond payroll for most employers. Since 2001, premiums for family coverage have increased 78 percent, while inflation has risen only 17 percent and wages have increased by 19 percent. In order to remain globally competitive, our nation’s businesses need to gain control of health care costs.

Increasingly, companies have turned to wellness programs to improve productivity and reduce health care costs. In fact, more than half of multinational corporations expect to

introduce or expand corporate wellness programs over the next five years.[1] Comprehensive worksite health programs focused on lifestyle behavior change can yield

a $3 to $6 return on investment (ROI) for each dollar invested.[2]

Prevention Matters to the United States…and the WorldIf current health care trends continue, studies show that by 2011, our country will be spending more than $2.8 trillion on health care, representing nearly 20 percent of our GDP. However, only one percent of the money spent on health care is devoted to

protecting health and preventing illness and injury.[3]

According to the Milken Institute, implementing primary, secondary and tertiary prevention in homes and workplaces nationwide would reduce the economic impact of disease by 27 percent—saving $1.1 trillion annually by 2023 and reducing cases of chronic disease by 40 million.

The World Health Organization estimates chronic conditions will become the world’s leading cause of disability by 2020. Comprehensive preventive health care can change this diagnosis.

What is Prevention?As defined by the American Medical Association, clinical preventive health care includes primary, secondary and tertiary prevention. Primary prevention identifies health risks and recommends behavioral changes to reduce those risks. Some examples of positive behaviors include maintaining a healthy weight, staying active, refraining from smoking, drinking alcohol in moderation and avoiding overexposure to the sun.

Secondary prevention detects disease through timely, targeted health screening. Regular screenings for high blood pressure, colorectal cancer, prostate cancer, diabetes and obesity can have dramatic results in preventing the development of disease. Similarly, diagnostics such as CT scans of the heart or lungs, carotid ultrasounds and other non-invasive tests can detect diseases in their earliest stages when treatment is more effective.

Tertiary prevention, also called disease management, encourages adherence to treatment plans and recommends behavioral changes to slow or reverse the progression of an existing condition. Research shows that people with chronic conditions receive less than half of the recommended care they should. Once a condition is identified, following a doctor’s care plan and making behavior modifications such as quitting smoking and managing weight are critical to successful treatment. Care management programs may offer nurse care managers who work with patients, their providers and community resources to ensure members receive the best possible care. With the proper medical care, support and lifestyle changes, people can slow and even reverse the progression of a disease.

The Wellness EvolutionThe health reform debate and subsequent dialogue about cost reduction has fueled demand for a preventive health care revolution. In reality, however, prevention has been an evolution over the course of about 25 years. Today’s programs have the benefit of learning from the mistakes and successes of their predecessors. Early wellness programs focused on group efforts, such as weight loss and exercise. Later programs added group health screenings. Many programs today still use these models, however, evaluating these programs and incorporating the benefits of technical advances has spawned a new generation of wellness. Second generation wellness, also called preventive health care, goes beyond traditional group programs to identify each individual’s top risks and provide specific action plans for averting those risks. The benefits of this increased targeting are twofold: they provide very specific action plans that resonate with participants, and they save money by recommending health screenings to the more targeted group of people at risk for a particular condition. Individuals are less likely to submit to a broad battery of tests than commit to the few tests that address their particular risks.

How does Preventive Health Care Work?Preventive health care works by assessing risks, recommending actions to reduce those risks and supporting people’s efforts to make lifestyle changes.

Understanding RisksParticipants in a preventive health care program can discover their health risks by

completing a brief Health Risk Assessment (HRA) and taking a simple blood test. A brief

questionnaire often available online, the HRA collects information about an individual’s personal health history, health habits, lifestyle and family health history. The blood test,

which can be completed at a local laboratory, a physician’s office or a participating

workplace, screens for dozens of key factors known to impact health. The results are evaluated through advanced technology and review by a qualified medical professional.

Taking ActionOnce risks have been identified, participants receive an action plan that outlines a detailed, step-by-step process for reducing the top health risks. For a woman with a family history of breast cancer, for example, recommendations might include an annual mammogram, a low-fat diet, increased exercise and reduced alcohol intake. The program may then provide action plans for the diet and exercise changes, scheduled reminders for

mammograms and personal health coaching to help the woman achieve the needed changes. Online tools and information may also be available to help her track progress and see the risk of breast cancer diminish.

Getting SupportBecause individual action plans often require lifestyle changes, such as increased exercise, reduced alcohol consumption or following a low-fat diet, understanding risks alone is not enough to sustain long-term behavioral change. We all know we should choose the apple instead of the donut, but habits are deeply ingrained. For this reason, quality preventive health care programs offer support and encouragement through 24/7 nurse hotlines, one-on-one health coaching, contests, group events and even monetary incentives.

Prevention in the WorkplacePreventive health care can be found in the many places people live, work and learn—hospitals

and medical groups; schools, groups and associations; Medicare and Medicaid programs; and programs available online for individuals. The largest and most common area of prevention,

however, is workplace wellness. Preventive health care is a natural companion to health care benefits. Because most people receive their health benefits from their employer, many

organizations wish to reduce their health care expenses, increase productivity and boost morale by improving the health of their employees. The workplace provides an excellent opportunity for improving people’s health. People spend 40 or more hours each week at work and eat one or more meals while on the job. The workplace may also contain health or safety risks that can be addressed with proper safety gear, ergonomic furniture, frequent breaks, onsite fitness or other programs.

Selecting a Preventive Health Care ProgramEmployers who wish to initiate a wellness program have more options than ever to choose from. They can develop an in-house program, use a program provided by their insurance carrier or select a third-party wellness program. However, understanding the issues and options for selecting a wellness program can be a daunting task. Wellness involves federal, state and local regulations as well as other potential legal issues. There are many programs and issues to consider and it can be difficult to distinguish an effective program from ineffectual window dressing.

Following are some key questions employers should ask a prospective wellness provider.

How will you support employee recruitment efforts? Wellness programs can only work if employees choose to participate. For this reason, the wellness provider should offer strong support in communicating the benefits of the wellness program, encouraging employees to participate and guiding them through the enrollment, blood testing and Health Risk Assessment (HRA) process.

Does your program provide personalized recommendations and one-on-one support for participants? While first-generation wellness relied mainly on group weight loss and exercise programs, today’s employers should demand more comprehensive programs based on each employee’s unique health risks and wellness goals. One-size-fits-all does not work for wellness. Employers should look for one-on-one support such as personalized action plans, individual health coaching and 24/7 nurse lines.

Is your program accredited? Wellness providers should be certified by objective, third-party organizations such as the National Committee for Qualification Assurance (NCQA) and URAC, government-sanctioned accreditation entities that evaluate the soundness of a health care services provider.

Is your program independent from insurance carriers? Employees resist revealing personal health information to their insurance carrier for fear that it will be used to raise rates or affect eligibility. They also feel uncomfortable sharing sensitive health information with another employee, particularly someone they interact with during the workday. Because this information is required to assess an individual’s baseline health and, therefore, critical to developing an effective wellness program, ensuring privacy and independence from employers and insurance providers is essential.

How do you protect member privacy? In their quest to improve employee health, companies can be inadvertently overzealous in collecting information and run the risk of violating privacy laws. Even inadvertent noncompliance puts a business at risk of violating state and local insurance laws as well as national acts such as the Health Insurance Portability and Accountability Act (HIPAA), the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), which include privacy protections. Ultimately, compliance is the company’s responsibility and the company will be held responsible and liable for any penalties associated with noncompliance.

How will you measure results? With many cost constraints impacting today’s employers, demonstrating a strong return on investment (ROI) for prevention is critical. By measuring participation, outcomes data and the impact on productivity and health care costs, managers can document the benefits of their programs. The wellness provider should offer a concrete means of measuring individual and group results.

Motivating Employees to Participate

While wellness managers may hope employees will jump at the opportunity to participate in any program that can improve their health, experience shows that it often takes more

than the promise of looking and feeling better to motivate people to change their habits. Incentives encourage employees to adopt new attitudes and make behavior changes that they may otherwise be reluctant to make.

Some considerations when evaluating the right incentives for your company include: Criteria : Why Will Incentives be Awarded?Participation-based – Awarded based on participating in a program.

Example: Completing smoking cessation module or Health Risk Appraisal. Achievement-based – Awarded based on achieving a measurable goal.

Example: reducing BMI by a specific percentage, smoking cessation proven by lab test, lowering cholesterol. Maintenance-based – Awarded for maintaining behavior change over time. Example: remaining smokefree or keeping weight off at one-year and two-year reassessment. Structure: Who can earn incentives?Opt-in – Often referred to as a “carrot,” these incentives offer positive

reinforcement and rewards to employees that engage in encouraged behaviors and/or achieve positive results.

Opt-out Engagement Model – Sometimes called the “stick,” these are actually

disincentives for employees who choose not to participate or to continue

behaviors that are discouraged, such as smoking, or not making attempts to improve biometric measures such as BMI and cholesterol. Types: What incentives can be offered?

✦ Recognition – Examples include paid time off and internal recognition, etc.✦ Merchandise – Examples include t-shirts, gym membership, workout attire,

gift cards, movie passes✦ Cash – Examples include cash awards and tax-advantaged incentives

including allocations to 401 K, FSA,✦ HRA or HSA, and reductions in the employee’s health care premiums.

Other Important Considerations Privacy and Confidentiality - Employees’ personal health information must be protected and be kept completely confidential. Equal Opportunity - All employees should be given equal opportunity to participate.

Create a Sense of Urgency – Employers should establish milestones with

deadlines and rewards for taking certain actions. Example: $150 for registering

and completing the Health Risk Appraisal and Blood work by January 31.

Tax and Legal Ramifications – Employers should consider the tax and legal

ramifications to the employee of cash or merchandise incentives and ensure taxes

are already deducted of the cash incentives. Allocations to health accounts and premium reductions generally are not taxable.

Sustainability – The program should be affordable and sustainable year over year. Employers should be

careful not paint themselves into a corner where employees expect greater and greater incentives eachyear in order to participate. Some Employees will Test the System - Incentive structure should not encourage employees to misrepresent their efforts. For instance, if employees are rewarded for not smoking or for quitting, a blood test for nicotine may be considered versus having employees self report their smoking status. Communications are Key - Effectively communicating the incentives in variety of ways and over a period of time is critical to helping employees understand, trust and engage in the program.

Healthy Foundation - It is important for employees to know the organization is offering the wellness program and incentives because the management team cares about them and wants them to become healthier and happier.

Measuring ResultsThe only way to be sure a wellness program is working is to put a program in place to measure results. Measuring employee participation and health outcomes can provide the objective information needed to motivate and reward employees.

Participation

Measuring employee participation in health improvement programs and screenings offers an initial indication of a wellness program’s success. While participation alone offers no guarantee of results, it provides a gauge of how many employees understand their health risks and have begun a program to address those risks.

Outcomes

Documenting outcomes through biometrics (Body Mass Index (BMI), lipids, glucose, blood pressure and tobacco use) is the most objective method for measuring results. As a wellness program matures, this method can provide direction regarding areas for improvement as well as strong clinical evidence for the success of the program. It is important, however, that employers accommodate people with chronic conditions by

providing modified parameters based on reasonable expectations for different risk categories.

Evaluating ROI

By evaluating the wellness program on an ROI basis, employers can objectively gauge results, make improvements and demonstrate the wellness program’s success. Wellness providers should provide ROI evaluation metrics based on national benchmark data, key assumptions and company-specific information, such as claims data, HRA results, incentives, average salaries and management support of the program.

The Leader in Preventive Health CareU.S. Preventive Medicine® (www.USPreventiveMedicine.com) is leading a global preventive health care movement focused on saving lives and money by keeping people healthy and better managing chronic conditions before they progress. The privately-owned company provides a

suite of innovative wellness; chronic disease management; concierge and care advocacy; and executive health services – all based on the clinical science of preventive medicine. The company is accredited in wellness and health promotion by NCQA and disease management by URAC. The Prevention Plan™, the company’s flagship product, is the world’s first preventive health benefit. Available to employers and individuals, The Prevention Plan (www.MoreGoodYears.com) moves beyond traditional wellness to identify each individual’s top health risks and recommend actions to avert those risks; detect diseases in the earliest stages; and slow or reverse the progression of disease. The Prevention Plan is backed by a highly distinguished medical board to ensure recommended action plans are based on accepted medical protocols and clinical indicators. Since individual action plans often include lifestyle changes, such as increased exercise, reduced alcohol consumption or following a low-fat diet, The Prevention Plan provides members with the support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events and employer incentives. Online education programs teach members to reduce risks and allow them to track results. Members can explore the symptom checker, health library, animations, and daily health news. They can also

use their personal online space to track medical information, medications, surgeries and medical tests.

U.S. Preventive Medicine helps employers objectively evaluate individual and group progress with The Prevention ScoreSM, a private, easy-to-use tool that rates prevention efforts, such as healthy eating, exercise, timely health screenings, and adherence to recommended programs. Employers can also evaluate return on investment using U.S. Preventive Medicine’s proprietary ROI calculator.

In addition to its groundbreaking prevention and disease management programs, U.S. Preventive Medicine partners with top quality medical facilities to offer world-class preventive services and follow-up care. The U.S. Prevention NetworkSM, provides a medical home for preventive services and follow up care, so members can easily access top quality medical care in cities throughout the United States. Beyond U.S. borders, U.S. Preventive Medicine is expanding its

reach with The Global Prevention Network™, which brings together the world’s preeminent

health care providers to offer highly advanced diagnostics, preventive medicine and executive

health services.

U.S. Preventive Medicine also maintains advanced diagnostic facilities, The Centers for Preventive Medicine®, which offer the latest imaging and laboratory technologies, along with extended consultative time with highly-trained physicians committed to preventive health care.In the United States, 70 percent of deaths and nearly 80 percent of health care costs stem from the same preventable chronic conditions. The good news is that, although chronic diseases are among the most common and costly of all health problems, they are also the most preventable. U.S. Preventive Medicine is dedicated to supporting the national transformation from a reactive, treatment-centric health care system to a proactive approach focused on prevention.

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[1] “Working Toward Wellness: Accelerating the Prevention of Chronic Disease” 2007 Survey of CEOs of global

companies, PriceWatherhouseCoopers Health Research in conjunction with the World Economic Forum[2] “Reducing the Risk of Heart Disease and Stroke, a Six-Step Guide for Employers” Centers for Disease Control[3] “Preventive Services” National Business Group on Health