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Healthcare Providers as Health Managers: Clock Issues

by Scott MacStravic

Okay, I admit that had I not begun with an obsessive commitment to “C” issues, the title of this piece would have been “timing” rather than clock issues.  But it is clear that deciding when the ‘clock starts running’ is a key element in health management (HM), for not only providers but all current and potential payors, as well as for consumers.  And generally speaking, nobody seems to start the clock early enough.

The total challenge of health management is to reduce the incidence and prevalence of disease and injury, in order to reduce sickness care costs, productivity and performance impairment, as well as move personal health and employee performance into “better than normal” range.  Different payors have different notions of what is the most important goal, and how best to achieve it, as well as when they should begin.

If it were up to healthcare providers, the time to begin is probably pre-pregnancy in preparing mothers for healthy pregnancies and having healthy babies.  During pregnancy has already been cited as a great point in time to prepare parents for promoting optimal health in their babies after they’re born, from healthy diet to immunizations to child development.[W. Boggs “Better Prenatal Education May Improve Childhood Immunization Rates” Medscape.com Aug 16, 2007]

Preventing childhood obesity is known to be vital for their future health, and preventing metabolic syndrome among children would avoid the fifteen times higher risk of heart disease that this risk condition creates for children. [“Metabolic Syndrome in Kids Ups Adult Heart Risk” Reuters.com Aug 7, 2007]  Teens are among the most susceptible to adopting unhealthy behaviors such as smoking, alcohol and drug abuse, which can condemn them to lifetime addiction.

Insurance plans are increasingly tailoring minimal health insurance coverage for young adults who already see themselves as invulnerable, but if they do not include coverage for risk prevention, at least, they are only adding to the likelihood that when they are older, they will also be sicker.  While capturing them early makes it easier to convert them to more complete and expensive coverage, it could also ensure that they will be more expensive members than is necessary, unless health promotion and risk prevention/reduction are lifetime pursuits.

For younger workers, often with minimal skills and low wages, their employers often deny coverage of health insurance of any kind, and certainly don’t invest in their long-term health.  But when these workers get older, they will likely be expensive risks and performance-impaired due to lack of health management by anyone.  And with older workers, Medicare should worry about what their health will be like when they retire and become eligible for government-paid coverage.

The great disadvantage this country has is the unsystematic plurality of efforts to manage health.  All kinds of different organizations, different providers, payors, and advocacy organizations approach their own narrow segments of the population, their diseases or risks, and their times of life, while there is not even a systematic, lifetime framework upon which they might coordinate their efforts for greater efficiency and effectiveness.  The free market is not capable of doing the job when there is no organized market for lifetime health management.

Clearly, all the stakeholders involved, from insurers to consumers to employers to governments and providers – could get together in an integrated effort to create a health management system.  And until we have the will, shared by enough of these to make enough difference, we can predict that the healthcare crisis will never be solved, and the potential of healthy children, workers, parents, and aging will never be realized.  The clock for health management ticks from even before birth, and continues until death, but we haven’t yet timed our health management efforts accordingly.

As far as I know, not even healthcare providers are organized around, nor do they have a lifetime health management structure to apply to the challenge. But at least they include among them specialists in every phase of the individual life cycle, so may have the best foundation for the job.  But it will take the cooperation of all the other stakeholders to make lifetime health management work, and so far, nobody seems to have even stepped up to the plate to take on the challenge.


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