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Are We Reaching the Tipping Point in Health Management?

by Scott MacStravic

We have been moving toward the adoption of health management as at least part of the solution to our “healthcare cost crisis” for decades, though with something close to glacial speed. The growth of health insurance, and its decisions not to pay for the limited amount of health management advice and support given by family physicians had forced that approach out of traditional medicine. Consumers’ belief that we could behave in as unhealthy a way as we liked, then get “fixed” by third-party-covered sickness care when the consequences arose limited personal efforts.

But employers began investing in “worksite wellness” in the 1970s, though their focus was mainly on reducing healthcare costs, with perhaps sickness-caused absences an added idea for some. And as they became slowly aware of the impact of employee health on workforce productivity and performance, not merely health, workers compensation and disability insurance costs, they have become far more likely to invest in health management for their workforces.

Insurers started managing disease, rather than health, once they recognized that roughly 75% of all healthcare costs came because of chronic diseases. But they have also recognized, gradually at least, that preventing the onset of such diseases can save far more than managing them once initiated. And they see health management as a way to attract and keep more employer clients for the added economic benefit to business it delivers.

Specialized disease and health management suppliers have emerged slowly over the past three decades or so, and an increasing number have expanded from limited focus on the most expensive consumers when serving insurers to managing the health of entire populations for employers and the insurers who seek greater economic benefit for their employer clients. They have been joined by employers and insurers, along with traditional healthcare providers offering their own health management services to employers and Medicare/Medicaid beneficiaries.

Governments were the slowest to recognize the health management potential, and have focused primarily on disease management since they function primarily as insurers, and of unemployed populations. They seem to manage to reach equivocal decisions about disease management in general, rather than recognizing that the success of some examples should cause them to focus on the methods that do work, rather than condemn the idea because they all don’t work.

More recently, private enterprises have joined the movement. Concierge medicine began and continues with health management as a major distinguishing focus to differentiate it from traditional medicine. A growing number of traditional practices have become “hybrids” mixing retainer-based, health management services to traditional primary sickness care for a handful or few hundred of their current patients.

Retail clinics such as the RediClinic chain have added “Stay Well” services to their “Get Well” sickness care array. Major pharmacy and retail chains have become hosts to and even owners of retail clinics that end up functioning as worksite health and sickness care sources for their own employees. And most recently, examples such as Wal-Mart and Walgreen have gone a bit further toward health management.

Wal-Mart’s CEO described its plans to help employers (and insurers, as well) cut their prescription drug costs. [“Wal-Mart CEO Lays Out Plans to Help Other Employers Cut Health Care Costs” Workforce Management, Jan 24, 2008] With its long history of working with its product suppliers to minimize their operating costs, it is a natural fit, as is its efforts to promote the development of electronic medical records and other technologies that can be used for managing health, as well as sickness.

CVS had already moved into the pharmacy benefits and retail clinic businesses, and its archrival Walgreen has gone one step further by buying two companies that offer onsite medical clinic services to employers, I-trax and Whole Health Management. [J. Goldstein “Walgreen Continues March into Health-Care Delivery” Wall Street Journal, Mar 18, 2008] With its chain of Take Care Health Centers, along with its worksite centers, Walgreen will have more than 500 locations where it can offer health management services. [B. Japsen “Walgreens Expands into Work-Site Clinics with Acquisition” ChicagoTribune.com Mar 17, 2008]

According to Malcolm Gladwell, author of “The Tipping Point”, a “tipping point” is the stage at which the momentum for change becomes unstoppable. It is bound to be difficult to determine whether this stage is reached before there is a clear “tip” toward change, but the accumulated developments in recent years in health management certainly look close. Recognition is growing that health management is the only way we can afford to pay for sickness care, i.e. by reducing the amount of sickness that has to be cared for. The far greater value of healthy employees and citizens compared to prevailing numbers of sick ones is being recognized by essentially all stakeholders, even hospitals, physicians, other medical professionals and complementary/alternative medicine practitioners, even though they may now depend mainly on sickness care revenue.

Once stakeholders begin to work together on what is becoming their shared goal of reducing the incidence and prevalence of disease and injury, it seems likely that the tipping point will have been reached. And from the kinds of activity mentioned above, that point appears to be at hand, or at least clearly in view.

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