
I had a good conversation with my friend and colleague Tom Emerick this morning, following an active thread among our little “think tankers” group. As you may recall, Tom is a consultant to corporations nationwide, following a long career at the helm of some of this nation’s largest corporate health care benefits plans – as the health benefits executive at employers like WalMart, British Petroleum and Burger King.
Our think tank is made up of a cross-section of thinkers in the health care equation. Everyone of us welcomes debate, criticisms – no one’s ox is protected. We are a microcosm of what we wish were taking place out there.
Physicians like Richard Young, Guy Culpepper, Jay Haynes and Bob Kramer – all primary care docs who have been stumping for the cause of primary care medicine – and practicing, writing, teaching and speaking out about why we need a healthy, strong system of physician “comprehensivists” (my new word) to help straighten out the misguided spending spree we’re on. Richard has written a great book (American HealthScare) that skewers the GIMeC – “government industrial medical complex”.
Brian Klepper, PhD, a health policy analyst has been super active in writing and speaking about the cause of primary care and the demonstrable advantages of employer on-site primary care clinics to rein in mindless spending, because employers are our last bastion of potential to plug the terrible leaks in our system.
Authors, thought leaders and policy activists Rosemary Gibson and Shannon Brownlee have been outspoken and influential at places like the New America Foundation, The Dartmouth Institute For Health Policy, The Robert Wood Johnson Foundation and the American Enterprise Institute. They need no introduction to those who are well-read on the subjects of medical waste in our economy and the harm it is doing to us in the name of profits that push the health care players to peddle more and more of what we don’t need.
All these rich thinkers have kept my mind active, and have eagerly and willingly committed their thoughts on the subjects that matter in the effort to fix of our American healthcare ship without a rudder.
WELLNESS FOR THE MASSES
Our latest thread (ire) has focused on the myth of “wellness” that has been around forever and that hospital systems and insurance companies (and their brokerage “consultants”) have been pouring into our heads in the hope that this feel good crap will lull us into ignoring essential truths. By the way, one of these insurance brokerage “consultants” states on their website the following when it comes to their wonderful new “Angies List” approach to solving employers’ health care problems …
“In a word, say the executives of ACAP Health Consulting, the real enemy is disease—and the way to defeat it is with a collaborative effort that involves all stakeholders: employers, employees, hospitals and doctors, and insurance carriers.
Key to ACAP Health’s approach is the implementation of common-sense strategies to prevent the onset of lifestyle-related conditions like obesity, Type 2 diabetes, heart disease, and some forms of cancer. Results thus far show dramatic improvements in participating employees’ health and quality of life, coupled with significant reductions in health care costs and insurance premiums.
Really? Let me quote some of our “think tankers”, on a day that one of Dallas’ big hospital systems announces a major new push to make us all feel good about wellness – (and them about their profit potential s as more of this drivel wins over gullible employers and their employees).
Richard Young, MD writes:
“As a physician, I can’t make a well person weller. And as I point out in my book, for most common services we provide in healthcare, an ounce of prevention costs a ton of money.
I’ve actually been wrestling with this concept for awhile, trying to come up with a pithy saying that more accurately reflects the goal in cost-effective care. My current working aphorism is stability. We should be promoting stability in patients, not wellness”.
For example, a person who has a bad case of heart failure will never be well again. A reasonable treatment goal might be to give him enough medicine to keep feet just barely swollen, but not too much so that he passes out when he stands up, but enough so that he can sleep reasonably well on 2 pillows at night. We want that state of health to remain steady for as long as possible — his heart failure will naturally get worse over time — but with good primary care the medications can be adjusted to try to keep this level of health stable. When he destabilizes from that state, he will feel bad and then seek care in an ER, and often get admitted to the hospital.
Similar stories could be told for patients with COPD, diabetes, and bipolar disorder. Spending a lot of time and effort on people who feel fine and have no severe chronic diseases never saves money.
Tom Emerick writes…
I see nothing in this but health and wellness and value-based purchasing rehashed.
They are using none of the right language to suggest they are going after misdiagnoses, overtreatment, over-surgery in the US. In short it looks to me to be just another effort to micromanage 20% of an employer’s health spending. “Let’s stop the blame game and start working with high value doctors.” We need action on the aspects of health care that are truly broken. If they had said they were focusing on the outlier population (where the huge costs reside) ….I might feel differently. Or if they said they were targeting overuse and over treatment…but alas. We have to get this message out.
The employers of DFW do not need more collaboration. They need action on the causes that are driving us into a wall. We offer action now.
Shannon Brownlee contributes …
“Re: looking for incipient signs of illness in well people not only doesn’t save money it often turns a well person into a patient and sometimes does him harm.
Anybody see the piece on cancer screening in the Science Times yesterday?”
And …
“The only way wellness saves money is by changing the survival curve and compress morbidity. As far as I can tell, there’s no treatment or health regimen that does that. There might be some argument for wellness programs saving money if they push off expenditures on illness to a later date, but the only way we are going to save money is by paying less per unit of service and/or cutting out the incredible amount of waste/over treatment/high tech useless stuff and futile rescue care at the end of life.”
Guy Culpepper, MD writes
The Wellness/Health Promotion jargon has been abused by multiple entrepreneurs looking to justify their efforts to capture healthcare dollars. No evidence exists that anyone is more effective at slowing disease progression than a good family doctor.
Yet sadly, employers desperately seeking to stop the bleeding have paid for this snake oil. And more companies are offering it. It’s a “savings placebo”.
Every insurance company promotes how they “help doctors to coordinate wellness care and prevent disease”. The wider they cast their net, the higher the premium charge.
So now that some margins in insurance companies are threatened, their leadership joins forces with the insurance brokers to create another level of bureaucracy between doctors and patients… ”to help employers talk to doctors”
Brian Klepper, PhD writes …
“Fee-for-service has made healthcare a merchant enterprise. Every product and service delivers a margin, and so the industry does as many as possible. The payment system’s clear incentive is to deliver more care, and more expensive care, where the absolute profit dollars are higher.”
And …
“Unless champions from the business community outside of health care arise, we may be doomed to stand by as a rapacious health care industry sucks the rest of the American economy dry.”
Readers of DocOnomics, I can’t add anything more or better than these comments of the people who make me smarter by the day. Their knowledge, opinions and insights give me hope that if enough people form reasoned thinking about the gigantic economic conspiracy taking place in this huge health care sub-economy, we might have a chance to avoid the inevitable – where everybody is standing around asking “what happened”.