The 56 participants, chosen by the results of the employee assessment, attended a seminar on the syndrome and received guidance on proper nutrition, water intake and exercise. Over the course of a year, they collectively lost half a ton, and more than half saw a complete reversal of three or more risk factors, with an average weight loss of 15 pounds. We hope to impact the entire population of Brinker with this program, says Tracey Posey, work life manager for the company.
Paul Handel, chief medical officer of HCSC, describes metabolic syndrome as a great place to start in terms of wellness because it reaches people early enough in the disease cycle. In April, the Japanese government mandated that all its citizens over age 40 be tested for metabolic syndrome; Japan is also requiring companies to reduce their ranks of overweight workers by 10% within four years and 25% by 2015. Employers that dont reach these goals face financial penalties.
In terms of the bigger picture, integrating the metabolic syndrome program into our services will allow us to take off into care management, Handel says, including diabetes and coronary heart disease prevention. All these pieces at the end of the day will fit together.
HCSC is working with employers to get employees attention. Part of the reason we have a crisis with health is that weve moved away from a sense of personal responsibility, Handel says. Instilling that sense of personal responsibility is part of the job of the insurer, he adds.
Insurers and the government are working together on this level in Indiana, where the state received a federal waiver to redesign its Medicaid program to promote prevention and drive people into health savings accounts. In January, the state began enrolling people in the Healthy Indiana Plan, which covers the very low income uninsured who make less than $35,200 for a family of three. Individuals have a $1,100 annual deductible and an HSA funded by the enrollee, government and sometimes the enrollees employer. But preventive care is not subject to the deductible and doesnt draw from the HSA.
Indiana requires participating managed-care plans, including Blue Cross and Blue Shield of Indiana, to cover up to $500 annually in preventive care, including annual checkups, mammograms and other cancer screenings. For now, participating insurers have chosen not to place dollar limits on preventive-care coverage. There are no copayments aside from up to $25 per emergency room visit. To date, more than 20,000 people have enrolled in the program and many more have applied.
To be sure, insurers are looking closely at the costs and benefits of prevention over treatment. About two years ago, HCSC saw that about 1 million Texans would qualify for bariatric surgery. The plan calculated that each surgery would cost about $30,000 without complications, or a total of $30 billion. We thought about this long and hard in Texas, Handel says. My response was, the pipeline for obese people is filling continuously. We have to cut off the pipeline and do a root- cause analysis.
Thats exactly what leading employer groups are talking about. We need to move the battleship of healthcare upstream to wellness and prevention, says Andrew Webber, president and chief executive officer of the National Business Coalition on Health. The employer and plan need to fit together. But its the employer at the workplace that has the captured audience. Employers need to lead, supported by the plans, and the plans need to lead on provider performance.
Theres much opportunity for employers and insurers to get in better sync on expectations, insurers say. This is not a one-year process, Handel says. But if in one year you can show increased productivity and a decrease in absenteeism, you can prove yourself.