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New Study on Exercise Guidelines

New Study about Exercise GuidelinesDespite religiously biking and working on both the elliptical and rowing machines, I recently learned that my blood pressure is somewhat elevated. I can only assume that this may be caused by my high-salt dietary habits. Having garnered my attention, it’s time to make necessary changes.

The motivation for change was also heightened by a new report on how high blood pressure can possibly be reduced without relying on medications.

A new study published in the American Journal of Preventative Medicine suggests that exercise guidelines from the U.S. Department of Health and Human Services (HHS) might require an update. Here are the new findings:

  1. Weekly Exercise of at Least Five Hours (300 minutes) – The current HHS guidelines suggest that adults should aspire to perform at least 150 to 300 minutes weekly of moderate-intensity exercise. Brisk walking, swimming, and mowing the lawn are three good examples. However, the new study concludes that moderate exercise should be around five hours per week. In other words, if you exercise at 150 minutes per week, you are only half-way to the new recommended level. As mentioned in the study, “Moderate physical activity levels may need to exceed current minimum guidelines to prevent hypertension onset using the 2017 American College of Cardiology/American Heart Association definitions.”
  2. How Five Hours Per Week was Determined – Researchers analyzed a mid-1980’s project that extended for 30 years. Of the 5,000 teens followed, only those who completed more than 300 minutes of exercise every week avoided hypertension. Hypertension occurs in nearly half of all American adults and is defined as blood pressure at or above 130/80mm Hg. High blood pressure levels can cause risk for cardiovascular disease and events, which can be fatal. In 2018, nearly half a million deaths in the U.S. included hypertension as a primary or contributing cause.
  3. Racial Disparities – The new study indicates that Black respondents exercise far less than White respondents. The result? Black individuals suffered more acutely from the effects of hypertension than White respondents. This finding, it should be noted, is not earth shattering. According to the Centers for Disease Control and Prevention (CDC) in 2020, racial disparities in hypertension prevalence is greater in non-Hispanic Black adults (54 percent) than in non-Hispanic White adults (46 percent), non-Hispanic Asian adults (39 percent), or Hispanic adults (36 percent). Hypertension rates also vary greatly by state.

Summary

It is widely known that high blood pressure can be treated by a combination of medication and lifestyle changes. For employers, worksite programs related to physical activities, nutrition, alcohol use, stress, type 2 diabetes and obesity can aid employees in prevention and reducing high blood pressure.

Of course, modifying behaviors is the ultimate challenge to employers, their employees and family members. It begins and ends with finding the ‘right’ motivations to alter lifestyle choices.

As for me, exercising is no problem, and I feel confident that my blood pressure can be reduced by making a few dietary changes that I should have been making earlier. With that said, I really will miss those salted pistachios!

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Tackling Healthcare Spending – One Percent at a Time

One Percent Steps Adding Up to Something BIG?In healthcare, there is plenty of waste…and this waste is enormously costly to those who pay. This unnecessary spending is baked into the outrageous health insurance premiums we pay. In 2019, I estimated that ANNUAL waste baked into Iowa premiums for single and family coverage averaged $2,400 and $6,600 respectively. This translates into nearly 34 percent of all healthcare costs as non-value-added. 

Now, to be fair, there are those who make a living from this waste. Waste becomes a paycheck. Removing this unnecessary payroll, however, will most likely erupt into anguished rebellion. Justifications can always be made by various healthcare stakeholders about the necessity of their ‘value’ in a highly-convoluted and dysfunctional system. Admittedly, some may have a point. 

Six Domains of Waste

In the broadest sense, waste is found in six ‘domains’ of healthcare – as identified by Donald Berwick and Andrew Hackbarth in a 2012 study:

  1. Overtreatment (low value care)
  2. Failures of care coordination
  3. Failures in execution of care processes
  4. Administrative complexity
  5. Pricing failures
  6. Fraud and abuse

Using each of these six broad buckets of waste, my aforementioned 2019 blog provided the estimated impact of waste to health insurance premiums. Eliminating too much unnecessary spending at one time, however, will most likely create a backlash of stakeholder opposition. This may result in missed opportunities to actually fix the expensive leaks in our healthcare ‘system’.

How can costs be incrementally reduced to make a sizeable impact to payers?

One Percent Steps for Health Care Reform Project

According to a February article in Health Affairs, authors Zack Cooper and Fiona Scott Morton discuss implementing a series of one percent solutions that could collectively lower healthcare costs by hundreds of billions of dollars. If you are an employer that offers health coverage, this should grab your attention.

The authors explain their reasoning on using the one percent solutions:

Rather than speaking about health spending via abstractions, we should view high U.S. health care costs as the result of a series of discrete problems that each incrementally raises health spending by a percent or two — so-called ‘one percent problems’. While each problem is unremarkable in isolation, the collective impact of a series of one percent problems can help explain why the U.S. spends more than other nations.

The vastness of healthcare issues require new approaches that disrupt the status quo from being replayed into the future. Doing so begins with smaller steps that make sense. Cooper and Morton prescribe 16 steps that economists and policymakers can take to reframe healthcare spending as a series of one percent problems. These problems, they argue, can be used as a road map for cost reduction. 

If implemented, the following 16 steps would decrease overall annual healthcare spending by nearly nine percent. This amount of savings may not sound impressive, but when nearly nine percent can be lopped off from the health system that absorbs $3.8 trillion of costs, it is an impressive beginning. Each step does not serve as a silver bullet, but rather, an incremental solution that makes sense.

These 16 evidence-based steps are ranked by their projected annual savings as a share of national health spending:

  1. Regulating healthcare provider prices: 1.89 percent
  2. Addressing surprise medical bills: 1.67 percent
  3. Increasing the efficiency of claims adjudication: 1.25 percent
  4. Addressing vertical integration of hospitals and physicians: 0.91 percent
  5. Introducing smart provider networks: 0.83 percent
  6. Addressing hospital consolidation: 0.69 percent
  7. Improving health insurance plan choice: 0.63 percent
  8. Improving plan auto-assignment in Medicaid managed care: 0.24 percent
  9. Reforming how Medicare reimburses biosimilars: 0.21 percent
  10. Addressing orphan drugs: 0.15 percent
  11. Reducing fraud in home health: 0.12 percent
  12. Reforming the payments for long-term care hospitals: 0.11 percent
  13. Decrease cost barriers for living kidney donations: 0.08 percent
  14. Expanding preferred pharmacy networks: 0.04 percent
  15. Eliminating prescription copay coupons: 0.03 percent
  16. Expanding kidney exchanges: 0.02 percent

Zack Cooper, Associate Professor at the School of Public Health and the Department of Economics (Yale), discusses the ‘one percent’ approach in a ‘Creating a New Healthcare’ podcast. He can also be found on Freakonomics Radio, “How to Fix the Hot Mess of U.S. Healthcare.”

As we fight the daily battles of the Covid-19 pandemic, we are reminded that many inherent problems continue to persist in our costly healthcare system. Without action, these problems will not go away. Will market solutions be able to fix many of these issues? The clock continues to tick – and healthcare costs continue upward.

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2021 Iowa Employer Benefits Study
POSTPONED

2021 Iowa Employer Benefits Study POSTPONEDAs many of you are aware, the Iowa Employer Benefits Study was not performed in 2020. The reason was quite simple – the unprecedented uncertainty facing most Iowa businesses during the Covid-19 pandemic. As difficult as the decision to postpone was, it was no doubt the right one.

In early 2020, during the beginning of the pandemic, we attempted to perform the survey and quickly learned that fewer organizations desired to be interviewed, which prompted us to suspend the survey process. The cost to perform surveys increases if more organizations need to be interviewed.

Now in 2021, another tough decision has been made. After visiting with many individuals and organizations, I have concluded that 2021 is just too soon to pursue this important survey.  I could certainly randomly interview 1,000 Iowa organizations, but many organizations are still digging out of massive business and personnel upheavals that will require a ‘reboot’ of their workplace practices.

We understand that many individuals who respond to our surveys are charged with multiple organzational tasks that come with time pressures. My desire is to be mindful of the key issues facing employers and to, yet again, refrain from being an additional distraction during this time. I do look forward, however, to performing an assessment this fall about whether to pursue the 2022 survey. By that time, we will have a much better idea of what changes Iowa employers will have made in their workplaces and how these changes may impact future workplace environments.

I am confident that 2021 will prove to be a year of great progress in overcoming the personal and professional challenges we have all endured.

Please continue to stay safe!

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