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Wellness: Bending the Cost Curve

Wellness and Health Care Costs in IowaWill wellness programs stem the tide of rising health care costs?

That’s the million dollar question.

Health insurance rates in Iowa increased an average of 10.2% annually during the last five years, according to our Iowa Employer Benefits Study©. No wonder employers are looking for ways to bend the cost curve.

So are wellness programs going to provide the magic bullet? I have to say, “Possibly, however…”

There are at least two major forces—upstream and downstream—that adversely affect health care costs, and only one is affected by wellness programs.

  1. Upstream force: unhealthy lifestyle behaviors        
  2. Downstream force: a dysfunctional health care delivery system

Conventional wisdom suggests that if we identify and minimize or treat health risks upstream before they become major (and more expensive), we should eventually incur fewer costs downstream.

I admit there is truth to this. Decrease unhealthy behaviors that lead to the “lifestyle diseases” —heart disease, stroke, some cancers, type 2 diabetes, metabolic disorder and a few others—and you lower the need for expensive procedures.

But for most people, improving lifestyle behaviors leads to involvement with the health care delivery system – the downstream force – and this fragmented system is not geared to provide efficient, coordinated and recommended care. In fact, in 2003 the Rand Corporation released shocking results from the largest and most comprehensive analysis ever undertaken on health care quality in the U.S.

Adults in the U.S. fail to receive recommended health care nearly half the time!

Unbelievable, you say. We have the best health care system in the world, you say. Well, here are a few examples:

  • Less than a quarter of diabetics had their blood sugar levels checked regularly, putting them at risk for kidney failure, blindness and amputation.
  • Just 45% of heart attack patients received medications that would reduce risk of death by more than 20%.
  • Patients with high blood pressure received less than 65% of recommended care, putting them at increased risk for heart disease, stroke and death.

Just as staggering—according to the study, inappropriate care happens everywhere! While a study that came out in 2003 may seem dated, the reality on the ground has not improved. The Dartmouth Atlas of Health Care continues to support the Rand findings by documenting the variations of how health care is delivered in this country.

So by all means, implement a well-designed wellness program. But don’t expect miracles when it comes to bending the cost curve. Until we address our dysfunctional delivery system, your payoff may come in healthier and more productive employees.