A Plan To Help You Stay Healthy and Fix a Part of Obamacare.
 
Senator Lamar Alexander may have said it most succinctly: “Congress Doesn’t Do Comprehensive Well.”  That seems true for health more than ever after the last few weeks.  But we’d like to suggest one touch up to the ACAPPA (AKA, “Obamacare”) that has bipartisan support (the first edition of this change was submitted by Senators Portman (a Republican) and Senator Wyden (a Democrat) as long ago as 2012, and that could by itself save $200 billions plus a year.  This plan hasn’t gone anywhere in the last 5 years as the Congress has tried to do big reforms…so let us suggest you encourage your Senators to take up this plan—called “Rewards for Better Health” that pays you to stay healthy, and will save your government and you big bucks. 
 
No this idea isn’t comprehensive—those things like prescription drug pricing and many more will still need be dealt with separately. But like Senator Alexander implied: doing small bills to help improve Obamacare can bring big benefits to you as an individual and to the nation. And since the passage of “Obamacare” when this change was encouraged for corporate America, this plan has been shown to work in a few key test corporations like the Cleveland Clinic and Lafarge-Holcim.  It is time to pass a law that would let this program work for all insured or covered by government programs, like Medicare, Medicaid, Champus, the VA, and people in exchanges etc..
 
Let us give you a few facts and then describe in detail how it would work.   
 
1. Chronic disease management now accounts for over 84% of health care costs.
2. The patient must be partners in their health care and accountable and rewarded for their behavior.
3. Only 2.7 % of American have even 4 of the 6 normals and 2 behaviors (see below) that reduce the chance of developing a chronic disease by over 80%, and only 0.6% of Americans entering Medicare have those 4 normals. (The CDC estimated that over 70 percent of this influx of chronic disease was due to tobacco use, food choices and portion sizes, physical inactivity and unmanaged stress. Within a 20-year period, the typical person in USA has increased daily calorie consumption by 400 calories a day, and nearly half of us don’t walk even 10 minutes a day.)
4. If you enter Medicare with those normal you reduce your yearly medical costs by over 70% and your lifetime costs (you live longer) by over 50%. Since you are disabled for a much shorter time, you even reduce your combined social security and Medicaid old age home costs.
5. No current program that pays anyone on any government insurance program to stay healthy exists to our knowledge, but Obamacare allowed a back door to that by allowing a reduction in  premiums for those achieving certain wellness numbers and being tobacco free by 50% starting in 2012.
 
Okay those are the facts, now the fun part of how you could earn money by being healthy:
 
Many companies saw these numbers and saw what they were paying for health insurance. The key for this fix is to stop the influx of chronic disease that is causing 84% of all medical costs now. And the influx of chronic disease was only predicted to get worse.  For example, the prevalence of Type 2 diabetes increased from 2.2 million in 1974 to 29 million in 2014 and predicted to continue to increase 5 to 7 fold faster increase than the population through 2050. Hip and knee replacements would also continue to increase by 5 to 7 fold, and costs to treat dementia are expected to increase to more than a trillion dollars.
 
Our genes had not changed since 1974, but our lifestyles had.
 
The Cleveland Clinic, seeing the reality of these numbers,worried that if it had to increase its costs to include these medical cost increases for its 101,000 employees and dependents, it would make itself and the corporations it serves non-competitive, and help make NE Ohio non-competitive for jobs.  So it started an experiment that has worked—it decided to pay employees (initially in check form and then in reduced premiums) to get six normal and to adopt those two behaviors,
 
Over the past nine years, adhering to these two principles our employees have become healthier and our costs have declined 3 years in a row. We believe this partnership is the model that could be used for nationwide health care.  This is how it works:
            It works with one simple principle: We give incentives to employees who hit six certain health-related numbers that reflect keeping chronic disease under control and engage in two behaviors (all validated by their primary-care physicians). The six and two are: blood pressure, LDL cholesterol, HgBA1C or FBS, BMI or waist size, Cotenine level (a reflection of tobacco use), able to do physical requirements of their job classification) and two behaviors: seeing primary care physician and keeping immunizations up to date).  We thought all of these are by and large controllable by the patient working his/her primary care physician (exceptions are allowed after appeal to a board). Here’s the abridged version of how we did it:
            Key 1: Seeing the Statistical Future. We educated employees about the facts above and the advantages to themselves, the Clinic’s competiveness and thus their jobs, and the competiveness of those corporations and individuals we serve.
Key 2: We Broke Down the Wall of Access. What prevents people from making bad health decisions? It has less to do with weak brains—and more to do with difficulty having access to resources and programs that can help. And buddies to encourage them and partner with them. So we started all kinds of programs that knocked down that barrier. We started free smoking cessation programs, free fitness center usage (already in many Medicare Advantage and other Gov’t programs), and other environmental changes like taking fryers out of all kitchens that serve our employees and patients, and removing all sugared beverages.
 
Key 3: We Put Our Money Where Our Mouths Were. We offered reduced insurance premiums to employees who could choose voluntarily to get those six normal numbers and two behaviors (partial success is rewarded as well). And we made the primary care physician the arbitrator—it changes the relationship of patient and primary caregiver from “I don’t want to take that BP drug” to “Get me to six normal”.  Our primary care physicians like it better.
 
The result: Our increases in medical costs (incentives and administrative costs included) have kept being considerably smaller than national benchmarks each year, and have decreased for each of the last three years. (The Cleveland Clinic's experience also shows that absenteeism has also gone down --the result being a 28% reduction in unscheduled sick leave).We have exported these processes with similar success to several other companies (Lararge-Holcim is willing to share its data, too), and we have added new programs that really save need for illness care fast, like stress-management programs. We’ve been talking about these benefits for stress management you can do in this column for years, but we have data now that it decrease need for illness care.
So what does this mean for you and the United States? You’ll live younger and have less disability and less need for illness care at any age.  And you’ll save in premiums and co-pays and deductibles enough to on average having $100,000 more during retirement in 2017 dollars. And our estimate is that a program like ours could be added to the Medicare, Medicaid, VA, and other Government Insurance Programs and Exchanges and save over $200 billion a year currently (maybe $400 billion in current Federal spend dollars after 9 years). This is after all administrative and incentive costs; 63 percent of our employees get a greater paycheck by $600 to $2,000. 
And the non-costs benefits are enormous. Huge!
It would lead to a more energized, healthier, and competitive work force, and reduced income inequality (thanks to the $2,000 for a family of four being more meaningful to the lower income families). Senators Portman (Ohio) and Wyden (Oregon) have submitted a scaled down (bipartisan) version of this plan (“Rewards for Better Health”) in 2012 when we didn’t have as much data. We now have that data and believe this plan and process can help America; the data show it works to lower costs and to improve health, and we’ve shown it can be exported to groups other than Cleveland Clinic employees and dependents.
This can be done immediately –and no it is not comprehensive, but the law change is needed if we are to help the government and doctors motivate the more than 40% of Americans now covered by insurance plans paid for or subsidized by the US Government. And while Congress is searching for how to make illness care more efficient nationally, this plan and bill could be done immediately, immediately help people be healthier, and save money.  No one loses coverage, It doesn’t deal now with drug pricing or use- more medications will be used to help control BP, etc., but it will decrease need for illness care, and achieve the goal of decrease costs and improved US competitiveness while all the other issues are debated.
Beauty is that it has bipartisan support, it doesn’t require a comprehensive health care solution, people become healthier and it saves enormous amounts of money for federal and state governments and does more than bend the cost curve, breaks the cost curve.   So call your Senator and Congressman now, especially if named Speaker Ryan, Leader McConnell, or Alexander.