Is the ‘Informed Consumer' Any Healthier?

Despite soaring consumer interest in gathering health-care information, the general population doesn't seem to be getting any healthier. What does it take to turn information into action against preventable health problems?

By Mary Kouri

National polls tell us that anywhere from 40 to 70 million people have visited medical web sites in the last year, but the search for enlightenment doesn't seem to make a dent in the rise of preventable health problems. Take weight control. There's a banquet of print and electronic information on dieting and weight management, yet one out of every five Americans isn't just overweight but clinically obese, a percentage that has doubled in the past decade.

Health care professionals have long counseled that if we would act on a fraction of our present knowledge, we could immeasurably improve the state of our health nationally. Our major affliction is "Sedentary Death Syndrome" (SeDS), says Frank Booth, PhD, professor in the Department of Physiology at the University of Missouri-Columbia. If people simply added three hours of brisk walking to their weekly routines, he reports, the risk of diabetes would decrease 30 percent. As it is, Type 2 diabetes has risen nine-fold since 1958. Excess weight is another contributor to SeDS.

Why this gulf between the interest in health information and the prevalence of unhealthy lifestyles? And more importantly, how can it be addressed?

Turning knowledge into action

Employers are certainly trying to address those questions. Some 76 percent of them currently offer disease management programs, according to Hewitt's recent study Health Promotion/Managed Health Provided by Major U.S. Employers in 2001.

One challenge for those programs is to find the right communication vehicles, according to Janet Solomon, health benefits and wellness manager at Dallas-based Texas Instruments (TI). The company uses its intranet to transmit health and benefits information, as well as announce seminars and health resource fairs. Participants in smoking cessation programs receive messages via their home phones. Workers with certain conditions have personal sessions with dietitians.

TI is a large company with 22,000 workers and some 50,000 covered lives nationwide. Other firms have banded together to achieve critical mass. Five members of the Dallas Fort Worth Business Group on Health (DFWBGH), for instance, have jointly "declared war" on cardiovascular disease with web-based risk assessment, education and disease management tools. Individual screenings will track the effect on associated costs.

Size alone, however, does not predict corporate involvement in health programs. Take the 130-worker Lowry Redevelopment Authority, a Denver-based real estate firm. Human Resources Manager Dianne Jordan disseminates health information through newsletters, bulletin board announcements and the intranet. Links to resources such as Kaiser Permanente's health education and patient service web site are very popular. For Spanish-speaking workers, Jordan uses packets and flyers on health care benefits provided by Kaiser Permanente, as well as bringing in interpreters for health information meetings.

But when it comes to getting people to participate in preventive services — whether it's stress management, Weight Watchers meetings or a walking group — Jordan acknowledges that fear is the most potent motivator. "If Joe has a heart attack, for instance, then people want to know how they can prevent that from happening to themselves," she says. "We don't think about things like that until they impact us."

The insurance provider Humana uses an intranet to enhance its wide range of employee screenings and wellness services. "We're trying to use technology to customize our wellness programs to fit individual needs," says Robert Walt, director of Consulting Services for National Accounts. For instance, covered employees and their dependents can sign up for a Personal Home Page offering personal health information. A member with high cholesterol might have a tailored plan of exercise and diet, as well as possible drug treatments to discuss with a doctor. Launched in late 2001, the Personal Home Page program serves 180,000 employees and their dependents.

Get the word out

Humana's disease management services consist of telephone and electronic reminders for employees and dependents with asthma or those at high risk for serious illnesses like cancer, explains David Steele, MD, Humana's medical director for e-health.

In health communication, tools that work for one group may fail for the next. "If the message doesn't fit their immediate needs and if it doesn't come through a channel they can use conveniently," cautions Lowry Redevelopment's Jordan, "it's going to end up in the shredder." For example, she learned a long time ago that paycheck stuffers and health newsletters from vendors were wasted on her employees. Try as many avenues as possible to help people change their lifestyles, advises Solomon. What works and what fails varies, "but we have to try something before we can find out what works."

Consistency and perseverance are key factors, contends Rick Dorazil, corporate vice president for Rewards and Benefits at Motorola. "Where health is concerned, you have to provide ongoing information and services," Dorazil says. Since 1995, Motorola has offered disease management programs for depression, asthma, diabetes, stress and other chronic conditions. "The programs speak to specific needs," Dorazil says, which may explain their appeal: Over half of the 189,000 covered employees and dependents enrolled in one or more programs at any given time. Participation is voluntary and lasts as long as a person deems necessary.

Why won't they listen?

Employees aren't always so willing to convert knowledge into action, and even the most conscientious employers still can't make their people act in their own best interest, notes Marianne Fazen, PhD, executive director of the DFWBGH. "People are in a just-in-time mode when it comes to health. It's like travel information; people don't visit a travel web site until they're ready to take a trip."

In other cases, program participants are seasoned travelers on the road to good health. "The people who go after information on how to be healthy are the ones who need it least. If I'm 50 pounds overweight or if I smoke, for example, I'm not likely to look for health information because I already know what's not good for me," contends Bruce Bagley, MD, practicing family practitioner in Albany, N.Y., and chair of the board of the American Academy of Family Physicians in Kansas City, Mo. Bagley indicts product advertising as a leading promoter of unhealthy behavior. "It would help if we replaced some of the food ads with preventive health care messages," he opines.

The problem is our fast pace of life, observes Solomon. "We're interested in healthy lifestyles, but often there's no time to do anything about it." In the same vein, Fazen observes that schedules are so cramped that in the 30 or 40 minutes it takes to look up health information, a person might be better off taking a walk.

What's the bottom line?

If employers go to the trouble of overcoming such obstacles, what will be their reward? Companies that track the impact of their health and wellness initiatives are quick to concede that their measurements are works in progress. Solomon notes that in the diagnostic categories where TI offers rigorous preventive services, the company has lower incidence of disease than its competitors. Even though she has no "true statistics" to single out TI's programs as a causative factor, "those comparisons work for me." Similarly, Solomon doesn't see the need for an in-depth study of absenteeism to justify spending $46 a shot on flu vaccine.

Motorola's Dorazil is quite confident of the correlation between its "Special Delivery" program and improved pregnancy outcomes among employees and dependents: Between 1989 and 1999, the number of high-risk pregnancies dropped 81 percent, from 47 to nine per year. He estimates that the dollar payback on the company's investment in its 12 disease management programs ranges between four- and eight-to-one.

Humana uses surveys and Web traffic reports to measure the impact of its personal health information programs. For example, "Maximize Your Benefits" informs members of their choices around prescription drugs via e-mail, phone and print messages. So far, 8.5 percent of those notified via e-mail and print channels — phone message results are still being tallied — have switched to less costly drugs like generics. The member savings amount to $750,000.

There's nothing wrong with letting employees know about such savings. Indeed, a key to helping workers become informed consumers, advises Steven Wojcik, director of Public Policy for the Washington Business Group on Health, is for businesses to level with them about the advantages of insuring people who take care of their health. "Employers need to be more transparent about how benefit decisions are made so that employees can be more aware of the true cost of health care," he maintains.

The spirit behind employee health programs holds as much sway as slick technique, according to Solomon. She says that employees have to see that you care for and respect them — and it has to start with the CEO.

"The health and wellness of your employees has to be ingrained in your strategic program," insists Motorola's Dorazil. "When times get difficult, you can't say, ‘we won't do these feel-good things anymore.' "

Covering all the bases

Even the most comprehensive corporate health program can fall prey to the assumptions that uninformed providers make about what a company insurance plan covers, say, regarding preventive programs. This came to light for the Dallas/Fort Worth Business Group on Health when its claims data indicated that people were under-diagnosed for diabetes and high cholesterol. Follow-up disclosed that an alarming number of providers assume that corporate plans mirror Medicare guidelines and thus do not pay for diabetes or cholesterol screening. When employees request screenings to which they're entitled, the providers tell them they will have to pay out of pocket.

Providers are so used to being denied payment for services, observes DFWBGH Executive Director Marianne Fazen, that they don't offer certain screenings. As a result, "some people are much too far along with diabetes before they even know they have it, and the benefits managers don't realize that they're not getting what they pay for."

The flaw, says Fazen, "is not people — it's the system. There's no one area to be tackled to solve the problem. The answer is going to take a larger effort than we thought would be necessary."

Benefits managers may find it helpful to brief providers about the differences between their company's coverage and the Medicare model. Or company literature might coach employees to tell providers when preventive screenings are covered by the company though excluded by Medicare.

Resource Links:

Washington Business Group on Healthhttp://www.wbgh.com/

Dallas Fort-Worth Business Group on Healthhttp://www.dfwbgh.org/

Mary Kouri. Is the 'Informed Consumer' Any Healthier?.

Business and Health

2002;10.