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The Underused Method of Controlling Health Care Costs


The Underused Method of Controlling Health Care Costs


At Work With the CDC

The Underused Method of Controlling Health Care Costs

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Choose article section...Why invest in prevention?Why isn't coverage of clinical preventive services enough?So what should employers be doing?How can employers use the community guide?What employers should require or look for in selecting or negotiating with health plans Worksite strategies that help employees take a role in preventionWhat employers can do to promote prevention by the community

By Bradford A. Myers

Employers have a lot on their minds these days besides health-care costs, but with spending on health benefits at 42 percent of total compensation (up from 26.6 percent in 1980), health care has become a total business issue.1 At the current rate of increase, health benefit costs will double by 2007.2,3 Little wonder then that employers are considering every possible tactic to reduce their exposure.4 As a supplement to pure cost control, some employers are also focusing on prevention, especially proven, effective preventive benefit, workplace health promotion and disease prevention strategies and services. These innovative companies know to turn to the Guide to Community Preventive Services for science-based recommendations to implement these strategies.

Why invest in prevention?

Cost control alone through increased deductibles and copays can have a disproportionate effect on workers with or at risk for chronic conditions by limiting access to preventive or routine care, thus raising the likelihood of poorer health outcomes and lost productivity.5 But, if you could prevent a poor health outcome rather than treat it, wouldn't you want to? Prevention benefits both the employees who receive it and the employers who provide it, because physically and mentally healthy employees have lower absenteeism, higher productivity and stronger organizational commitment. 6

"Prevention" is one of those buzzwords that we've all heard, but have you considered the breadth of what preventive services might mean for your company?

Why isn't coverage of clinical preventive services enough?

Prevention means supporting clinical preventive services through health care insurance benefit plans (for example, paying for flu vaccine, cancer screening and smoking cessation services). But recent work from Partnership for Prevention ( www.prevent.org ) documented that some of the most effective and cost efficient preventive services are delivered to fewer than 50 percent of the patients who should be getting them.7 Beyond coverage of clinical services, keep in mind that prevention is also what you do to (a) maximize the appropriate delivery of the services you are already paying for, (b) promote health and safety in the workplace, and (c) promote prevention in the community from which you draw your workforce.

Assume, for example, your benefits plan covers all recommended smoking cessation therapies. If physicians are not advising smokers to quit, or there are no workplace or community restrictions on smoking, your investment will not be maximized. That's why population-based interventions are important, and where The Guide to Community Preventive Services (Community Guide) comes in.

So what should employers be doing?

Employers make constant choices about resources. That's the reality. In making choices about health care expenditures, and especially for investments in preventive care, employers need to go beyond clinical services to seek out scientifically proven population-based services. General Electric's highly successful ‘Six Sigma' initiative — designed to increase profits by eliminating variability, defects and waste that undermine customer loyalty — is not just a trendy management notion. It has a scientific basis.8 The Community Guide provides the same kind of science base for population-based preventive health strategies. But like Six Sigma, the principles of prevention must be "baked in" and made a priority through every layer of the organization.

How can employers use the community guide?

The Community Guide provides scientifically proven strategies to help employers maximize their current investments in health care and promote prevention outside the clinical environment. It provides practical solutions for employers to use in (a) negotiating with health plans, (b) helping employees take an active role in their health at the worksite and (c) working within local communities to encourage prevention investments by and for the community. Specifically, its findings include the following:

What employers should require or look for in selecting or negotiating with health plans

For smoking cessation 9

  • Provider reminder systems to improve delivery of advice to quit,
  • Reduced out-of-pocket costs for effective cessation therapies such as nicotine replacement, and
  • Access to proactive telephone support for people who want to quit.

For adult vaccination 10

  • Provider reminder and recall systems to let physicians know when it's time for patient vaccinations,
  • Standing orders protocols allowing non-physician clinical personnel to deliver vaccinations and reduce missed opportunities for vaccination, and
  • Reduced out-of-pocket costs for vaccinations.

To keep persons with diabetes healthy 11

  • Disease management programs to manage care in several different ways across the disease spectrum (e.g., from pre-diabetes to diagnosed diabetes mellitus), and
  • Case management programs (i.e., assigning a case manager [often a nurse]) to oversee all care from diet to treatment).

Worksite strategies that help employees take a role in prevention

As employers look to find ways to engage employees in taking personal responsibility for prevention, the Community Guide has identified several interventions that promote prevention while requiring minimal investment of resources:

  • Restrict or ban smoking to minimize exposure to secondhand smoke,
  • Provide access to and time for physical activity (e.g., walking trails, office gyms),
  • Place signs near elevators encouraging stair use, and
  • Promote exercise buddies and exercise contracts.

What employers can do to promote prevention by the community

Employers are valued and respected leaders in their communities. Lending support or advocacy through local chambers of commerce or other leadership organizations at the city, state or national level can have substantial impact on the enactment or implementation of proven prevention strategies. These include the following:

  • Promote and support community wide smoking bans and restrictions,

  • Support and advocate for primary safety belts laws, enforcement of child safety seat laws and lower blood alcohol concentration laws to reduce alcohol-impaired driving,

  • Promote and advocate for increased access to physical activity resources such as walking trails and bike paths, and

  • Promote community water fluoridation to prevent tooth decay. (Dental illness results in a loss of more than 150 million work hours per year.12)

To minimize the burden of health-care costs within your organization, start addressing the health-care concerns that affect your workforce by using proven effective strategies from the Community Guide. Findings and an employer "scorecard" can be found at www.thecommunityguide.org .

Bradford A. Myers is the dissemination coordinator for the Community Guide Branch, Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA. He can be reached at bam6@cdc.gov .

Be sure to check out previous "At Work With the CDC" columns in our archive.

More Business & Health Articles on This Topic

Target Your Health Dollars to the Root Causes (Dec. 1, 1999)

Finding the Value in Health Screening (Feb. 1, 1997)

Resource Links

Partnership for Preventionhttp://www.prevent.org

The Guide to Community Preventive Services (Community Guide)http://www.thecommunityguide.org/

Centers for Disease Control and Preventionhttp://www.cdc.gov/


1Employee Benefit Research Institute. Facts from EBRI-April 2002, "Employer Spending on Benefits 2000". Available at http://www.ebri.org . Accessed October 15, 2002.

2Strunk, BC, Ginsberg, PB, Gabel, JR .Tracking Health Care Costs: Growth Accelerates Again in 2001. Health Tracking: Trends, A Web Exclusive from Health Affairs dated September 25, 2002. Available at http://www.healthaffairs.org . Accessed October 15, 2002.

3Washington Business Group on Health. New Rules for Managing Health Costs — Seventh Annual WBGH/Watson Wyatt Survey Report. Available at www.watsonwyatt.com . Accessed October 15, 2002.

4Kaiser Family Foundation. Kaiser / HRET 2002 Benefit Survey. Available at http://www.kff.org . Accessed November 7, 2002.

5National Public Radio. Health Insurance Sticker Shock. Summary of National Public Radio report October 10, 2002. Available at http://npr.org/programs/morning/features/2002/oct/healthcare/index.html . Accessed October 10, 2002.

6Partnership for Prevention. Healthy Workforce 2010, An Essential Health Promotion Sourcebook for Employers Large and Small, Partnership for Prevention, Fall 2001, pp. 3-6. Available at . Accessed December 10, 2002.

7Coffield, AB, Maciosek, MV, McGinnis, JM, et.al. Priorities Among Recommended Clinical Preventive Services. Am J Prev Med 2001;21(1):10-19.

8Pande P, Neuman R, and Cavanagh R. The Six Sigma Way - How GE, Motorola, and Other Top Companies are Honing Their Performance. McGraw Hill; New York, New York; 2000.

9Task Force on Community Preventive Services . Recommendations Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke. Am J Prev Med, 2001;20(2S). 10-15.

10Task Force on Community Preventive Services. Recommendations Regarding Interventions to Improve Vaccination Coverage in Children, Adolescents, and Adults. Am J Prev Med 2000;18(1S), 92-96.

11Task Force on Community Preventive Services. Recommendations for Healthcare System and Self-Management Education Interventions to Reduce Morbidity and Mortality from Diabetes. Am J Prev Med 2002;22(4S), 10-14.

12CDC. Fact Sheet — "Oral Health for Adults". Available at http://www.cdc.gov/OralHealth/factsheets/adult.htm . Accessed November 7, 2002.

Bradford Myers. The Underused Method of Controlling Health Care Costs.

Business and Health


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