Health Care Part II – The Individual Perspective

There are references in the Bible and in the work of ancient philosophers such as Plato about the relationship of the individual to the greater good. I believe this holds is true in many different contexts such as community, city, state, nation or organizations such as a government, business, non-profit, or churches. Common wisdom dictates that that the organization will not be better than the sum total of the individual talent that it consists of. This is why such great care is taken in the hiring process to make sure that outstanding individuals that fit the organization are found. Ottawa County has truly achieved its place as one of the top performing counties in the State, a county that has developed and even pioneered programs and policies that have been emulated on the state and sometimes even national level. This has clearly happened because of the quality of employees that Ottawa County has at every level of the organization and because the quality of the citizenry that elects the Board of Commissioners, Judges and Elected Officials.

The County has accepted the responsibility for providing health care insurance benefits for its employees for many decades and also the responsibility for managing these benefits as efficiently and effectively as possible. However, the County can only do so much and will only achieve future health, savings and efficiency in proportion to how individual employees manage their own personal health – both from a healthy lifestyle and from a financial informed consumer perspective. While many employees have worked and continue to work to make Ottawa County a place of continuous organizational improvement, we need to take the same approach to our own personal health. Ultimately, the aging process takes its toll and we will all pass from this world, but how quickly and in what condition we are when we get there will be determined by how we manage our health between now and then.

The Health Management Plan rolled out on January 1, 2011 represents a major initiative on the part of the County to create a healthier future workforce and to control future claims cost. The first year of the plan focused heavily on incentives to try to develop awareness and data in order to better target health plan initiatives. Employees were presented with three action items, each of which if completed by the employee and spouse had a $50 incentive attached. The three action items included completing a health assessment on the Priority Health website, completing a physical, and completing one action item, the easiest being the online stress evaluation. Any individual data collected is maintained by Priority Health and individual health care offices. We only see aggregate data for the entire group. I need to reiterate that County Administration does NOT have access to individual health data per federal HIPAA requirements. A health management committee was named a few months ago and they are digging into health management culture. The ultimate health management plan will be rolled out over a minimum three year period. In the second year, 2012, work on developing baseline data will be completed and disincentives identified for application beginning on January 1, 2013. Disincentives could take various forms but will have the net impact of costing certain employees more for insurance. So when would a disincentive apply? The disincentive will ONLY apply if individuals choose to NOT participate (after a certain point in time) in completing screenings or physicals, or refusal to follow doctor’s orders. As an example, if an employee (or spouses) physician identifies their condition as leading to diabetes unless behavioral changes are made and the person refuses to follow their doctor’s advice, the disincentive would be applied whether diabetes is ultimately experienced or not because that person increases the cost for the County and for every other individual in the plan. It makes sense for that person to pay a higher cost for their health insurance. On the other hand, if the person follows doctor’s orders and still gets diabetes, there would be NO disincentive applied.

A great example of this thought process is the person who makes the lifestyle choice to smoke. Information provided by Gallagher Benefits, the County’s health insurance agent, shows that the average smoker costs their health plan $2,400 extra per year. I don’t know how many smokers we have in our workforce but if our County workforce mirrors the general population, 9 percent of employees would be smokers. We have 1,348 employees and spouses on the County health plan. We don’t know how many of our employees and spouses smoke but we do know from the 2011 Ottawa County Behavioral Risk Factor Surveillance data that 17.2% of Ottawa County adults are “current smokers”. Thus, we can estimate that 232 County employees and spouses are smokers. That results in additional estimated health plan cost of $556,800, or $413.06 in extra cost per employee and spouse in the plan with the greater portion of this expense borne by non-smokers.

Another major area is obesity. Michigan’s combined rate of obese and overweight adult residents is 67 percent! Unfortunately, I am among this group. We all respond better to new initiatives when the people who lead them actually walk the walk and not just talk the talk. Thus, if I am to talk about how we all need to take personal responsibility for our health, I need to take responsibility for my own weight as I meet the technical definition of obesity. A study in the journal Health Affairs noted that per person health care spending for obese adults is 56% higher than for normal-weight adults. Over 15 years, the additional costs incurred by obese adults with private health care insurance versus normal weight adults increased from $272 to $1,244 per person per year. Health care costs are 75% higher for severely obese workers which results in an additional cost of $2,441 annually per employee.

My slow climb to obesity started as I transitioned from high school jobs in landscaping and as a cook in Grand Haven’s Rendezvous Restaurant to office jobs where much of the day is spent sitting while at work and in meetings instead of constantly being on my feet as the previous jobs required. The amazing thing is that I have the will power to lose weight and once I put my mind to it I can rather easily lose weight. I have lost 30 to 58 pounds or more at least seven times in the past 25 years on diets including Slim-Fast, a fruit and vegetable diet, Cabbage Soup diet, Adkins, Body For Life, purge diet, etc., etc. For all of the things that I have worked hard at in my life and career and been satisfied with the results, I have failed miserably at keeping weight off. The insidious nature of this is that each time I lost weight I eventually gained even more back. My lack of success keeping weight off reminds me of a certain king in Greek mythology, Sisyphus, who incurred the wrath of Zeus and received the punishment of having to roll a huge boulder up a hill and just before reaching the top, watch it roll back down, and then forced to repeat this process continuously throughout eternity. My personal challenge for myself is to finally break this futile cycle of weight loss and regain and hopefully prevent being like Sisyphus in the future.

My doctor prescribed my participation in the Weight To Wellness Program, a 26 week program that includes a pretty severe 12 week diet (800 calories per day for 12 weeks) and then retraining on how to eat without putting the weight back on for the duration of the program and hopefully for life beyond the end of the program. Priority Health covers the cost of the program if prescribed by a doctor and if certain diagnostics exist. In my case, the combination of BMI, cholesterol, blood pressure and weight made me a candidate for the program. I can’t be a leader with where we are going with health unless I walk the walk. Obesity leads to many different serious diseases that will shorten my life and cost my employer much more money if I do not get it under control. I have noticed that many employees have started down a similar path and are getting great results. My peak weight was 282.2 pounds when I began a purge diet in January of 2010. I started the Weigh to Wellness Program three weeks ago and my weight was 262 and today it is 240 with a long way yet to go.

In the most recent Casting For Comments, I mentioned that the State approach to health management is almost non-existent and that the State corporate posture to-date has been to debate and determine what percentage of health care expense should be borne by public employers versus the portion that should be borne by public employees. Governor Snyder’s September address on healthcare clearly shows that he understands the issue of improving individual health and by extension lowering future health claims expense. He listed evidence based practices that can significantly improve personal health such as a healthy diet, regular exercise, annual physical exams, and avoiding tobacco use. He also listed corresponding health measures that are tied to incidence of chronic disease including BMI, blood pressure, cholesterol, and blood sugar. He challenged individual citizens to take personal responsibility to improve these measures. Helpful information is available on Governor Snyder also announced that a new Michigan dashboard with key public health metrics will be used to measure progress on a state level.

If you’re struggling with or have defeated the same condition, or just have some insight, I would welcome your response to this message, either via a post on Casting For Comments or via email message to me.

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One Response to Health Care Part II – The Individual Perspective

  1. Kim Hewitt says:

    I have tried many diets also. I went on the Diet Center diet when I was 28 and managed to keep the weight off for 14 years. Then I quit smoking and started working in an office and 50 extra pounds piled itself on me. It really does make a difference. Now, I am trying the Jillian Michaels Diet from her book, Mastering your Metabolism. It really means making some lifestyle changes. Such as, exercising 5 days per week. Taking time for myself. Reading the ingredients on boxes and making sure that I am not eating foods that are full of chemicals. So far, in three weeks, I have lost 8 pounds on the diet and do not feel starved. Congratulations on your success and I wish you further success with your endeavor to lose weight. It is one of the most difficult things to do. After all, you have to eat food to live and it is hard to eat perfectly all the time.

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