NCHC recommendations for reducing health care spending overlook schedule control as key to adoption of healthier lifestyles
The National Coalition on Health Care has issued its recommendations for bending the relentless rise in health care costs, Curbing Costs Improving Care the Path to an Affordable Health Care Future. The bulk of the report focuses on treatment and payment reforms with one section devoted to “Prevention and Population Health.” A key recommendation is sin taxes to deter the consumption of tobacco, alcohol and sweetened beverages. That’s hardly a prevention and wellness strategy.
Conspicuously absent are meaningful recommendations to give people more control over their lives and schedules so they can spend more time engaging in healthy behaviors like getting adequate exercise and sleep and eating a nutritious diet. Achieving it will involve nothing short of a transformation of how we conceptualize knowledge and information-based work and when and where it gets done. We no longer need to commute daily to an office to do it, thanks to the widespread availability of information and communications technology. Here’s how one blogger described this arguably obsolete work routine:
1 – Wake up earlier than you want to.
2 – Get stuck in traffic on the way to work.
3 – Feel stressed all day at work.
4 – Go home, throw a frozen dinner in the microwave because you’re too tired to cook.
5 – Plop down in front of the TV because you’re too exhausted to do anything else.
6 – Go to bed later than you meant to.
7 – Repeat.
This is a toxic societal lifestyle that over time sets the stage for the development of chronic, preventable conditions that drive much of the health care spend. A 2011 University of Minnesota study found when people are afforded control over when and where they perform their jobs, they got more sleep and exercise. Bravo. That’s true, low (negligible) cost prevention that can go a long way toward maintaining health and reducing medical utilization and spending.
The Health Care Cost and Utilization Report: 2010 found that while medical care utilization declined by more than five percent from 2007 to 2010 for inpatient admissions, emergency room visits, primary care provider office visits and radiology procedures, prices rose across all categories of service with outpatient services experiencing the fastest growth.
“Unlike other recent reports on health care spending, we find that the increased spending is mostly due to unit price increases rather than changes in the quantity or intensity of services,” the report concludes.
The report by the Health Care Cost Institute (HCCI) is based on a review of health insurance claims for more than 33 million individuals covered under employer sponsored, private health insurance from 2007 to 2010 including both fully insured and self-funded benefit programs. The dataset represents about 20 percent of all individuals younger than 65 with employer-provided coverage, according to the HCCI.
In an information intensive economy, those who create, process, analyze and add value to information can do so from anywhere thanks to the proliferation of Information and Communications Technology (ICT) over the past two decades. Yet paradoxically, many Americans still engage in a daily commute to the office as if it were the 1950s of Dagwood Bumstead or the 1980s that inspired the more modern day office place comic strip, Dilbert. In those days, commuting to the office was necessary because that’s where the office equipment was — telephones, typewriters (and later, dedicated word processors), photocopiers and fax machines. Not anymore. Today, nearly any setting can function as an office where a knowledge worker can concentrate and be productive.
Nevertheless, on average Americans spend nearly an hour a day getting to and from an office that ICT has effectively rendered obsolete. That adds up to a lot of wasted and often stress filled time piled on top of an increasingly sedentary culture that battles the rising health care costs of lifestyle-induced chronic conditions linked to a lack of exercise, poor diet, and inadequate sleep. For the time crunched trying to balance family obligations with work, avoiding these adverse health impacts is even more challenging. Just look around any traditional office setting and chances are you’ll see plenty of stressed out, sleep deprived, and overweight people who are more likely use medical services and in turn increase their employers’ health care utilization costs.
What’s needed is a new model for traditional office-based work that can free up time for exercise, healthier home cooked meals and sleep that would otherwise be wasted on daily commuting. Fortunately, such a model better suited to today’s highly connected, information everywhere economy exists: ROWE or a Results Only Work Environment. A ROWE values getting the work done over daily office attendance. Early indications are that workplaces that adopt ROWE can achieve better health status at a time when workplace wellness is getting increased attention to slow the nation’s unsustainable rise in health care costs. A University of Minnesota study issued in December 2011 found workers in a ROWE realized increased health-related behaviors of more sleep and exercise — behaviors that can go a long way toward maintaining health and reducing medical utilization. ROWE is poised to become the successor to traditional “workplace wellness” programs that have been slow to demonstrate tangible progress in reducing employer health care costs.