Healthcare’s ‘Magic Bullet’ Still Working

By Toby Cosgrove

It’s no secret that healthy lifestyle choices — eating right, exercising and not smoking — lead to healthier people. The challenge, though, is getting people to make the right choices.

As a nation, we have to do better. And we can. It just takes some incentive.

Consequences of unhealthy choices

Three years ago, I wrote a Linked In column that offered “A ‘Magic Bullet’ for Healthcare Costs.” A bold claim, perhaps, but three years later I’m more convinced than ever that we have an effective approach.

As we know, those who are overweight or obese are twice as likely to suffer heart disease or stroke, two-and-a-half times as likely to have high blood pressure and 20-times as likely to be diagnosed with diabetes.

It’s not just bad for our health, it’s also bad for our economy. Healthcare costs have risen to 18 percent of the gross domestic product and are expected to reach 20 percent by 2024 – due largely to the rise of obesity-driven diseases like diabetes, high blood pressure, heart disease and stroke. Beyond healthcare costs, the economic impact reaches into the billions of dollars in increased absenteeism, reduced productivity and even additional fuel costs.

Reversing the trends

At Cleveland Clinic, we’ve begun to reverse the trends. As a healthcare organization, we believe that we have to be a model of appropriate healthcare, which means building a culture of wellness, promoting personal responsibility and rewarding healthy lifestyles.

We no longer hire smokers and provide free smoking cessation programs to current employees. We offer free Weight Watchers and gym memberships. We have weekly farmers markets on campus throughout the summer and fall. We’ve removed fried foods from our cafeteria and sugared drinks from our vending machines.

Self-improvement

But here’s the key, or the “magic bullet,” if you will: Through our employee health insurance program — we are self-insured— we offer discounts for physical activity or enrollment in a disease management program.

Our employee health plan covers more than 82,000 employees and their family members. Each member is selected for one of two groups – those who have a chronic condition or those who are healthy and able to exercise.

Members in the healthy group have the option to enroll in our Shape Up & Go! program, which allows them to earn discounts on their healthcare premiums if they visit a fitness center 10 times a month for six month or reach 100,000 steps or 600 exercise minutes each month for six months.

Members who are battling a chronic condition — such as high cholesterol, high blood pressure, diabetes or asthma — can choose to join the appropriate coordinated care program. In these programs, registered nurse care managers work closely with members and their doctors to help them better manage their chronic conditions while improving their overall health through diet, fitness, goal-setting and monitoring.

A culture of healthy choices

When we floated this concept, we expected a flood of outrage. Instead, we have found tremendous participation — 55 percent of those eligible for a disease management program have signed up.

As I pointed out at our 10th Annual Cleveland Clinic Obesity Summit earlier this month, the results have been impressive:

• Our organization’s body-mass index (BMI) has steadily decreased. In other words, we’ve gotten thinner — which is the exact opposite of what’s happening in the rest of Ohio and the United States.
• Prior to 2010, our health insurance costs were going up at 7.5 percent annually; they are now just under 3 percent, which saves us money and allows us to drive down the cost of care to our patients.
• We’ve seen a 20 percent reduction in hospitalization among of those in disease management programs, compared to those not in disease management program. Emergency rooms visits are also down.
• Just 5 percent of our employees are smokers.

While we see that insurance discounts are a strong motivator, that’s not enough. As I mentioned earlier, our culture must match these goals, which requires leadership from the top. We must encourage healthy choices and recognize those who succeed.

By making healthier choices, people can avoid medications and procedures. And that truly is the best medicine.