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12. Don't Hire Smokers
Drop the smokes or don't bother applying: That's the ultimatum Jim Hagedorn, CEO of Scotts Miracle-Gro, gives his prospective employees.
It all started back in 2003, when Hagedorn learned that a quarter of his 6,000 employees were smokers and half were overweight. What's more, health care costs were up 42 percent in four years, jeopardizing the health of his company. Invoking some of the bravado of his years as an F-16 fighter pilot, Hagedorn implemented a sweeping wellness program to hold his employees accountable. Now those who don't get help to kick the habit or take a comprehensive health-risk assessment pay higher premiums.
A former chain-smoker, Hagedorn also developed a $5 million Wellness Center, including a medical clinic that employees use free. There are no co-pays for the doctors, nurses, dietitian, physical therapist, or pharmacy (where generic drugs are free). Hagedorn predicts the facility will pay for its $4 million operating costs in the next few years. "Only a focus on wellness can change things for the better," he says. "If companies don't demand creative solutions, then we have no right to complain. We will get what we deserve: increasingly less productive workers, higher costs, and reduced profitability."
The payoff: He has reduced the number of smokers from 25 percent to 8 percent and wants to get it even lower. About 90 percent of employees complete the assessment, and 82 percent use the medical center.
The action plan: Learn more at takecareemployersolutions.com.
13. Electronic Medical Records
Experts agree that electronic medical records (EMRs) are a must, but fewer than 25 percent of hospitals and 15 percent of doctors have these systems, mainly because of cost, privacy issues, and the lack of one compatible, easy-to-use infrastructure.
One model that works is the VistA system, which has been keeping electronic health records for seven million veterans since 1996. Everything is electronic, including images from CT and MRI scans. "I can check a San Francisco patient's scans from my office in Washington, D.C.," says Ross Fletcher, MD, chief of staff at the VA Medical Center. Congress is considering a bill that would invest at least $300 million in setting up a health information infrastructure similar to VistA. But why not just use VistA nationwide?
The payoff: If 90 percent of hospitals and doctors' offices participated, we could save about $80 billion a year, says public-policy researcher Richard Hillestad, PhD.
The action plan: Start by keeping your own EMRs with free, secure online services such as Google Health or Microsoft HealthVault. Ask your MD to make the switch too. Urge your representative on Capitol Hill to support bills that promote EMRs.
14. Save Primary Care
Soaring office costs, demanding insurance companies, low Medicare payments, staggering medical school debt (the average is $140,000), and politicians who refuse to make hard choices are driving primary care physicians out of business. That, experts caution, will result in fragmented care and higher costs as Americans turn to high-priced ERs and urgent care centers for even routine problems.
Already, 20 percent of internists have bailed since the early '90s, and a survey by the American College of Physicians (ACP) suggests that if Medicare rates aren't increased, another 62 percent will "retire" early. And they won't be replaced. The number of medical school students going into primary care is half what it was ten years ago. "It's an evolving crisis of unprecedented proportions," says ACP president-elect Joe Stubbs, MD, an Albany, Georgia, physician.
Three things will help: "forgiving" medical school loans, digitizing medical records to help deal with insurance company demands, and improving the way Congress dictates Medicare payments, which influences how much health insurance companies pay doctors.
The payoff: Keeping primary care physicians in towns all across America, many studies show, would keep us in far better health than relying on hospital-based care. "If we were to increase the number of primary care physicians from 35 percent of doctors, as it now stands, to 40 percent, we could expect 800,000 fewer hospital admissions every year and 4.8 million fewer ER visits and save $10 billion a year," says researcher Steven Kravet, MD, chief medical officer for quality and patient safety at Johns Hopkins Bayview Medical Center.
The action plan: Find out more about Medicare reform and share your story at the AMA Patients' Action Network, patientsactionnetwork.org.
15. Award Prizes for Affordable Drugs
Drug companies spend as much as $800 million to develop a drug and get it approved. In return, they may get a patent and the exclusive rights to sell it for 20 years. Prices have risen 500_percent since 1990, and many patients can't afford their prescription meds.
Washington, D.C., economist James Love has a simple proposal: Scrap the "monopolies" and sponsor government-funded billion-dollar prizes for breakthrough medicines instead. After clinical trials, rights to make and sell the drug would extend to competing generic firms, which produce pills for up to 80 percent less.
The payoff: Love says the current exclusive pricing system may have accounted for as much as $480 billion of the $600 billion worldwide sales in 2006. Abolishing drug monopolies could remove much of that cost and lower prices for consumers at the pharmacy.
The action plan: Go to Love's home page, keionline.org, for links to blogs, articles, and ways to learn more.
16. Visit a Virtual Doc
Doctors can often diagnose or prescribe without seeing the patient. Problem is, in most plans, doctors don't get paid for phone or e-mail time. That's starting to change. GroupHealth Cooperative in Seattle (ghc.org) has reduced costs and won high satisfaction scores by having patients and doctors discuss medication changes and test results through an online system.
Roy Schoenberg, MD, is taking the concept further with Online Healthcare Marketplace, an interactive service that lets you talk to a physician in real time 24/7. (It rolls out in January, starting in Hawaii, with thousands of doctors to choose from.) You log on, scroll through a list of available top specialists, and connect immediately via phone or webcam. The physician sends e-notes to keep your personal doctor up to speed. Anyone can use it for a small fee. If your insurance plan offers it, you pay a co-pay, the doctor gets paid, and everybody's happy.
The payoff: Dr. Schoenberg says this could save millions of dollars for even small health plans.
The action plan: Get more information at americanwell.com.
17. Team Up in Hospitals
The Cleveland Clinic is tearing down traditional silos for a more team-based approach designed to detect problems early, provide the best treatment, and save money and lives, says CEO Toby Cosgrove, MD.
The clinic's Neurological Institute was the first to reap the rewards. Patients who suffer from seizures, for example, are screened by a neurosurgeon, a psychiatrist, a neuropsychologist, and a neurologist to determine whether an attack was triggered by a neurological imbalance or a psychological problem.
The payoff: Epilepsy patients' hospital stays have declined 10 to 20 percent.
The action plan: Read the book that inspired the plan: Redefining Health Care: Creating Value-Based Competition on Results by Michael E. Porter and Elizabeth Olmsted Teisberg.
18. Let Everyone Shop for the Best Plan
Members of Congress get to shop among 250 affordable health insurance plans to find the one that's best for them. Within each plan, premiums are the same for everyone regardless of age or other risk factors. They can even take it into retirement. What if we could all do that? The Federal Employees Health Benefits Program (FEHBP) has maintained stable prices for years, often rising less than private plans and Medicare. Part of the reason is that it doesn't pay providers a "fee for service" but rather negotiates one price to access a bundle of benefits, such as doctor's visits, inpatient care, surgery, and more.
The payoff: A bipartisan health care bill before Congress would offer similar benefits to all Americans with estimated savings of $1.5 trillion over ten years.
The action plan: For more details on this plan, go to lewin.com and search for Healthy Americans Act.
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