Three Market-Based Strategies to Prevent Chronic Illness

In prior posts, I’ve asserted that both the individual and society share responsibilities for the prevention of chronic illness (see Individual v Community Responsibility for Health, KP 101: our philanthropy, and A Tour of Trees, among others).  I’ve also described the gap that often exists between what an individual knows he/she should do and what is actually done (The Knowing Doing Gap).

the vitality institute logo

In this post, I’ll combine those themes in the context of the Vitality Institute, a non-profit NGO launched last year seeking the creation of public-private partnerships that promote health (rather than healthcare) and prevent illness (rather than measures to treat it). Instead of arguing my point using the traditional science of public health, however, I’ll use the science of market-based economics, believing the latter more useful when understanding and influencing human behavior. Each example I provide is scalable, from a small to large company or community.

First, Create Supply… of healthy food choices, fitness opportunities, and preventive services. I know, I know. Traditional econ says demand precedes supply. But I believe the opposite is true when creating healthy human behavior, because 2 million years of evolution has hard-wired us to prefer simple sugars, dietary fat and animal protein, and the conservation of calories.

atlanta beltline

Public Supply – provide multiple points of entry to multiple green spaces (see Atlanta Beltline); set aside land for future public parks (see Trust for Public Land or Georgia Conservancy); provide subsidies for communities to nurture Green Markets and Buy Local campaigns; correct the imbalance of supply of unprocessed ingredients (i.e., grocery stores) and processed food (i.e., fast food restaurants) in low socioeconomic communities; create bike and pedestrian space (see TED Talk of Janet Sadik-Kahn, NYC DOT under Mayor Bloomberg, Atlanta Beltline); spread Power Up for 30 in our public schools (see GA Shape); and embrace certain provisions of the 2010 ACA (preventive care has no co-pay).

nyc bike and pedestrian lanes

Private Supply – corporate subsidies of gym memberships or Zumba classes; provision of showers and locker-rooms in the building; change the contents of vending machines; create non-smoking campuses; arrange for healthy food trucks during lunch; build on-site health clinics;  sponsor nutrition classes and flu-vaccine fairs.

Second, Create Demand… for those good choices. Wouldn’t it be cool if we changed our worship of beautiful appearance to worship of healthy behavior?  I’m told some women do indeed prefer salad-eating, gym-going men.

Public Demand – insist grocery stores provide the provenance of produce; create compelling advertising and marketing campaigns that express the benefits to individuals of buying local (think of the successful Made in the USA campaign); revise the school lunch program to provide healthier choices, then make those choices more appetizing to kids (yes, it’s been done successfully);

buy local

Private Demand – sponsor participation in fitness or philanthropic programs like the annual KP Corporate Run Walk, AHA Heart Walk and Komen for the Cure; sponsor corporate “challenges” like the TSPMG 21-day Vegan Challenge, or one of the biggest loser competitions;

Lastly, Facilitate Consumption … of those good choices.  Seldom do we behave in healthy ways merely because those choices are available, coupled with the knowledge those choices are “good for us”. Our belief systems, borne from our past experiences, dictate our behavior much more than “perceived choice” or “possession of knowledge about the potential benefits of the better choice”. Those better choices must align with our individual, immediate feelings and benefit our individual, long-term interests, whatever they are.

weight of the nation

Public Consumption – make the public green-space safe at all hours of the day; make city-bike programs easy to use and affordable; ensure the safety of pedestrians and cyclists on city streets; halt the subsidization of high-fructose corn syrup (watch Weight of the Nation), and perhaps begin a modest subsidization of fresh produce; create funding for infrastructure that reduces commuting time (such as the 2012 Georgia Transportation Referendum), thus increasing discretionary time for fitness or food preparation.

Private Consumption – employers can provide podometers and incentives to employees to “consume” fitness or proven preventive screenings; healthcare providers (physicians, hospitals and delivery systems) should prove that a specific level of in-year employee consumption of their employee’s good choices will guarantee for the company an equally specific decrease in healthcare costs or increase in profitability.

jawbone

In my market-based approach, I’ve deliberately ignored the important area of Reducing Risky Behavior. Institutions such as the CDC, States Department of Public Health, National Transportation Safety Board, NIOSH and OSHA (among many others), have that covered.  But one could summarize all as “abstain from tobacco, avoid excessive alcohol, use condoms, and wear seatbelts”, roughly in that order).

Kaiser Permanente has been a national and local leader in creating and enhancing such public-private partnerships for the betterment of America’s health. Just here in Atlanta, we’ve sponsored the Green Market at Piedmont Park, the Annual Corporate Run-Walk, the Eastside Trail of the Atlanta Beltline, the HBO documentary Weight of the Nation, the 21-day Vegan Challenge, gym memberships for employees, and so on.  More such partnerships and infrastructure are needed in Atlanta and across the US to create the supply, demand and consumption of healthy behavior, if we are to reverse America’s raging epidemic of chronic diseases.

Stickin’ It to The Man

A rising number of physicians, nearly all of whom are primary care physicians, are moving toward a more pure fee-for-service (FFS) compensation system for their professional fees and simple office tests (e.g., ECG, spirometry, urinalysis), no longer accepting The Man’s insurance payments, and eschewing trends toward non-FFS compensation systems. Of course, this is the model of physician compensation that existed for the majority of America prior to 1965.

stick it to the man - baby

I get what’s in it for the patients who choose to afford the $1,600-3,000 annual retainer fee – same day office appointments, night-time telephone advice, and more time with the doc in the exam room (20-60 minutes rather than 6-10). I also understand the benefit for the docs – more time with patients, a simpler business model, and more time doctoring (rather than dealing with insurance companies). Some report higher incomes too – a result of fewer office staff (less overhead) and higher professional fees (including that annual retainer).

But the following questions occur to me:

1. Have we physicians, particularly primary care physicians, given up on creating those same desirable and justifiable outcomes through other means, particularly authentic payment reform?

2. Have we become a guild of independent business-men and -women, rather than a profession dedicated to public service?

american family - rockwell

3. Will Primary Care soon devolve into a caste system: Americans who can afford a main doctor (concierge practices), versus those who can’t (relegated to see a NP at Wal-Mart for straightforward and low-risk stuff, and the ER doctor-du-jour, followed by a cadre of disassociated proceduralists for all other maladies)?    That is a recipe for Anarchistic Waste if ever there was one.

Give me your answer to those questions (or comments of your choosing) below.

In Search of The Holy Grail – being successful

beautiful waterfall #1

This post concludes a four part series I’ve written this week about the search for The Holy Grail of the new and future healthcare market … integrated delivery systems (IDSs) such as ours lowering the cost of a unit of care, such as an office visit, rather than relying upon relatively lower hospital and pharmacy costs to subsidize our relatively higher office visit costs.

Certainly our patients have benefited from those higher office costs in the past (more time with the doc, more preventive care, more care coordination), but payors have said they won’t pay extra for those benefits in the future, largely because they believe those desirable attributes should be “included” in the base price of the office visit / unit of care.  They have a point … you and I don’t pay extra for our water to be clean, or our groceries to be fresh, or clothes to last more than one season; whatever we pay, we expect it to cover all basic attributes of the good or service.   Good healthcare is now considered a basic attribute by payors, whether they be individuals, municipalities or corporations.

hbr 3 rules for success

That said we must reconcile that new direction with three overarching business principles that might appear on the surface to be in conflict.  Mr. Michael Raynor and Mumtaz Ahmed, both from Deloitte, recently wrote a book entitled The Three Rules: how exceptional companies think.   They provided a summary of their findings in the April 2013 issue of Harvard Business Review:

#1 Better Before Cheaper – “compete on market differentiators other than price”.  Great brand, an exciting style, or excellent functionality, durability or convenience are business strategies superior to offering a minimally acceptable standard, trying to attract customers solely with lower price.  In the past, our one-stop-shopping convenience has been easier for our members to see and understand than our eight-years-running highest quality outcomes in Georgia.  And companies and individuals in Georgia naïve to us have more often labeled us “less expensive” rather than “superior quality and convenience”.   The “me-too competitors” in the Atlanta area are attempting to  blur our hard-won differentiation on quality and service.  So, getting our office costs from 250% of market to 100% of market, while improving the recognition of our distinctly higher quality and service, should satisfy Rule #1 – outstanding business performance is more often created by greater value than lower price.

#2 Revenue Before Cost – “prioritize increasing revenue before reducing costs”.   In our industry, this rule was translated in the past as “its more important to grow profitable membership than reduce medical costs”.  But in the new economics of US healthcare, the amount of revenue per member is becoming fixed, whether because of sequestration, defined-contributions from companies, or transparent pricing in the Health Insurance Exchange (HIX).   Discretionary medical care, such as cosmetic surgery, will of course remain in the new healthcare world, but accounts for only 0.4% of the overall healthcare market (CNN, March 2010); and anyway, that’s not our mission.  So Rule #2 is satisfied by default … as revenue is now fixed (more or less), the only strategy that will lead to higher margins is that which lowers costs – eliminating waste in the system.

#3 There are no other rules – “so change what you must in order to follow the other rules”.  The authors continue, “the absence of other rules doesn’t give you permission to shut down your thinking.  You (must) still … follow the rules in the face of what may be wrenching competitive change.  It takes enormous creativity to remain true to the first two rules.”

in summary

In summary, here’s what we need to do in anticipation of the coming era of consumerism and disintegration in healthcare:

1.       Reduce the waste of current office resources (people & space) by …

2.       Practicing at maximal scope of practice, matching patient demand to clinician supply every day if not every hour, and increasing visit rates per exam room per unit time, while …

3.       Substantially increasing the patient’s discretionary effort to better manage his / her chronic condition, through more compelling use of “connected care everywhere” and behavioral motivation

In Search of the Holy Grail – the how

where the magic happensThis week I’m writing about the search for The Holy Grail of the new healthcare market … integrated delivery systems (IDSs) such as ours lowering the cost of an office visit, while simultaneously improving patient outcomes.  This is to be differentiated from the soon-to-be old IDS economy in which lowering the number of units (e.g., fewer hospital days for a population of patients) paid for the higher cost of an office visit (which commonly includes the cost of integration [e.g., EMR], plus space and personnel).   I’ve written about the Why and the What of such a Holy Grail, now it’s time to imagine The How.

#1 Optimize the scope of practice for all clinical personnel:  let’s face it, highly compensated surgeons and other interventionists are most efficiently used (a) determining what needs to be done, and then (b) doing it. Highly complex decision analysis, sequential probability equations, and shared decision making discussions are the work of cognitive specialists, or at least should be.  And real population care … matching each of 2,200 individuals to best-practice “prevention intervention”, along with prompt, effective resolution of straight-forward clinical problems, is the domain of Primary Care, 100% of the time. We need our nursing teammates and associate practitioner colleagues and practice / process advisors to tell us how best to distribute the remainder of clinical work.

#2 Better match patient demand to clinician supply:  historically, we’ve “permanently planted” our physicians and associate practitioners at a single site, despite the ebb and flow of patient volume and complexity. More than occasionally, we have a full complement of nursing staff in the office when the surgeon is in the operating room. We must use PMG Medical Economics (Analytics and Modeling) to better match supply and demand.

#3 Do more with the space we have, rather than replicate space we already have: we have relatively low patient flow in our exam rooms if viewed over the course of a year.  Each of us knows a particular day, month, season or department that the office was busting at the seams, but overall, across all 35 departments and 29 offices and 12 months, we use our exam rooms only ~60% of their maximal capacity, and that capacity is not evenly distributed across our delivery system.   We’ll have to enlist the help of you, our process engineers, and department administrators to help us solve this puzzle.  The new Kaiser Permanente ACC/CDU at Southwood, scheduled to open sometime in 1Q2014, provides new functionality for patients using that MOB – functionality that could not be created repurposing the current space.

#4 Better activate patients to work harder on their behalf, during the 99.9% of their lives spent not in the exam room.  Imagine your practice delivering to the patient technically relevant, emotionally compelling information in the precise moment of decision-making … choosing food, exercise, self-monitoring activity … that reliably and repeatedly led to the behavior you both want. What would happen to control rates for hyperglycemia, hypertension, hyperlipidemia, depression/anxiety, obesity, and so on? Using motivational psychology, Big Data, patient preferences and personalities, genetic information, we could craft a series of well-timed electronic communications and data uploads to activate and empower patients in ways that words, spoken by a doctor in 20 minutes every three months, can’t. I believe someone will figure this out, why not us?  Of course “laying on of the hands” will always be a critical part of the clinical sacrament, but as a specific healing intervention in itself, rather than a perfunctory ceremony.

be more explicit

Together, we’ll figure out the specifics, led by the clinicians doing the work, and our “rocket-scientist” practice and process engineers.  Our members will be thankful … thankful they can enjoy the benefits of KP Integrated Care, at a price they can afford.

Click here to read the next post in the series, “In Search of the Holy Grail – Being Successful”

In Search of the Holy Grail – the what

monty python and the holy grail

This week I’m writing about the search for the Holy Grail of the new healthcare market … integrated delivery systems (IDSs) such as ours must now lower the cost of a unit of care, while simultaneously improving patient outcomes. This is to be differentiated from the soon-to-be old IDS model in which lowering the number of units (e.g., fewer hospital days needed for a population of patients) paid for the higher cost of an office visit (the cost of systems of integration [e.g., KP HealthConnect], space and personnel). I know what you’re thinking … Which Holy Grail are we talking about here?

But consider this … if we believe our current healthcare operations, efficient as they no doubt are, still have imperfect processes, redundancy of activity, clinician-brain use <100%, inadequate enlistment of patient effort, and inconsistent pairing of physician and nursing staff, then in fact it is possible to further reduce waste and thus cut costs for members. So, imagine a future day in which …

(1) every member of the healthcare team practiced at his/her maximal scope of practice, all the time: surgeons spent more of their time operating; physicians spent more of their time doing diagnostic and therapeutic analysis for individual patients and populations of members (and doing no nursing work); RNs did more patient education and care coordination; LPNs did no MA work … you get the idea.

(2) better match patient demand with clinician supply: all personnel needed for a specific office visit for a specific patient were present 100% of the time, and never present when not needed.

(3) more effectively use each physical asset we have: space costs lost of money to create, maintain, heat and light.  Is every exam room we now own enhancing the health of our members in that area?

(4) more thoroughly motivate the patient / member to act on their behalf; the next billion dollar drug / procedure will be that which changes patient behavior in ways she / he finds specifically beneficial to their health, rather than adherent to prescribed healthcare.

lean five steps

If we could do all four, reliably, we’d solve more patient problems in less time at less cost compared with today’s operational design.    The age of the EMR has a tendency to lower team productivity in unexpected ways – workflows designed to accommodate the latest EMR functionality defaulted to the physician doing more work, even though that new work was below her/his scope of practice, rather than doing the hard engineering work to distribute the new work to the most appropriate member of the team.

The historical difficulty of designing such maximally efficient clinical operations has been due to: (1) our profession’s insufficient ability to anticipate all of the patient’s needs at a future location and time – a manifestation of American healthcare’s decades of reactive care, rather than proactive care, (2) fighting against, rather than planning for, the inherent complexity of the human condition, and (3) our insufficient flexibility in operations to respond to those predictions and uncertainties.

castle ruins in scotland near lock ness

But we should not assume it can never be done; we simply haven’t done it yet.  In the third segment of this series, I’ll take a stab at The How … how we execute upon those four goals by redesigning operations in a manner that is more accommodating, effective and less costly – indeed, less reliant on capital-intensive healthcare, like space and people (see Of Castles and Trebuchets).

Click here to read the next post in the series, “In Search of the Holy Grail – the How”

In Search of the Holy Grail – the why

the holy grail

Most of my posts the last few months have focused upon the altruistic dimensions of providing healthcare – high-quality outcomes, empathetic service and the process-engineering that continuously improves that care. I’ve also written about the crisis in paying for America’s healthcare; private and public payors demand we use less money to achieve better outcomes. This week I’ll write about the search for The Holy Grail that connects the two … how integrated delivery systems (IDSs) such as ours lower the cost of a unit of care, while simultaneously improving patient outcomes.

total cost of healthcare

Historically, IDSs have gotten away with having higher costs for a patient office visit by having lower hospital and pharmacy costs for that same patient. Indeed, our “relative expense” from the former is more than offset by the “relative savings” of the latter, thus enabling us to charge a total price that is lower than non-integrated (traditional) care. That math works only as long as the patient (or her employer) pre-pays for total care (office visits + hospital + pharmacy).

value = improvement over cost

But what if the highly touted “Consumerism Movement” in US healthcare (individual patients making individual buying decisions for individual units of care), coupled with “Pricing Transparency” (every price for every unit of care from every provider in the neighborhood available on the patient’s smartphone, right now) led patients to truly shop for a unit of care (say, an annual GYN exam or diagnostic colonoscopy or laparoscopic cholecystectomy) among a number of IDS providers in the city? In the new healthcare market, if our price for a unit of care is higher, the patient must believe ahead of time we are worth the additional cost, or she’ll spend her Healthcare Savings Account (HAS) dollars elsewhere. If our price is market competitive and our service or outcome superior, more deductible HMO (dHMO) and high-deductible healthplan (HDHP) members will choose to receive their care from us, rather than the IDS down the road.

In the next three posts, I’ll propose a “what” and a “how” of reducing our unit costs (prices for an individual unit of care), followed by some business principles that must be reconciled in order to succeed.

Click here to read the next post in the series, “In Search of the Holy Grail – the What”

Happy Doc = Happy Patient

As a patient, it’s in your interest to be cared for by a physician fully satisfied in his/her practice.  Happy docs achieve higher quality scores, provide better customer service to their patients, and concentrate harder on the task at hand – perhaps your surgery!  This relationship between professional happiness and customer outcome has been described in many industries.

doctor patient relationship

So you might wish to know what attributes of a physician’s practice to look for.  In the current issue of The Annals of Family Medicine, researchers from Boston, Iowa and San Francisco answer that question for adult primary care practices (Sinsky CA, Wilard-Grace R, et al.  In Search of Joy in Practice.  Ann Fam Med 2013;11:272-278).  Their findings of the five (5) critical components of a highly fulfilling practice are no surprise to our physicians:

#1 ProActive Planned Care:  Our population-care nurses and care managers reach patients in need of preventive screening or attention to their chronic conditions.  Our physicians order lab testing be done in the days prior to the patient’s visit, empowering shared decision-making in the exam room, highly satisfying for both patient and physician.

#2 Sharing Clinical Care Among a Team:  Our Permanente Practice employs ProActive Office Encounter (POE), a collaborative nursing process of ensuring all patient needs will be met and care-gaps closed during today’s visit.  All team members (MA, LPN, RN, Behavioral Health Practitioner, Pharmacist, MD) make unique and valued contributions to the care of all patients, expediting the care and recovery of patients.  We also have an active and successful nurse-advice service for our patients.

team

#3 Sharing Clerical Tasks Among a Team:  our Proactive Office Support (POS) nursing staff handle the non-physician parts of the workflow for medication refills, school/camp/work forms.

#4 Improved Communication:  through our redesigned process known as EDGE, the duration of time that lapses between an inbound patient-call or patient-email to the outbound resolution has been cut in half in many departments.   We’ve improved our co-location of physicians and advice-nurses in many departments as well, an important aspect of practice satisfaction (and efficiency) the researchers found.

#5 Improved Team Functioning:  team meetings answer the question “what’s working well; what needs changing?”, necessary to continuously enhance quality, workflow and efficiency (better care and less waiting for you!); we have a team-learning curriculum that leads to the elimination of holes in processes (“Highly Reliable Team Training”); team huddles in the morning anticipate individual needs of patients and team members.  Our practice engineers make our healthcare very safe and easier to navigate for our patients.

happy healthcare team

We are proud of our primary care physicians and their patient-centered practices – they lead to happy docs … the fuel that generates the best service and quality for you.

Of Castles and Trebuchets

Throughout history, investing in capital-intensive, fixed-defensive positions has failed as a military strategy.  For more information, see castle v trebuchet, Great Wall v The Hun, Siegfried Line v Patton’s highly mobile Third Army.  Indeed, rapidly deployed, highly flexible Special Forces are working well in today’s warfare, not heavy bombers, rear artillery, or cruise missiles.

castle ruins in scotland near urquhart, better pic

In today’s healthcare, I continue to see capital-intensive, fixed-defensive positions being built, despite our county’s inability to afford such infrastructure, and despite the clinical requirement we relocate our healthcare from single, stationary to multiple, mobile locations.  Oh yeah … the pace of change in the industry is very much akin to the speed of today’s warfare.  For more information, see hospital oligopolies and single-specialty mega-groups, the creation of which is solely designed to fix high prices in a marketplace changing how heatlhcare is paid.

hospital facade, good sam

What if a more mobile healthcare delivery system, made possible by low-cost IT-peripherals and connectivity, was the better strategic choice, both offensively and defensively?  Imagine a patient being electronically “touched” by her physician team 4 times a month for preventive health, wellness, nutrition and disease management, rather than a single office visit + ER visit + collateral costs from inadequately managed DM?  The combined cost of the mobile care and connectivity, driven by true population-based care, would have to be 50% less than the cost of building and maintaining today’s healthcare castles (stone and mortar, guards, wardrobes of kings and queens, maintenance on the moat, etc).

medical informatics doctor

Regardless, we’ve got to get America’s healthcare spend from the current 18% GDP to 12-14% over the next ten years.  That can’t happen if we continue to invest in the capital-intesive anachronisms of fee-for-service (FFS) healthcare.

 

The Problem to be Solved

I continue to hear physicians in our state rant about ObamaCare, as if the latter is the root cause of healthcare’s ills, rather than merely a symptom (or solution, depending upon your politics).  We humans use our cultural biases and personal experiences to form (correct or incorrect) assumptions about changes in our world, too often failing to deeply understand the root cause of those changes.

I maintain that ObamaCare is NOT the problem to be solved; the Sustainable Growth Rate (SGR) and its offspring, Sequestration, are NOT the problem either; whether Governor Deal will or won’t expand Medicaid in the state – also, NOT the problem for us to solve.  What then?

The root cause of all those symptoms is in fact The Cost of American Healthcare.  That high and rising cost ($8,000 per year for individuals, $12,000 per year for families) is the problem causing the symptoms (2010 ACA legislation, 50% of state budgets used for healthcare, and the 2013 Federal Sequestration).

Here are some more symptoms: (1) employers shifting costs to employees (changes in benefit structure and financing of those benefits), (2) uninsured or underinsured individuals shifting costs to the general economy (see spike in personal bankruptcies due to healthcare bills, the cost of caring for the uninsured or underinsured and the cost of diminished productivity), and (3) the general economy struggling from lower spending in areas other than healthcare (innovation, education, infrastructure, the environment).    Dr. Atul Gawande revealed we physicians are part of the problem (New Yorker, “The Cost Conundrum”, June 2009), and Mr. Steven Brill revealed so are hospitals, pharmaceutical and device manufacturers (Time, “Bitter Pill”, March 2013).

So what’s the sustainable way out?  I see a short list of choices:

  1. Price controls (what Mr. Brill argues)
  2. Mandate all insurers be non-profit, coupled with community rating (our model in the US 1940-1960, and one of two European models today)
  3. Payment reform coupled with a free market (partially underway in the US – see  ACOs)
  4. Rationing of healthcare expenses (see UK or Canada)

What’s your preference?

Where’s the Line Between an Owner’s Right to Run Her Business, and an Employee’s Right to Personal Liberty?

Allow me to tell you the exact same story, but from two different (and equally valid) points of view.

woman business owner

The Business Owner: “During the last 10 years, I’ve seen my company’s healthcare costs increase 160% in total, now over $12,000 per year per employee. During that same time, I did everything the benefits consultants told me to do: (1) first increase the copays for doctor visits and drugs, then when that didn’t lower total costs, (2) change the employees’ financial obligation from copays ($15 per visit) to coinsurance (15% of the cost of the visit), then when that didn’t work, (3) change the plan design to place more of the financial obligation of healthcare expense onto the employee, which chased away my top 10 employees, lowering our sales productivity.  Now those same consultants are telling me the only way to lower next year’s costs is to insist my employees make themselves healthier this year.  So I’m financially mandating wellness from each employee.”

american workersThe Business Employee: “During the last 10 years, I’ve seen my payroll deduction for healthcare coverage rise 220% in total.  At the same time, my pay has increased only 30%, barely keeping pace with inflation, with fewer colleagues to share the workload.  The owner keeps changing our healthcare coverage every year or two, saying she can no longer afford the older, richer package, so my out of pocket expenses for healthcare have also increased.   Now she’s telling me I have to lose 50 lbs (get my BMI < 35) by the end of the year, or I’ll pay $1000 more than my slim and fit colleagues next year, for the same coverage.  There goes Christmas.  What’s next – fire me for having diabetes and bad knees from my weight?”

It’s a true story playing out all over America.   The Wall Street Journal recently reported that up to 60% of companies surveyed plan to implement penalties (rather than incentives) upon workers who don’t get healthier (Leslie Kwoh, “Shape Up or Pay Up: firms put in new health penalties”, A1 and A6).   This leads to at least two questions, “Are such penalties legal?” (Yes, within limits), and “Where do an employer’s rights end and an employee’s rights begin?” (Harder to answer)

Most would agree the employer has no obligation to build and run an onsite gym or cater lunch every day from Whole Foods (although high-tech, high-profit companies often do something similar).  All would agree that the employee has the right to quit if she/he finds the corporate rules, salary or benefits unacceptable (but that’s very hard to do in the new global economy).  Let’s seek the middle ground.

weight of the nation

Given the facts that obesity is now directly or indirectly responsible for (1) ~ 50% of the deaths in the US (CDC, Weight of the Nation), (2) ~ 30% of healthcare costs (several sources), and (3) 450 million missed days of work annually in the US (2011 Gallup), business owners feel financially obligated to structure benefits to attract and retain fit employees.  The question is, “how will the US workforce respond?”  Will we argue the financial reality of the business owner, or redirect those energies against the real enemy – overweight and obesity.

What is in an employee’s control?  Certainly not whether they get leukemia (Act of God if you will), but diabetes, hypertension and hyperlipidemia might be (diet and exercise balanced against our genetic inheretance).

What is an employer’s obligation?  Certainly not gym memberships and delivered veggie-humus wraps, but civil workloads and facilitating an exercise-at-desk-program might be.

At KP Georgia, we have the highest HEDIS ratings in the state for Adult BMI assessment, as well as, Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents.  We join our members and corporate partners in the fight against obesity, and its sequelae.