The Equitable Health Care EquationImproving our health by sharing the wealth A White Paper by Gary L. Earl

45443WPEENANC 04/14

Making the case for change

America accounts for nearly half of the world’s total health care expenditures1 yet rests at or near the very bottom of all developed nations in critical areas of measurement such as infant mortality and life expectancy.2

The past three decades have seen a dramatic rise in the percent of the population diagnosed with chronic disease such as diabetes and childhood asthma. The incidence of these health conditions, compounded with other serious health issues, including obesity and stress, continue to increase year over year. They are eroding our nation’s overall health status3 and driving health care costs steadily upward at unsustainable levels.4

The results have placed America on a collision course with evolving demographic, social and economic trends. Without intervention, businesses, individuals and our communities can expect dire consequences in the future.

Reducing the avoidable costs, while simultaneously addressing the natural and unnatural causes associated with these conditions, is critical in meeting the twin challenges of promoting affordable health care and fostering continued economic growth. We have a choice: continue along the pathway of the status quo in the workplace and community or alter it by modifying our behaviors while focusing on primordial prevention, wellness and early intervention.

Tackling the challenge, growing the opportunity

American businesses are faced with a challenge but also an opportunity to lead the dialogue, direction and gains associated with:

£ Improving individual health and well-being.

£ Regaining control of the situation.

£ Benefiting from the subsequent results, which can ultimately influence the company bottom line.

The challenges extend beyond the growth of disease and associated health care cost trends well into the business operations, company mission and sustainability.

We can no longer view health through a tightly focused lens of a line-item expense or as an employee benefit alone. We must view health as an asset or tool that creates improvements for employees and the company.

More than half of the U.S. population receives its health care coverage through employment-based plans and programs.5 This creates the opportunity for American business to take the leadership role in reducing the rising trends of disease and costs, and to stimulate and share in the gains that come from this desired change.

“Poor health is a serious individual, business and economic threat to our way of life. This serious threat cannot be tolerated and thus we need to act now. Therefore, it requires a serious business and economic strategy to reverse past and current ways of thinking and use of resources.” – Dee Edington, PhD, Founder and Chairman, Edington Associates, LLC; University of Michigan, Health Management Research Center, ret.

American businesses are uniquely and naturally positioned to exercise their governance within the broader framework of the communities that are more than mere benefactors of improved health. They are vital partners in the effort to engage in the change itself.

Expanding health beyond health care

For meaningful transformation to occur in health and health care, we must first expand our view and comprehension of the definition of health. This new approach broadens our understanding of what contributes to health in the first place.

Health is more than the absence of disease6 and wellness is more than a lifestyle or behavior alone. The limitations of focusing solely on an individual’s behavior or access to appropriate medical care have produced today’s results. Health springs from a deep root that is personal, expansive and interconnected to our life’s experiences, our environments and the conditions we face that ultimately form our choices.

While we have invested a majority of our attention, energy and resources on an individual’s behavior and related access to care and treatment, evidence has been mounting for decades that it is in fact the broader and more complex environmental, cultural and social dimensions of health that actually account for more than 50% of morbidity, mortality and costs.7 Those factors range from food insecurities and transportation policy to culture, context and control. The important information has, for the most part, been overlooked and often misunderstood.

This has exposed the limitations of focusing solely on the individual’s behavior, genetics, lifestyle and access to quality medical care. Clearly, a person’s health is influenced by a wider range of factors than generally understood.

These factors can’t be reasonably addressed through today’s traditional medical and behavioral interventions alone. While much of today’s policy change is focused on important initiatives seeking to improve coverage and access, and the quality and intensity of health care, the evidence suggests that medical care in itself, although a vital contributor to the overall health of the population, plays a smaller role than conventionally thought.

What is unique about this approach is potential for change that lies within the understanding and addressing of health from the perspective of far more than an individual’s behavior. This paradigm shift includes the social and environmental determinants that are embedded within the business and community that influence or create health. It is these factors, such as socio-economic status, that often drive the acute symptoms we are failing to control today. These factors expose and create new opportunities to approach the problem, drive results and experience the shared values and gains that come from success.

“Individuals don’t leave the impact of their personal health risks on the doorstep when they leave for work and they certainly don’t leave the impact of their workplace environment behind when they return home. The two spheres are related and we need to better integrate workplace health strategies within the home health strategies.” – Ronald Kessler, PhD, Department of Health Care Policy, Harvard Medical School

Achieving transformational health

A new model is emerging for American businesses that have the foresight to transition out of the classical role or obligation of providing health care coverage to their workforce for competitive reasons.

Through this approach, employers move from inside the workplace into the community at large – all while using the community to bolster the company and take it forward under the banner of health and well-being in an innovative and integrated fashion.

This new company/community model exceeds today’s common corporate practice of social responsibility, which involves charitable giving or employee volunteerism, into a “socially symbiotic” model. The company acts as the catalyst for change, a trusted guide and a potential resource partner. In turn, the community is invited to provide its resources, both human and economic, which foster a collective inspiration, incentive and movement to achieve each individual stakeholder’s desired goals.

This innovative and fully integrated strategy is built upon a practical foundation of individual, business and community investments and improvements through health, based on the principles of shared-value. The framework is built of common purpose, objectives and measurements, while construction is directed from a well-defined, collaboratively created blueprint of guiding principles, values and strategies. This socially symbiotic movement creates necessary steps that differ from anything American business is doing today. Key tenants include:

£ Discovering and connecting to the broader determinants of health.

£ Empowering community partners to participate in the creation of solutions from investments that come from inside and outside the company walls.

£ Engaging all stakeholders in open participation and collaboration that creates economic incentives while establishing responsibility.

£ Creating business, individual and community partner-investor solidarity, while building a blueprint supported by shared investments and returns.

Case study: gambling on solutions

The vast amount of research and evidence covering this topic is hardly new. Over the decades, innovative pilots and research projects in both business and social structures have established and pioneered new ways to address – from a business perspective – what truly influences health, the impact on the company health or bottom line and the community as a whole.

As health costs continue to pose a serious threat to the competitiveness of U.S. businesses, there are a number of companies that have assumed a leadership role and driven this matter to the forefront. These same companies have also achieved significant success through their inventive and courageous actions. Beginning in 2001, a well-orchestrated and successful initiative to create a more balanced health eco-system was conducted by a leading gaming organization located in Las Vegas, Nevada. The organization envisioned, designed and implemented a company-community approach. The results showed clear economic gains for

When businesses invest in the health of a community, the community invests back in the health of the company.8

the business, while simultaneously impacting the health outcomes of its employees and building community accord.

Inspired by the support of company leadership who understood the risks of following the status quo, the human resources team developed a partnership with internal interdepartmental investors and the employees at large. They additionally invited an external pool of partners, such as providers, suppliers, vendors and services, to participate in the work, thus forming a true “collection of colleagues.”

The group served as a representation of the various pieces of the system that are linked to health – business, government, academia, public health, safety, education, religion and activism. They collaborated to research and explore the broadest view of health. The group quickly learned the company and the community, or individual and environment, are inseparable. This realization resulted in the creation of a social cooperative-based model designed to stimulate the changes that were needed to improve health. The success of the model’s blueprint depended on the evolution of perception. The thought that an individual’s health is determined by lifestyle, nutrition and exercise choices alone was expanded to incorporate other influential factors such as:

£ Lack of open space

£ Excessive TV viewing

£ Severe commuting conditions

£ Extreme weather

£ Limited access to healthy and affordable food sources

Together, they constructed and implemented a holistic, personalized strategy based on shared investment and return focused exclusively on creating opportunities for each individual to engage in healthy behaviors based on the choices they had.

This approach included imaginative healthy food sourcing and distribution, innovative health and wellness events hosted both inside and outside the business environment, co-op-based learning laboratories, condition-specific centers of excellence, multi-cultural communications and the inclusion of onsite resource centers that included wellness and well-being education, resourcing and behavior counseling, to name a few. In each case, the planning and actions, including resourcing emerged from cross-sector cooperation. Each program was established on the concept of an equitable equation of shared value for each investment and investor.

The model created access and solutions by:

£ Using common cultural language.

£ Stressing the critical importance of wellness and well-being.

£ Placing individual mental and emotional status at the core of each decision.

£ Identifying and addressing the fundamental influencers of health.

As this broader effort moves forward, calculating the full benefit and return of this revolutionary transformation will take time. It will also require new ways and models to measure value. Early evidence, however, demonstrates a more robust return on investment than is understood in classical terms. In the case of the Nevada project, the returns for the company after three years included:

£ A multi-year insurance premium stabilization and liability reduction.

£ Improvements in the adherence to and compliance with medications, treatment and preventive services.

£ Further decrease in cost avoidance through a reduction in the rates of disability, workplace injury and absenteeism/presenteeism.

£ An increase in productivity, customer experience and employee retention.

As it relates to the employees and their dependents, although anecdotal, evidence suggested that the reduction in disease such as diabetes and hypertension, as well as improvements in rates of obesity and medication adherence, led to a positive impact in key areas, including job satisfaction, sense of control, quality of life, volunteerism and longevity.

As for the community, several social, environmental and economic awareness efforts and minor improvements surfaced that benefited and positioned the community for sustainability and growth in areas such as:

£ Urban renewal

£ Community development

£ Social-business cohesion

£ Community brand promotion

Assuming our roles and responsibilities

To drive this level of change, we must do so together. We need to develop an equitable equation that creates the level playing field on which the transformation of health into economic gain truly takes root. The principles of shared investment and shared value are the end game. If we are to achieve our goal, we must identify the challenges to better health that we face – from lack of services to education to absence of appropriate incentives.

The value of the return must also fit into the equation, including advancement, longevity, economics, sense of security, freedom and belonging. With each value equally important as the others, this model has the promise to bring all people together and the power to improve each condition that initially created the challenge. This can only occur if the collective can more clearly see their potential returns in a unified, organized approach to the problem.

A final word

It can no longer be left to our government, employers, health service professionals and medical providers alone to reverse the rising trends of conditions and costs. For it is within the collective wisdom and energy of all stakeholders, including each individual, that we must come together to envision, build and invest in innovative,transformational solutions that will drive change. This possibility can become a reality based upon a new understanding that health is more than health care.

We now have before us both an opportunity and obligation to approach health improvement by inspiring and leading an integrated, inclusive and contemporary approach – one that moves beyond healthy lifestyles and access to quality care and evolves into expansive and integrated solutions. Strategies must be implemented that address holistically and simultaneously the fundamental causes of health, create opportunity for diverse and equitable gains and returns among all shareholders, including the individual; businesses, both large and small; and our communities and towns in which we coexist.

Together, we can.

Gary Earl is the Health and Well-Being Ambassador, Anthem Blue Cross & Blue Shield, National Accounts. Nationally recognized as a visionary, passionate business leader, Gary’s 30 years of experience and expertise include extensive knowledge in the disciplines of health, wellness, behavioral and social science, economics and business leadership. He has been recognized and rewarded for providing leading-edge collaborative concepts that create, execute and exceed business and individual goals that encompass organizational, individual and community imperatives.

Appendix

1 World Health Organization (WHO) World Health Statistics (2010): who.int/topics/statistics

2 National Institutes of Health (NIH) website: ncbi.nlm.nih.gov

3 Health, United States (2008): U.S. Department of Health and Human Services (HHS): cdc.gov/nchs/data/hus/hus08#071

4 Kaiser Family Foundation website: Health Care Costs – A Primer: kff.org/insurance/upload/7670-03

5 DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith: Income, Poverty and Health Insurance Coverage in the United States (2011): Current Population Reports, P60-243, U.S., Census Bureau, Washington, D.C., 2012

6 World Health Organization (WHO) website: who.int/governance/eb/who_constitution

7 M. Marmot. The Status Syndrome; How Social Standing Affects Health and Longevity. New York. Henry Holt, 2004

8 National Philanthropy Benchmark Study, Council on Foundations & Walker Information (2002): and Cone Corporate Citizenship Study, The Role of Cause Branding (2002)

Gary Earl

The Anthem National Accounts business unit serves members of: Anthem Blue Cross Life and Health Insurance Company and Blue Cross of California using the trade name Anthem Blue Cross in California; using the trade name of Anthem Blue Cross and Blue Shield for the following companies in: Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Connecticut: Anthem Health Plans, Inc.; Georgia: Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.; Indiana: Anthem Insurance Companies, Inc.; Kentucky: Anthem Health Plans of Kentucky, Inc.; Maine: Anthem Health Plans of Maine, Inc.; Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits; Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada.; New Hampshire: Anthem Health Plans of New Hampshire, Inc. Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc.; Ohio: Community Insurance Company; Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123.; Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. In 28 eastern and southeastern counties in New York, Empire Blue Cross Blue Shield, the trade name of Empire HealthChoice Assurance, Inc., underwrites and/or administers the PPO, EPO, POS and indemnity policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

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