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Five Key Trends for 2011

By Cyndy Nayer, January 3, 2011

Businesses are refocusing their efforts on the health of the workforce as new evidence shows that the right investments in the right context can drive better health and performance.  ACA, and the chaos surrounding it, had quieted down around July of 2010, but with the elections and their aftermath, the noise in the health care reform efforts became a cacophony of confusion.  And, somehow, with the approach of the holidays, the cacophony gave way to a new surround-sound system:  we have to get back to work in America.  So, while the legislators appear to be ready to fight to the knockout, America appears to be tuning out that noise.

It's imperative that the noise is muffled so that business can grow again.  Key trends that are accelerating this return-to-work philosophy can be drilled down to 5:

1.  Benefit design.  The realization is that business depends upon a healthy workforce.  Some businesses can off-shore their work to a less-expensive locale, but most cannot.  Therefore, innovation in benefit design is paramount.  And while there is some tension to leave health insurance benefit altogether, the mood appears to be softening a bit.  It's a profound realization that, with or without the health insurance benefits, business still needs a healthy and productive workforce.  So, un-managed individuals can't deliver on improved health, and insurance exchanges may offer a bit of relief to the healthcost-weary.  But the risk of the underinsured to the business is that safety incidences may rise (people engaged in their health are also engaged in their work); health costs may rise in the market, demanding higher tax revenues; and higher taxes and/or unhealthy people do not purchase products at the same rate as engaged, healthy people do.  So, benefit design, whether in-house, independent, or insurance exchange, will not go away.  And, value-based benefit designs will continue to show the improved health and reduced trends so very much needed at the business budget lines.

2.  Expansion of prevention and wellness.  As the former Chair of the Missouri Governor's Council on Health, I've never seen the rush to prevention and wellness at the speed in which it's now moving forward.  Partly it is attributable to the need to acquire healthier beneficiaries, that's true.  But it's also due to the fact that so much of the disease management efforts have delivered results only "around the edges":  rates of chronic disease continue to climb, every time one person stops smoking, another starts, and obesity is sweeping through our children like measles.  We must create a better waistlines in order to manage our business waste-lines:  obesity drives up rates of chronic disease across all populations and starts at a much younger age.  Innovation is building that will support physical activity, goal-setting and achievement, and personal health success.

3.  Acquisition of new care sources.  A quickly growing trend is the installation of onsite services and the expansion of onsite clinics into business sites in order to manage the total costs of care, reduce the barriers to early intervention, and even to treat the dependents and, sometimes, the community's health.  Using the skills of medical directors in these clinics, the rise of the medical director is reshaping the seat of power inside the business.  No longer is the medical director and his or her staff recognized only as the education director or the point person for flu shots.  Medical directors and their onsite clinics are showing phenomenal results in engagement and accountable care, and this growth will continue.  Telemedicine and medical travel will expand to competent providers with measurable outcomes.

4.  Personal Health Records will become the standard for IT.  As the use of electronic health records grows, there will be some who continue to rely on the physician and his/her office to manage "my" health.  But the real power of the first 3 trends noted here is the opportunity to create competent individuals who manage their health, health cost, and health purchases as wisely as the CEO of a business.  They record goals, strategies, measures, directional approach to targets; they use the medical system as a consult instead of the head of business at "My Health."  "My Health" becomes a tangible asset that the individual can take from employer to employer, from one physician to another.  Without it, and without putting the total information into the individual's repertoire for asset management, the rest of the IT will fail to connect all the points, because the real point of health care must be the improved health of the individual, and that only happens when the individual is engaged in the management.

5.  Outcomes-based contracting(TM).  I'm a bit biased here, so I want to be especially transparent on this one.  The level of interest in paying for outcomes is growing rapidly.  Transparency and quality forms the comparative platform for choosing which services to buy and from whom.  Creating a contractual arrangement in which all parties share risk (usually defined through a series of desired behavior changes) and share in rewards (savings are distributed across the stakeholders, including the individual) if the best way to insure value accrues to all the participants.  OBC is growing from the focus on pharmaceutical contracting to the outcomes improvement at the health system level, the accountability for care at the clinician level, and the benefit design that most fits my family or yours. For more information on OBC, please check out:

These are powerful trends that hold the promise of delivering more value for the money spent in health care.  But they also re-focus the conversation on units of health instead of health care.  Any business knows how to buy units of supplies to create the products they will sell.  Individuals know how to buy units of bananas, weigh them, and pay for only the weight they receive.  Purchasing health care must be the same:  we need to know the cost, agree to the terms and manage the acquisition and use.  We need to get back to business.  The ACA will continue it's march...American business needs to get back to the business of America.

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