The article focuses on a series of reforms implemented at the Cleveland Clinic, which employs about 40,000 people, making it the largest employer in Ohio. They've managed to do an amazing thing: reduce health-care costs for their employees.
I'm pretty sure we're all familiar with the rising cost of health care - as much as I'd like to complain about my premiums, my health care provider has paid about $74,000 in medical costs this year, leaving me with under $1,000 to pay out of pocket. I'm pretty sure I've just covered the premiums for the rest of my life, more or less. While things like broken arms are not easy to anticipate, the Cleveland Clinic looked at a rather startling statistic from the CDC - according to the article,
70 percent of all medical costs are related to smoking, physical inactivity, food choices and portion size, or stress. Cut smoking, increase physical activity, persuade people to make better dietary decisions, and help them manage their stress, and you can reduce health-care costs before an employee ever steps into a hospital.That's kind of amazing, if you think about it. Seventy percent. That means things like Adam's $45,000 broken arm aren't included in that seventy percent. You could assign most of that seventy percent to poor personal choices.
So, how did the Cleveland Clinic change some of those choices? By giving their employees less of a choice. They offered free tobacco-cessation programs, free fitness classes, and free stress management classes. They took every deep fryer and sugary drink off the campus. They also raised insurance premiums for employees, then offered them an incentive - if they agreed to participate in healthy initiatives, they didn't have to pay the new rates.
That left enforcement. The clinic tracks its employees’ blood pressure, lipids, blood sugar, weight and smoking habits. If any of these are what the clinic calls “abnormal,” a doctor must certify that the employee is taking steps to get them under control. Otherwise, no insurance rebate. The idea is to force employees to have regular conversations with their doctors about wellness. If they participate, they can lock in the rates they were paying two years ago. The savings amount to many thousands of dollars.Not only are the employees paying less, but the employers are also paying less. That's pretty amazing. But it also raises a lot of questions: Would this program still be cost-effective at a business that didn't have cheaper access to things like blood sugar tests? Is the labor force at large willing to accept these restrictions on their personal lives from their employer? Could this be applied to Medicare and Medicaid or even a future public option? Are people willing to have their choices restricted?
What I like about the program is that, other than smoking, nobody got fired for not participating in the reforms. They simply had to pay more. Monetary incentives are pretty successful when you're trying to get people to change habits, but I imagine you could find more than a handful of employees who were not happy about the changes at work.
Personally, I would love to see my employer do more to encourage a healthy lifestyle. My current building used to have a gym available to employees, but it got shut down. We've asked to use another room to exercise in if employees brought in their own equipment, but that was denied too (probably for insurance reasons). Our HR web site doesn't have much in the way of promoting a healthy lifestyle. This is surprising to me, given that my company is one of the largest employers in the country. Those of us who are bargained employees enjoy low premiums and great health care, and I imagine some of these initiatives would save the company a lot of money. While I'd be all for it, I can see the other side of the argument as well. What do you think - would you be okay with this much interference in your life from your employer?