Eric P. Durak MScIntroduction
For years, the wellness community has been looking in the window of health care, hoping to be an integral part of health care delivery system, and obtaining reimbursement for their services. For many practitioners, it has been a constant struggle to justify their services. Some health reports state that since health promotion has done a poor job at creating proper outcomes, it has been hard for them to become part of the multifaceted health care program.
The introduction of HMO’s in the 1980’s has changed the face of health care, and health promotion. Since the primary objective of HMO’s is to curtail health care spending, they are looking for innovative ways to save health care dollars. One way is through prevention and wellness programs.
Wellness and Cost Savings
Health promotion programs have saved money for companies for many years. In his 1981 text, Dr. Kenneth Cooper discusses the cost savings for corporations such as Tenneco, Ford Motor, etc. With the implementation of in-house health facilities, these companies have been able to track employee adherence, track physical changes, and measure cost-savings measures. In his 1988 book entitled: The Economic Benefits of Physical Activity, Dr. Roy Shephard looks at cost savings from an epidemiological perspective, tracking health savings over large populations over years.
Perhaps the most recent report on corporate savings is the highly publicized study from the Steelcase Corporation in Grand Rapids, MI. Over a 10 year program, the company saved over 50% in health care claims – a total of over 14 million dollars.
There is a mood in America today that saving costs may be taking precedence over quality of care. There are many in the medical world who are discontented over the tone of the HMO mentality, because they feel that their portion of medical practice may be in jeopardy over the next few years. The solution may not be wellness, per se, because the portion of the health care pie allocated to wellness (however small), may be taking reimbursement dollars from other elements of health care. If you prevent a serious medical condition from manifesting in the first place (primary prevention), that patient will never seek medical attention, because it has never happened (re-allocation of funds). It is easy to see why even health care professionals are leery of the barrage of wellness programs that are springing up over the country in clinics, health clubs, and hospitals. It may mean that these patients may not see them for health issues, because they have participated in alternative programs. None the less – there is a relationship between smart medical professionals (such as Dean Ornish), and health promotion specialists who wish to combine the elements of education, health, and classic medical practices.
Where Medicine Fits In
The world of health care has two elements. One is competition – which is part of the American way of business. Millions spent for drug research, marketing new devises, techniques, and medications. Hospital mergers, additions, and closings. Employee turnover and the new work force. The second element is monopolistic. Licensure laws, legislation, and state statues have guaranteed some health care professionals an almost monopolistic reign over their services. It is impossible to obtain reimbursement for certain types of “alternative programs”, while more expensive medical services are paid for (many times at taxpayer expense) through insurance payments.
The future may hold some predicaments for the medical profession, as wellness services, IPA’s, and MCO’s may become a more integral part of the health care horizon, but the relationship may not have to be a malevolent one, as relationships may be beneficial to health and medical specialists. This is discussed in the next section.
HMO’s and the Push for Prevention
Leaf has suggested in his article in JAMA that the move to prevention may be a natural extension in medicine based on health care cost escalations. It is doubtful that most medical organizations will jump on the bandwagon soon (because physicians are still trained in treating the sick, not preventing disease). However, organizations such as the Association of Hospital Health and Fitness, Florida Hospital Association, National Wellness Institute, American Institute of Preventive Medicine, etc. have all developed instructional tracks to teach professionals about the basics of dealing in the managed care environment – from outcomes assessments to contracting for services. HMO’s will contract with professionals from these organizations because of the profitability of doing so. In contracting for one sum of money per month (or year), the burden of maintaining profit margins now falls on the provider. Managed care benefits because their payments are constant. Providers who understand how to work in this business environment can increase revenues at a time when many in rehab are seeing revenues decline.
Therapy and Wellness
Working relationships with allied health professionals and wellness practitioners may soon expand because the push for prevention may see more of a “one stop shopping” mentality among payors. In other words, they would like to see many types of services under one roof. If traditional rehabilitation practitioners can incorporate wellness services into their practices, they may be more accessible to HMO contracts in the near future. As contracting becomes the norm in terms of reimbursement, the matching of the professions may be more than a good bargain, it may be a necessity.
In closing, perhaps the best reason for an alliance is the most important. Having many services under one roof means more help for patients. In the push for managed care, many health care professionals measure the changes in terms of dollars. Patients still measure changes in terms of the quality of their care. Many of these patients are upset at the system because of a lack of caring for their condition, more difficulty in seeing their own physicians, and trouble in reimbursement for miscellaneous services. A program that can help patients both in the acute phase and long term rehab needs will be in demand in future health care contracting, and will be in favor with patients who are seeking more from their health care system than just routine diagnostic tests and prescription drugs for most of their conditions. The next few years will see a system that incorporates both wellness and rehabilitation to treat patients, educate them, and control costs over the long haul.
References
1. Banja, J.D. Ethics, outcomes, & reimbursement. Rehab Management. 1994, Dec./Jan. pp. 61-65.
2. Bly, J.L, Jones, R.C., Richardson, J.E. Impact of worksite health promotion on health care costs and utilization. JAMA. 1986. 256:3235-40.
3. Borzo, G., McCormick, B., Somerville, J., Voelker, R. Pulling for a piece of the healthcare market. American Medical News. 1993. pp-3,9,47, April 19.
4. Cooper, E.S. Prevention: The Key To Progress. Circulation. 1993. 87;4:1430-33.
5. Cooper, KH. Aerobics Program for Total Well Being. MC Evans Publishers, New York, 1980.
6. Hatziandreu, E.I., Koplan, J.P., Weinstein, M.C. Caspersen, C.J., Warner, K.E. A cost- effectiveness analysis of exercise as a health promotion activity. American Journal of Public Health. 1988. 78;11: 1417-21.
7. LaForge, R. Health reform and the future of fitness and health promotion. ACE Insider Newsletter. 1993, 3;3:1-4, Winter.
8. Leaf, A. Preventive Medicine for our ailing heath care system. JAMA. 1993. 269;5:616-18.
9. McGinnis, J.M. The public health burden of a sedentary lifestyle. Medicine and Science in Sports and Exercise. 1992, 24;6:S196-99.
10. Sciacca, et al. The impact of participation in health promotion on medical costs: A reconsideration of Blue Cross and Blue Shield of Indiana study. American Journal of Health Promotion. 1993, 7;5:374-83, 395.
11. Shephard, R.S., The Economic Benefits of Fitness. Human Kinetics Publishers, Champaign, IL, 1986.
Jim Strohecker
Tom Ferguson MD