I believe strongly that health is enhanced by healthy behaviors, such as good nutrition, exercise, and healthy lifestyles. To some degree, we can mandate healthy behaviors by law and regulation, or by centralized controls.

However, just as I noted in a blog several months ago in which I described some of the findings in the book Mindless Eating, authored by Brian Wansink, the best behavior change drivers are those of which the individual is not conscious. Steve Victor’s Fit For Life blog provides a brief summary of the book’s key takeaways.

For example, in our World Headquarters at Pitney Bowes, we have created a healthy environment by the food we serve and the way we price it. We have an on-site clinic and on-site fitness center, and we have many outreach programs for preventive screenings and immunizations. (more…)

I strongly oppose the so-called single-payer health care model. I have previously articulated my reasons for doing so in this earlier post. One of those reasons is that cost-effective health care is highly-personalized and, by necessity, highly tailored and non-standardized in terms of processes and approaches, but highly-rigorous and standardized in the measurement of results.

Everywhere in the world in which government has operated or regulated health care, including this country, it has tended to create exactly the opposite: a highly-politicized and highly-rigid regulation of processes and approaches, and almost no standardization or regulation of results. The American College of Physicians recently released a relevant position paper “Achieving a High-Performance Health Care System with Universal Access”, which evaluates the condition of the US health care system in comparison to other countries. (more…)

I keep seeing influential groups, particularly here in Connecticut, advocate that we switch to a “single-payer” health care system. There are many variations on single-payer proposals, but they typically have the following characteristics:

• The Government takes over the administration of health care plans from insurance companies, private provider-based plans like the Kaiser Permanente plan, and employer-based plans;
• The Government would decide on coverage provisions, the reimbursement for physicians and other providers; and
• The Government would use its bulk purchasing power to decide on, and acquire, pharmaceuticals, lab tests, and preferred providers.

Single-payer systems are different from single-provider systems like the UK National Health Service because the single-payer system providers would not be Government employees, but would retain their ability to invest in, and own, parts of the health care system. (more…)

In the past month, I have had the privilege of immersing myself in a number of health-based dialogues. As we think about how to get people to engage in healthy behaviors, we must understand the importance of the social networks of which people are a part in driving behavior change.

At Pitney Bowes, we start with the realization that the most important social network is the family unit. If we can reach the individual who makes health-related decisions for the family and persuade that individual to drive healthy behaviors in the family, we have gained a great deal. That’s why we did a home mailing in October to urge our employees and their families to get flu shots.

The workplace peer group is the second most important influence because individuals typically spend more waking hours at work than anywhere else. That’s why we have emphasized creating a culture of health in the workplaces we control. (more…)

Having just recently attended a meeting at the Boston University Alzheimer’s Disease Center, which I find to be exceptionally entrepreneurial, collaborative across many disciplines, departments, and even schools, and innovative, I am struck by the huge opportunity our health care system has available by focusing on good genetic risk assessment, prevention screenings, and early diagnosis and treatment for medical conditions.

We have made considerable progress over the last 20 years in covering preventive screenings in health plans, and in publicizing the importance of screenings such as mammograms for breast cancer, colonoscopies for colon cancer, and Pap smears for cervical cancer. We also are getting more people than ever to test for blood sugar to test for diabetes.

However, we still have too many medical conditions that go undiagnosed until it is either too late to treat them, or prohibitively expensive to do so. The investment in early diagnosis for many treatments is hugely positive for a health plan. For example, I learned that a diagnosis of breast cancer at Stage 1 results in a $1,500 per month treatment cost. A later-stage diagnosis results in a $9,500 per month treatment cost. The HealthCheckUSA blog provides more details about the specific benefits linked to health screenings of all kinds. (more…)

In my last posting, I referred to parts of America that have been described as “food deserts,” meaning that residents living in those areas do not have access to supermarkets or other food stores or restaurants from which they can purchase affordable healthy food. One of my Pitney Bowes colleagues referred me to a satirical YouTube posting called The Bronx Bodega, which powerfully illustrates what I have noted in a few postings: in many poorer communities with less healthy people, not only is healthy food unavailable at affordable prices, if it is available at all, but the unhealthy food is exceptionally inexpensive and attractively packaged.

But I have learned that the absence of healthy food is just one form of deprivation for low-income communities. They lack four other prerequisites for healthy living:

• Safe outdoor play areas, like parks, to get exercise;
• Primary care clinics for treatment of minor illnesses and injuries, preventive screenings, and immunizations, as well as referral to medical specialists;
• Pharmacies; and
• Information sources. (more…)

Recently, I gave a speech at the American Health Insurance Plans (AHIP) business conference in Chicago on the prerequisites for a workable solution to our health care cost crisis.

One of the main points I made is that convenient and affordable access to healthy foods, prescription and over-the-counter medications, and primary care physicians and nurses for preventive screenings, immunizations, and treatment of minor illnesses and injuries was a more important issue to attack than simply expanding coverage. The more I learn, the more convinced I am that I am right.

This morning, I was listening to an interview on WFAN-New York radio, and the interviewee, a founder of an organization trying to address the issue of hunger in America, referred to “food deserts,” a term I had not heard before. He defined the term as a geographic area in which many people live, but they do not have convenient access to a supermarket or any other food store that carries healthy foods. He said that the entire city of Detroit and major chunks of New York City have no supermarkets. As a result, residents of these communities eat fast food or they go to bodegas or convenience stores that stock inexpensive junk food and nothing else. (more…)

As an employer responsible for our employees’ health care, we have wrestled with a problem every health care professional faces: how to get individuals with chronic diseases to adhere to treatment plans for chronic diseases.

How do employers confidentially and optimally encourage employees to be compliant with the treatment plans they develop with their physicians?

According to Dr. Cynthia Rand, Director of the Johns Hopkins Center for Adherence Research, “Medical nonadherence — failing to take medications according to directions — is a major healthcare problem, accounting for more than $300 billion in unnecessary medical costs annually due to adverse drug reactions, emergency department visits, and worsening health.”

What can we do? We must understand why people stop adhering, and then we can devise strategies to address root causes. (more…)

Last week, I appeared at the National Press Club an event sponsored by the Century Foundation, the AARP, and the Commonwealth Fund to discuss health care reform.

In preparing for that event, I came to realize that my vision of a national health policy has undergone refinement since I started my blog a few months ago. So here it is, although in abbreviated form:

• Any national health policy has to be based on the goal of maximizing health, safety, well-being, and productive capacity of all Americans.

• These goals, if achieved properly, will improve economic growth and competitiveness. They will not drain our economy, and we will not need to ration care to achieve them.

To achieve these goals, our health system will have to be based on six principles, all of which need to be followed:

• Americans need to know how to engage in healthy behaviors, and to be in an environment which encourages healthy behaviors in a healthy environment.

• We need universal, affordable, comprehensive health care coverage, and everyone needs to have that coverage. (more…)

I continue to be disappointed by the incompleteness of the discussion of issues in the national health care debate. There is abundant discussion of coverage and affordability, considerably less coverage of preventive and wellness, almost no discussion of what is needed to assure adherence to required treatment programs for chronic diseases, and little discussion of the issue of access gaps.

Everyone associates unnecessary emergency room visits with lack of insurance coverage. Certainly, many people in emergency rooms are individuals lacking insurance coverage. However, there are many people who have relatively minor illnesses or injuries, but who go to emergency rooms because they incur their medical condition after their primary physician’s office closes for the day or on a Sunday, when their physician’s office is most likely closed.

The first question we need to ask is why physicians have office hours comparable to the hours of business for American retailers over 40 years ago. The main reason is that the majority of medical practices are either sole practitioner or small groups, with little ability to provide Sunday or late evening coverage.

Beyond that, there simply are many areas that do not have what we have in Stamford, Connecticut, an urgent care center that is open seven days a week, the Tully Center, which is part of the Stamford Health System. I have been in communities as diverse as downtown Chicago, downtown Los Angeles, and King of Prussia, Pennsylvania, that have had no non-hospital-based urgent care facilities for minor illnesses and injuries. (more…)