Some Americans believe that health care reform legislation (the Patient Protection and Affordable Care Act) will bring about a decline in the quality of health care in our country. But Wes Alles, PhD, director of Stanford’s Health Improvement Program (HIP), believes that health care reform will create a significant positive impact on the health of our nation through wellness, health promotion, clinical preventive strategies, and care management. BeWell asked him to explain his views.
How are health care reform and wellness related?
Health care reform provides a powerful boost to wellness, prevention, and care management initiatives by encouraging employers to develop and maintain effective programs on behalf of employees. When our nation spent 10-12% of our gross domestic product (GDP) on health care, prevention was hardly noticed and rarely discussed among legislators. Policy makers, health plans, medical providers and employers understood that prevention was less expensive than treatment and rehabilitation, but there was little motivation to invest in wellness. As health care spending rose to 17% of the GDP, it became clear that escalating costs were no longer sustainable and prevention was perhaps the best option to manage costs and at the same time create a healthier nation.
So much of our health care spending is “preventable”?
According to the Centers for Disease Control and Prevention (CDC), more than half of Americans live with a chronic disease, and the CDC reports that chronic disease is often related to obesity, poor nutrition and physical inactivity. Trust for America’s Health, a non-profit organization, has released a new report projecting that the United States could save $29.8 billion in five years and $158.1 billion in 10 years if obesity rates were reduced by five percent. Last year, the American Heart Association (AHA) published a review of more than 200 research studies, concluding that most cardiovascular disease can be prevented or at least delayed until old age. The review also reported that for every $1 spent on wellness programs, companies would save about $3.27 in medical costs and $2.73 in absenteeism costs. Prevention Institute found that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years.
Have things begun to change since the law was enacted?
Yes. Even before the passage of health care reform, legislators in both houses of Congress, the President, and officials within the Department of Health and Human Services discussed the value of wellness and clinical preventive strategies. While there was much debate about the Health Care Reform Act itself, both political parties and the administration agreed that wellness, care management for chronic disease, and population medicine are essential to any positive forecast about bending the curve of health care costs. Legislators in Washington D.C. and in every state in America see the wisdom of prevention as a healthy alternative to expensive treatment.
What can we expect in terms of worksite health promotion?
In the next couple of years, three cabinet level secretaries will review the evidence of worksite health promotion and make a recommendation about how much to reward employers that offer wellness programs. The government’s motivation is to pay less for Medicare and Medicaid. The employer’s incentive is to pay lower health care premiums. The employee benefits with better health and lower out-of-pocket expenses on co-payments, deductibles, prescriptions, and other costs not reimbursed by health plans.
In terms of wellness, was Stanford ahead of its time?
Stanford was certainly one of the first universities to have a wellness program. The Health Improvement Program began in 1983 and has been an important part of campus culture ever since. With the Provost’s initiative called BeWell@Stanford, campus wellness has surged. Last year, 9,331 faculty and staff took the SHALA and 6,326 completed the Wellness Profile (making them each eligible for the $480 incentive). Early evidence suggests the program works: Our cost increases have been less than those of other Silicon Valley employers, and both SHALA and biometric data show positive trends in lifestyle and motivation for health improvement. I also want to emphasize, however, that wellness and health improvement have been a priority on the Stanford campus for nearly 30 years. Throughout this time, employee health and consequent quality of life have been central to our mission. The administration has always believed that the health of employees is the most important benefit of our wellness programs.
Does Stanford need to find additional ways to demonstrate that wellness is a good investment?
The university is spending a good deal of money on the health improvement of faculty and staff. Beginning this year, we will be looking at ways to demonstrate that our efforts are making a difference. Intuitively, it seems to most people that prevention must be less expensive than treatment for preventable conditions. Nevertheless, it is important to demonstrate this point. We already have a strong culture of wellness on this campus and we seek to prove that a healthy lifestyle is as important to us as individuals as it is to the university.
Interview conducted by Julie Croteau