Ted Almon believes in healthy living. He works out every morning, he eats well, he gets regular checkups, and as president and CEO of the Claflin Co. in Cranston, he’s setting up a wellness program for his 100-plus workers to encourage them to do the same.
But when it comes to slowing the rise in health care costs, Almon is skeptical of health insurers’ new emphasis on wellness.
First of all, with a mostly young and healthy work force, he knows if everyone starts seeking preventive care, getting cholesterol screenings, etc., it’s going to cost more money in the short run. Plus the workers aren’t likely to stay long enough to save him money in the future.
And even society as a whole won’t save in the long run, he says, because those workers may stay healthy for a longer time, but eventually they too will be old, sick and in need of care.
So when the Rhode Island Public Health Association invited Almon to offer his views on the new “wellness health plans” designed by insurers with R.I. Health Insurance Commissioner Christopher F. Koller, he suggested there might be a touch of “blame the victim” going on.
Insurers don’t want to take responsibility for fast-rising costs, Almon told the audience last Tuesday at the Radisson Airport Hotel Providence. In the 1990s, they blamed “fat-cat doctors” and cracked down on them. Now they’re blaming individuals.
The bottom line, Almon said: Wellness is great, but it’s not the solution. The real problem is an inefficient insurance system, and that should be the priority.
Almon was one of eight panelists at the event, which also included a presentation by Koller explaining how the plans will work and the rationale behind them.
Created under a legislative mandate, the plans, tentatively named HealthPact RI, will be available through both Blue Cross & Blue Shield of Rhode Island and UnitedHealthcare of New England for coverage starting Oct. 1.
The average premium for a single person will be $322 for Blue Cross and $309 with United. The coverage is skimpy, with a $5,000 deductible and big out-of-pocket costs. But subscribers can get a much-richer, $750-deductible “advantage” package if they meet five requirements:
• Pick a primary-care doctor.
• Complete a health risk assessment.
• Avoid smoking or commit to try to stop.
• Commit to trying to maintain a healthy body weight.
• If they have a chronic illness or other high-cost health problem, participate in the relevant disease or care management programs.
For employers, the plans are an alternative to dropping coverage or offering a standard high-deductible plan, Koller said. And for workers, the plans reflect an attempt to the ongoing community discussion about healthier living and “translate it to the individual.” He’s not sure it will work, but he believes it’s worth trying out this kind of “smart benefits.”
“We have to experiment, because the status quo is not working,” he told the audience.
And all the panelists agreed with that point.
Dr. Diane Siedlecki, an internist at Anchor Medical Associates who represented the Rhode Island Medical Society on the panel, said she needs to take so many patients to make ends meet, and she has so much paperwork to fill out, that she can’t serve everyone properly.
That is actually one of her biggest concerns with the “wellness” plans, she said: While she likes the concept, she’s not sure primary care doctors will be able to do their best for the patients if broader problems in the health care system aren’t addressed.
Dr. Stephen R. Smith, associate dean of medicine at Brown University, a member of the board of the National Physicians Alliance, and a volunteer at the Rhode Island Free Clinic, said the goals of the new plans are “very, very laudable,” and he’s “100 percent behind them.”
Yet his experience at the free clinic, he said, tells him that for a key population the plans aim to help – lower-wage workers – wellness isn’t that easy. Many of his patients are overweight and diabetic, he said, but they also have children and jobs that take up all their time. And many live in unsafe neighborhoods, so even going for walks is tough.
Having just visited Scotland and England, Smith said, he knows there’s a better option: Those countries have national health care systems, public child care, low-cost public transportation, and community centers where families can go exercise.
“Instead of threatening punishment on the most vulnerable and the most stressed communities,” he said, “let’s offer positive incentives, like free membership in a community center … and let’s eliminate any financial barriers to access preventive care services.”
But Craig O’Connor, lead organizer for Ocean State Action and a member of the advisory committee that helped Koller shape the new plans, said he’s been impressed by the thought and effort that went into the process. Plus the alternative is to let the number of uninsured keep rising and rising.
And Dr. Albert J. Puerini, president of the Rhode Island Primary Care Providers Corp., said he’s not sure how the payoff from this emphasis on wellness will be measured, but he likes this effort to make people take more responsibility for their health.
“Patients are not involved enough in their care,” he said. “If they do go to their checkups, a lot of them go because their wives make them go, or it’s marked on the calendar … and there’s not a lot of incentive for them to do what they need to do. Ask any primary care physician how patients come in every six months or year after year with the same problems.”
