PROVIDENCE – Employers are wasting almost all of the money they invest in workplace- wellness programs because they simply don’t understand the lives, problems and needs of their employees, according to Jim Purcell, former CEO of Blue Cross & Blue Shield of Rhode Island and the founder of the Returns on Wellbeing Institute.
Purcell was part of the first of two panel discussions at Thursday’s Providence Business News Spring Health Care Summit at the Providence Marriott Downtown, where there were 200 guests in attendance.
In addition to workplace-wellness programs, the first panel, comprised of insurance executives, data-analysis specialists and others, talked about using data to understand patients’ needs and limitations, improving equity of medical care and coping with the advantages and disadvantages of electronic medical records.
Purcell opened the conversation by saying that most of the $8 billion spent on workplace-wellness programs in this country is wasted, garnering less than 30 percent participation from employees.
He gave a hypothetical example of an employer offering a smoking-cessation program to a overweight, diabetic single mom struggling with depression. “She would laugh at you,” Purcell said. “Smoking might be the only pleasure in her life.” He added, “Companies are oblivious to employees who need help the most.”
Data specialist Shannon Shallcross, co-founder and CEO of BetaXAnalytics, concurred. She called herself a “reformed veteran of the wellness industry” who advised employers on best practices. “I thought I knew what was best and I was wrong,” Shannon said. “Now, we use data to understand the problem. Before you attack the problem, you have to understand it.”
Insurers are among the institutions trying to reach a solution to getting medical care to people in ways that make sense to them and work for them.
Stephen Farrell, CEO of UnitedHealthcare of New England, mentioned an initiative called Vim, a venture of Optum Ventures. He said Vim collects information on the quality and cost of health care in order to help doctors make the best possible referrals, even to the point of scheduling appointments.
In another example, Marc Backon, president of Tufts Health Plan’s commercial division, talked about a program that notified customers via cellphone of possible savings on prescriptions. If the customer replies “yes,” the insurer contacts the doctor to say, “Here is a cost-saving opportunity for a patient of yours.”
Panelists were generally upbeat about the potential of the pending CVS Health Corp.-Aetna Inc. merger to be more responsive to patients than existing systems are.
The CVS/Aetna merger “maximizes engagement at the touchpoint with customers” at CVS retail stores, said Shallcross.
The second panel of the morning focused on the national debate surrounding the government’s role in the health care and health insurance sectors.
If the Trump administration succeeds in replacing the Affordable Care Act with an alternative such as the Graham-Cassidy plan and scrapping premium-free plans, the implications in Rhode Island could be dramatic, Marie L. Ganim, the state’s health insurance commissioner, said.
“We would suffer significantly from the economic impact, those dollars are not only dollars that help people stay well, they also help our provider community to stay vibrant,” she said of federal Medicaid spending.
The state would suffer the largest federal funding cuts in the nation, including the elimination of federal financing for expansion of the Medicaid program, and substantial decrease or loss of subsidies to low income families, Ganim said.
Replacement of the ACA could also destabilize insurance markets in Rhode Island, where 96 percent of residents and 98 percent of children are now insured, she added.
Those numbers are so high in part because of the ACA, Zachary W. Sherman, director of HealthSource Rhode Island, said.
About 89 percent of the state was insured prior to the implementation of the ACA and HealthSource RI, he said, adding that should Obamacare be repealed, premium prices will go up and people may begin to lose coverage.
Numerous reports on the skyrocketing price of prescription drugs have garnered national attention as well, but Stephen Kogut, professor of pharmacy practice at the University of Rhode Island, offered a less dire perspective.
The purchase of prescription drugs made up about 10 percent of $3.5 trillion in medical costs in 2017, he said.
Health care demands roughly parallel what patients spend on drugs, according to data Kogut compiled from 1970 to 2017, but brand name drugs, oftentimes new medicines developed to treat very specific symptoms or rare conditions, tend to give the impression that the average cost of drugs is shooting up.
“That’s been pretty static for the last decade or more… that what we spend for prescription drugs has been 10 cents on the dollar for health expenditure. What has changed is the way that they’re financing that spending and patients’ exposures to the cost of those therapies and the therapies that they’re using,” he said.
Mary Lhowe is a PBN contributing writer. Elizabeth Graham is a PBN staff writer.
