Benefits Business

Health management poster child speaks out

Treating chronic health problems—employers need to take a long-term view

By Len Strazewski

I am your employee benefits clients’ Public Enemy Number One.

Not me, personally, but certainly people like me, who are a living collection of mid-life maladies and health-risk factors that could make us very expensive health claims if not managed properly.

About 15 years ago, I was diagnosed with type 2 diabetes, a non insulin-dependent version of the disease that is identified by abnormally high glucose levels in the blood. Type 2 is one of those so-called “lifestyle” diseases because it can be linked to excess weight and a lack of exercise.

At the same time, I was diagnosed with hypertension (high blood pressure) and hyperlipidity (high cholesterol), which usually comes with the package of metabolic malfunctions. All of these are linked to an inactive lifestyle.

Guilty as charged. I’m a sedentary writer and scholar with a schedule that is similar to most office employees. I work more than 40 hours a week, usually in front of a computer monitor—and spend much of my free time reading, watching television or communicating online. I’m considered very productive and am often asked to mentor other employees and serve on quality committees—at the cost of more time engaged in sedentary work.

But before I accept all the blame, I should add that I also have all of the genetic baggage that leads to these diseases. Both parents were overweight and were hypertensive and diabetic. My father, whom I resemble in body type, was diagnosed at age 40 with all of the same conditions and after a while took his physician’s advice about exercise to heart.

When he retired at 56, he stopped drinking alcohol, began walking five miles a day and became obsessive with his diet. It didn’t help his blood sugar or blood pressure much, but it did ruin his knees, which were already in bad shape from high school sports. He died at 78 after a heart bypass and an implanted defibrillator that pretty much ruined his quality of life. (The defibrillator was one of those that had been recalled and probably never functioned.) When he died, he was also taking pain medication for back and joint disease and an anti-anxiety drug that treated his fear about his heart and defibrillator.

The role that employee benefits plays

Why is this important to agents and brokers who help their customers manage employee benefits and the resulting health care costs? Being me—or someone like me—is expensive and particularly expensive if I do what I need to do to stay healthy by adhering to the prescription treat­ments that keep the diseases and risk factors under good control and reduce the future risk of very expensive invasive medical procedures.

I take lots of drugs: five diabetic drugs, two of which are injectable; four hypertension drugs; two cholesterol drugs; two asthma drugs for what may be related to a side effect of one of the hypertension drugs; one acid reflux drug which may be needed because of all the pills I take.

The last time I checked the monthly retail cost of all this, it approached $2,000 (even with several generics), and that probably has increased over time with changes in dosage and prescription drug prices.

Drug costs are only going to increase. According to the prescription drug trend report compiled by Medco, a pharmacy benefit management company in Franklin Lakes, New Jersey, prescription drug spending increased 3.3% last year, driven primarily by higher prices and new diabetic and specialty drugs. The overall spending would have been worse except for an offset by increased use of cheaper generic drugs, which jumped 64%.

Diabetes drugs, my favorites, were the biggest trend driver, with spending up 8.6%. Medco says new, more costly treatments, including the two injectable drugs I use, and the growing “obesity epidemic” will increase drug spending about 33% to 36% through 2011.

The drugs expected to drive increased spending include rheumato­logical and cancer drugs, both of which are likely to increase more than 40% by 2011.

That’s all bad news for employers and the trusted advisors who help them with their cost strategies. The good news is that with my expensive treatment, I’m doing well and may be able to avoid even more expensive acute care—such as the heart surgery that made my father’s last years miserable.

My blood glucose level goes up and down a little but is pretty close to American Diabetes Association bench­marks. My blood pressure is normal for my age and my doctor describes my lipid levels as “gold standard,” even for a diabetic—with treatment.

My employee benefits pay for most of this and provide significant support. My physician is an endocrin­ologist and a diabetes specialist who, I am sure, charges more than a family physician, but he is on top of the latest treatment and in network so my health plan covers his charges. It also covers my regular laboratory health risk assessment blood tests and my personal glucose testing equipment, which I use several times a day.

I also am in a disease management program and talk every few months with a nurse and health coach and, while I sometimes think I know more about my diseases than she does, I admit she provides some good tips and advice, particularly about diet and exercise. I try to follow most of them. I still fail on the exercise, but another expense—health club membership—would help.

Disease management programs, by the way, cost about $500 or less a year, a fraction of my prescription drug costs and, in the long run, I am sure will help moderate the drug costs and acute care by helping me adhere to good health practices.

I am, indeed, a pricey poster child for my employer, at a time when its overall benefit costs are on the rise.

According to a recent report from the Council of Insurance Agents & Brokers in Washington D.C., at least 87% of small and medium-sized employers are reporting employee benefits cost increases, with more than half reporting increases ranging from 6% to 15%. About two-thirds of large employers reported increases in the same range.

With these levels of increases, many employers are asking their agents and brokers for ways to reduce or moderate their costs—and some of the ways they may be considering include reducing levels of coverage, abandoning wellness and disease management programs, and increasing employee charges for prescription drugs.

This poster child for health care costs asks that you advise your clients to look into expanding programs that support wellness and treatment adherence, with health coaching and, in particular, financial support for medications for the chronic diseases.

I’m trying to avoid the complica­tions that lead to more acute and expensive health care. I don’t want the misery and pain they will cause me—and my employer doesn’t want the costs.

Let’s not be enemies. Let’s be partners. I’ll even try to step up the exercise.

The author
Len Strazewski has been covering employee benefits issues for more than 25 years and is employee benefits editor at Human Resource Executive maga­zine. He is a university professor and has an M.S. in industrial relations from Loyola University in Chicago.