Sunday, May 9, 2010

Are Wellness & Prevention the Solution to the High Cost of Health Care?

The laconic Disease Management Care Blog attended a business leader meeting over the weekend. There were a series of presentations (this guy truly rocked), but it wasn't until a panel discussion on the promise of genetic medicine that the curmudgeonly DMCB was unable to resist raising its hand. Noting that insurance claims expense from genetic testing can run into thousands of dollars per patient, it asked the panelists to reconcile the cost of their enthusiasm with runaway health care inflation.

The panel gave the right answers, but that isn't why the DMCB is posting this tale. During the subsequent coffee hour, it was approached by a print media executive and was asked a simple question: isn't the purpose of covering wellness and prevention in the first place to fix things so that we can afford everything else - like genetic medicine - in health care?

The DMCB was aghast. It recovered its game face, however, and answered the question "no."

There are three good reasons for the uncoupling of wellness/prevention from sickness care which, in turn, helps explain how health insurers approach issues like genetic medicine.

1. Even if $2 to $4 are saved for every dollar spent on wellness activities, the total number of dollars revolving around wellness and prevention for the average health insurer or employer pale in comparison to the short term and unbelievable amounts of money being spent on, for example, testing and treatment for cancer.

2. Even if there is an eventual long term wellness and prevention "dividend" for diseases like cancer and heart disease (which is doubtful), we have a cost trend problem in 2010 with no end in sight.

3. Last but not least, a former editor of the New England Journal of Medicine pointed out to the young DMCB that money saved in one sector of health care doesn't mean that the savings get transferred to other sectors. He was right: actuaries and CFOs don't manage insurance that way.

The DMCB doesn't necessarily agree with the Carter-esque view that the Tooth Fairy is dead. American genius will make genetic testing - and all the other good things in our future - affordable. In the meantime, the belief that we can use wellness to "save money" and use that to pay for whatever we want today regardless of cost is a pipe dream.

No comments: