Frederic S. Goldstein on Healthcare Reform

September 16, 2009

Originally posted on our collaborative site, Ourblook.

OurBlook interviews Frederic S. Goldstein, president of U.S. Preventive Medicine, Inc.

Auto insurance goes up or down depending on your behavior … down if no accidents, up if you have one. But most health insurance stays the same no matter what you do. Would it be a good idea to promote the use of incentivized health insurance plans that emphasize preventive medicine (i.e., individuals are rewarded for good behavior, penalized for bad)?

FG: Since group health insurance rates may be based on risk, it makes sense to encourage healthy behaviors. Members who follow a clinically based preventive health care program are less likely to develop chronic conditions and, therefore, less likely to trigger health insurance rate increases. Most employers share health insurance costs with employees through a co-payment structure. Basing that structure on adherence to a preventive health care program makes sense both philosophically and financially.

What would be the disadvantages?

FG: I don’t foresee a downside to incentives, however, there are potential pitfalls to avoid. Any program must rigorously protect privacy and tie incentives to participation rather than outcomes.

Strong employee participation is key to realizing the benefits of preventive health care. While proactive communication and creative incentives encourage participation, companies must also address a critical issue … employee resistance to sharing sensitive health information. Employees resist revealing personal health information to their insurance carrier for fear that it will be used to raise rates or affect eligibility. They also feel uncomfortable sharing sensitive health information with another employee, particularly someone they may interact with during the workday. Because this information is required to assess the individual’s baseline health and, therefore, critical to developing an effective wellness program, ensuring privacy and independence from employers and insurance providers is essential.

Additionally, incentives must be tied to participation and adherence to the prevention plan, not outcomes. No individual should be penalized for getting sick.

One of your clients, Ed Voyles, a 340-person automotive group in the Atlanta area, is using an incentive model. Could you take us through how it would work with an individual member of this group? While it’s probably easy to reward good behavior, how tough is it to penalize bad?

FG: The Ed Voyles employee enrolls in the program and completes an online health risk appraisal, answering questions about lifestyle and family history. He or she then receives an on-site blood test and has biometric measurements, such as height, weight and blood pressure, taken. Results are posted in a personal health record, along with the Health Risk Appraisal results.

The member receives a customized Personal Prevention Plan, which identifies top health and lifestyle risks and provides step-by-step recommendations for lowering those. A physician reviews all results and provides written recommendations, including suggested screenings and exams. The member also receives a lab result summary and a review of the preventive benefits covered by the company health plan. Additionally, the member receives a personalized, easy-to-understand Prevention Plan Report, along with a customized Health Dashboard on The Prevention Plan web site.

RN Advocates provide personalized coaching, health education and encouragement every step of the way, day or night. Action programs address key health areas such as nutrition, weight management, smoking cessation, depression and lowering cholesterol. Members can access a library of health news, “how to” videos and medical animations.

If the member enrolls in the program, completes a health assessment and takes a blood test, he or she receives a $300 reduction on the health insurance co-payment. The member can earn an additional $300 reduction by being a nonsmoker or committing to a smoking cessation program. The program is structured as a reward, not a punishment. However, an employee who reverts to smoking is again required to pay the additional $300 co-payment, which may feel like a punishment. So far, the program is working, with a 68 percent participation rate and a reduction in smoking from 20 to 14 percent of employees.

Would there be overall cost savings for the U.S. health care system? If so, should such plans become mandatory? Would there be any impact on American culture beyond one’s physical health?

FG: Clinically based prevention programs can produce dramatic savings for a national health care system. The United States would save hundreds of billions annually in the next few years and up to a trillion annually by the 2020s if all 300 million Americans were covered in The Prevention Plan. That is not accounting for the increased productivity of a healthier workforce, which would make U.S. businesses more competitive in the global marketplace. More importantly, hundreds of thousands of lives would be saved and people would have a better quality of life.

Is health insurance the major way to bring about more preventive care in America, or are there other methods? In your experience, do people with health problems have to be forced into engaging in good behavior?

FG: Motivation is a critical issue in preventive health care. We all know we should take a healthy walk, but sometimes we choose to stay on the couch. This is why a combination of personalized health coaching and incentives plays a significant role in improving behavior.

Is there anything else you’d like to say about incentivized health insurance plans?

FG: The United States can no longer afford a system where 70 percent of all U.S. deaths and 80 percent of U.S. health care costs stem from the same five preventable chronic conditions. Providing Americans with a program of prevention, early disease detection and chronic condition management could save billions by avoiding expensive medical treatment and improving worker productivity. The only way to truly fix our health care system is to deploy integrated clinical preventive medicine guidelines for primary, secondary and tertiary prevention. Our government must serve as the catalyst for a health care paradigm shift from reactive to proactive care.


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