Attacking the Production of Disease

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One of health care reform’s goals is to stabilize or reduce costs. While the government focuses on things like outcomes-based reimbursement, we started thinking: What if we could reduce employers’ costs by reducing claims?

And how do you reduce claims? By identifying and mitigating risk – or, as we like to say, by attacking disease before it starts.

It was a bold suggestion in 2009. You can’t stop people from getting sick, can you?

It turns out you can. And we have.

The first step to attacking disease is to identify what is driving your claims. Type 2 diabetes is a major culprit. The Centers for Disease Control says 26 million American adults are diabetic, and 80 million are prediabetic – meaning they are on a path to develop diabetes in the near future.

On average, non-obese, non-diabetic employees will incur $5,800 a year in health claims. A diabetic will average $13,000 a year. The economic impact on employers is clear: 80 percent of claims over $250,000 are diabetes-related. The direct medical cost of diabetes in the United States was $176 billion in 2012, according to the American Diabetes Association. An additional $69 billion was lost in reduced productivity.

But it doesn’t have to be. Consider that 95 percent of diabetics are Type 2 – meaning it’s largely attributable to lifestyle choices, not genetic makeup. In 9 cases out of 10, Type 2 diabetes is preventable. With early identification and intervention, this costly, chronic disease can be stopped before it even gets started.

That is why McGohan Brabender set out to chart a new course for our clients, one that will slow the destruction from existing disease and stop the production of new disease. In the health care industry, historically about 4 percent of the population generate over 60 percent of the claims. We have a tool to identify that 4 percent, and we have a strategy to intervene before those claims happen.

Highlighted human image showcasing 4% of population that drives 60% of annual claims costs

The key to identifying future claims is biometric screening for metabolic syndrome. Metabolic syndrome is an established precursor to diabetes and cardiovascular disease. Metabolic syndrome refers to a cluster of risk factors: low HDL cholesterol, high triglyceride levels, excess abdominal fat, high blood sugar and high blood pressure. A person with three or more of those risk factors has metabolic syndrome. According to the American Heart Association, 34 percent of adult Americans have MetS.

Target Biometric Ranges for men and women

People with metabolic syndrome are nearly three times more likely to suffer from heart attack, stroke or other cardiovascular disease, and nearly seven times more likely to develop Type 2 diabetes.

MetS is also associated with higher mortality. People with MetS are five times more likely to die from any cause, and four times more likely to die from cardiovascular disease.

34% of your employee population have Metabolic Syndrome

The good news is that when you identify where your risk lies, you can mitigate that risk. Reversing metabolic syndrome is an attainable goal for most of the population.

Let’s look at one risk factor and how it impacts your costs: waist circumference. Waist circumference is an indication of obesity, and obesity, like diabetes, is a major driver of chronic disease and health care costs in the United States. The Centers for Disease Control says more than one-third of Americans are obese, and obesity-related conditions account for $190 billion of U.S. medical costs.

A 2014 study in the American Journal of Health Promotion found that people of normal weight cost employers an average of $3,800 in claims, sick days, short-term disability and workers comp. For their obese counterparts, that number topped $8,000.

Average weight for men and women from 1960 to present

So we know the key drivers for health care costs, and we can identify who will be the next large claimants. Let’s talk about the next step – attacking disease before it gets anywhere near that catastrophic claims arena.

We have a clinically proven program that shows half the people who come into the program with metabolic syndrome no longer have it after 10 weeks. In other words, we cut the risk in half.

Let’s break it down: 78 percent of the participants reduced their waist circumference, 66 percent reduced their triglyceride count, 49 percent increased their HDL or good cholesterol, 56 percent improved their blood pressure readings and 54 percent had improved their glucose readings. And that’s just after 10 weeks.

Our 10-week intervention is not a weight-loss program. It’s a lifestyle program that doesn’t rely on any special products or gimmicks, but minor modifications in behaviors. People who complete the program measurably reduce their metabolic risk factors, and many also report success in losing weight and keeping it off, averaging a little over 11 pounds per participant. Many continue to improve their risk factors and lose weight after the 10 weeks by continuing to apply the principles they learned during the program.

When we launched our plan to attack the production of disease, we took a risk. We had our share of industry naysayers and bystanders. Today, we have the data to show our disease-prevention and risk-mitigation program works. And a lot of brokers across the country are playing catch-up.

Overall, the entire population experienced significant improvement.

Biometric numbers for a woman's health

For 40 years, McGohan Brabender has been simplifying the delivery of health benefits by managing risk and reducing costs. We are passionate about what we do and have the tools and experience to guide you through the chaos of health benefits management.

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