November 26, 2008 
I was recently at the AHIP Business Forum Chicago and was in a session where Amy Holmes, CNN Political Analyst and Peter Beinart, Editor-at-Large of The New Republic held a discussion on Decision 2008 and What it Means for the Future of Health Care. They are two of the sharpest people I have seen speak in a while and they hosted a very engaging discussion on the issues and what the Obama win means for healthcare from both sides of the political spectrum. (They also had a very entertaining “He Said, She Said” style that captivated the audience.)
The big changes they felt were bound to happen were cuts in Medicare and an expansion of the SCHIP program, and there were others that they said would be debated including being able to sell insurance across state lines, the government offering coverage, individual coverage mandates and coverage for pre-existing conditions. But the biggest part of the discussion was around healthcare costs. Costs that are out of control, who pays for services, and where will the money come from. While at an aggregate level talking about healthcare’s spiraling costs is simple, it is not the heart of the issue.
Isn’t the issue about how as an industry we get individuals to change their behaviors?
The most powerful force for changing the economics of healthcare is the healthcare consumer. If the consumer changes behavior (even small changes) there are billion dollar impacts in cost. Our research shows that if a plan the size of Aetna is able to improve adherence by 1% they could save $238M! According to the Journal of Occupational and Environmental Medicine (JOEM), 70% of all healthcare expenses are lifestyle related. This is not a new number but it translates to $1.4 trillion in healthcare costs that could be controlled simply by modifying healthcare behaviors.
So if our lifestyles are “killing us” and destroying a system meant to improve our quality/length of life, why are we not talking about that at the national level as THE core issue? How can we as industry professionals develop solutions that support consumers and facilitate the changes they need to make?
I was excited to see in the third Presidential debate that both candidates addressed responsibility being in the hands of the individual. Next steps: Let’s see some discussion on programs and policies that truly look to impact healthcare consumer behaviors.
(This is a guest post from Chuck Eberl, VP of Marketing, at Silverlink Communications.)
Enabling Healthy Decisions 
You wrote: “Isn’t the issue about how as an industry we get individuals to change their behaviors?”
Change behaviors to what? Just improve adherence? Of course you know that all of those adherent people are going to get sick and die one day, and will then demand even more care from the system they know so well and trust in (and the system will oblige them as long as somebody can get billed).When the costs of adherence are added to the care requirements in the final years of life (which keep getting extended!), society will not be ahead.
When you talk about behavior change, you need to realize that behavior is motivated by psychological factors in response to biological needs, and environmental situations. Medicine focuses on biological issues, but we all know that medical solutions do not reduce costs. CDH plans, in spite of the name, focus on engineering environmental cues (e.g. online information, pointing to economical choices, shifting cost burdens), and based on recent research, these are not working as well. Short of across-the-board rationing (not just rationing based on ability to pay!), the final realm of hope may be to directly deal with the psychological patterns that motivate behavior directly.
In 2004 and 2005 a statewide health plan examined claims across 1.2 million member months. Controlling for age, gender and region, the claims associated with ten consumer types defined by health specific cognitive styles were examined. The cognitive styles represent perceptions, attitudes and predispositions that motivate health related behavior. One type, about 15% of their members, consistently generated about $800 more in medical claims per year than the average member. A second type, about 12% of members, consistently generated $200 less than the average member. Comparing the health specific cognitive patterns of these two types, they only dramatically differed across two issues.
Projecting the spending rate and percentage of the first cognitive type to the 210+ million adult population of the U.S., adults with the one high cost cognitive style (controlling for age, gender and region) generate about $25.2 billion more than the average health care consuming adult.
Understand that identifying this one health specific cognitive type is NOT accomplished by asking about behaviors like smoking levels, days of exercise, and adherence patterns, or biological states like obesity, blood pressure, or cholesterol levels.
If you want to talk about changing behavior, we need to get a lot smarter about the psychology behind it first.
FHN