Major Points. Part I: The Health Care System Is Crumbling Around Us. Part II: A Lot Of Employers Are About To Make A Huge Mistake

W E L L N E S S C O U N C I L O F A M E R I C A 2 0 11 N AT I O N A L T R A I N I N G S U M M I T

Major Points Part I: The Health Care System Is Crumbling Around Us Part II: A Lot Of Employers Are About To Make A Huge Mistake Part III: Prevention Programs Are Taking Hold Part IV: Beware The Smoke Enema Part V: The Violent Torpedo Of Truth Part VI: Welcome To The Revolution

Part I Houston We Have A Problem

The Experts Take Aim

The Bottom Line As a nation, we have the best emergency and acute care in the world. In addition, we have the greatest medical and research institutions in the world. Our scientists and practitioners push the most significant advances. Our physicians are phenomenal. Our pharmaceutical companies are the best innovators, our biotech companies drive understanding of the essence of human life. But, what s becoming better understood is that our health care crisis is fundamentally a business problem. The system is overstrained and is breaking down due to outdated information technology overall inefficiency in terms of workflow, care delivery, and the spreading of best practices. John Hammergren, Skin In The Game

Sign, Sign, Everywhere A Sign Demand Is Increasing # of hospitals that report overcrowding 91% % of hospitals (in the last five years) where ambulance 70% drivers had to be diverted because of overcrowding # of days to schedule an appointment with a PCP 55 day Typical time it takes to be seen in an ER 3:43 Quick Fixes Abound # of unnecessary antibiotics prescribed annually # of Americans taking at least one prescription daily 20 million 70 million

By Jeff Donn, Martha Mendoza and Justin Pritchard, Associated Press A vast array of pharmaceuticals including antibiotics, anticonvulsants, mood stabilizers and sex hormones have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows. To be sure, the concentrations of these pharmaceuticals are tiny, measured in quantities of parts per billion or trillion, far below the levels of a medical dose. Also, utilities insist their water is safe. WATER DEPARTMENTS: Reports rarely released to public BOTTLED WATER: Is it any safer? NEW YORK CITY: Sedative traces found in water LOS ANGELES: Water tops national taste test RELATED: Problems in fish blamed on contamination But the presence of so many prescription drugs and overthe-counter medicines like acetaminophen and ibuprofen in so much of our drinking water is heightening worries among scientists of long-term consequences to human health. In the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas from Southern California to Northern New Jersey, from Detroit to Louisville.

Even More Clues Paperwork Runs Rampant # of insurance claims generated annually % with errors 33% Quality Suffers % of treatment that does not improve health/ 33% redundant % chance of getting the best recommended care 55% # of unnecessary surgical/medical procedures performed # of illegible prescriptions written each year 1.5 trillion 7.5 million 140 million

Ha ha ha, Biff. Guess what? After we go to the drugstore and the post office, I m going to the vet s to get tutored.

And The Hits Just Keep Coming Medical Errors Are On The Rise # of hospital patients that get staph infection # of medical injuries each year 1.2 million 1 million # annual deaths from medical errors 100,000

The Real Numbers Behind Medical Errors

With 80 Million Boomers In Tow, Costs Are Skyrocketing $3,000 $2,486.3 $2,500 $2,000 Dollars In Billions $1,500 $1,000 $724.0 $1,378.0 $500 $0 $27.3 1960 $74.8 1970 $255.7 1980 1990 2000 2009 5.2% 7.2% 9.2% NHE as a Share of GDP 12.5% 13.8% 17.6% Source: Centers for Medicare and Medicaid Services Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/nationalhealthexpenddata/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip).

And Now For The Real Stunner 50 million people in the U.S. do not have health insurance.

50 Million And Counting New York Los Angeles Chicago Houston Philadelphia Phoenix San Antonio San Diego Dallas San Jose Jacksonville Indianapolis San Francisco Austin Columbus Fort Worth Charlotte Detroit El Paso Memphis Baltimore Boston Seattle Washington Nashville Denver Louisville Milwaukee Portland Las Vegas Oklahoma City Albuquerque Tucson Fresno Sacramento Long Beach Kansas City Mesa Virginia Beach Atlanta Colorado Springs Omaha Raleigh Miami Cleveland Tulsa Oakland Minneapolis Wichita Arlington Bakersfield New Orleans Honolulu

So What Does $2.5 Trillion Buy Us? For a tiny percentage, a lot 5% consumes 50% of the health care. But for the vast majority of us, not much 50% consumes 3% of the health care.

Who Is Paying For All Of This? Total = 303.3 million Uninsured 17% Employer- Sponsored Insurance 49% Medicaid/ Other Public 17% Private Non-Group 5% Medicare 12% Note: Includes those over age 65. Medicaid/Other Public includes Medicaid, CHIP, other state programs, military-related coverage, and those enrolled in both Medicare and Medicaid (dual eligibles). Source: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on the Census Bureau s March 2010 Current Population Survey.

Part II A Lot Of Employers Are About To Make A Huge Mistake

Average Health Insurance Premiums And Worker Contributions For Family Coverage, 1999-2009 131% Premium Increase $13,375 $5,791 $4,247 $1,543 1999 128% Worker Contribution Increase $9,860 $3,515 2009 Note: The average worker contribution and the average employer contribution may not add to the average total premium due to rounding. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009. Employer Contribution Worker Contribution

The Shift Is On! Companies Are Responding Recklessly To Increasing Health Care Costs % of companies 70 60 50 40 30 20 10 0 31% Switched providers 66% Increased copays 59% Increased participant costs 56% Increased deductibles 55% Participant pay for prescription drugs Source: Society for Human Resources Management, 2006

Remember: Shift Always Runs Downhill Eliminating benefits and/or recklessly shifting costs will alienate your employees and wreck your competitiveness.

Health Care Matters To Employees Workers are making career choices based on copayments, preexisting conditions, and other minutiae of health insurance They are not necessarily making decisions based on what would be best for their careers and, in turn, for the American economy. David Leonhardt, NY Times http://www.cfr.org/health-science-and-technology/healthcare-costs-uscompetitiveness/p13325

Rising Health Care Costs Worry Employees 50 45 40 35 30 25 20 17% 18% 19% 24% 40% 45% Source: Kaiser Family Foundation, 2005 15 10 5 0 Losing job Terrorism Stock losses Paying rent/mortgage Inflation Paying for health care

A Bitter Pill To Swallow For middle-class Americans, second rate health insurance offers little protection. Most of us have policies with so many loopholes, co-payments, and deductibles that illness can put you in the poorhouse. Unless you re Warren Buffett, your family is just one serious illness away from bankruptcy. J. Himmelstein http://www.businessweek.com/bwdaily/dnflash/content/jun2009/ db2009064_666715.htmcompetitiveness/p13325

Fact: Employees Are Feeling The Impact Of Escalating Health Care Costs A recent Harvard university study showed that 68 percent of surveyed people who filed for bankruptcy had health insurance but in spite of it they struggled with an average out of pocket medical debt of $12,000. Another study indicated that 1.5 million families lose their homes to foreclosure every year due at least partly to medical bills. One out of every five Americans already has so much medical debt that he or she is paying it off over time. Andrew Weil, Why Our Health Matters

Median U.S. Family Income: 2009 $62,857 $47,143 $3,928 $179

Eureka! Companies Are Turning To Wellness To Contain Costs Source: Society for Human Resources Management, 2006

Part III Prevention Programs Are Beginning To Take Hold

Fact: A Significant Portion Of Health Care Costs Are Avoidable Or Potentially Modifiable Reliable estimates are that 30% to 60% of an employer s health plan costs could be potentially modified or avoided altogether. Larry Chapman, WELCOA Interview

Comprehensive Wellness Programs Improve Health And Save Money Improved health risk status documented in 11 national lit reviews 400 individual peer reviewed studies documenting health improvement and cost effectiveness ROI ranges from 3:1 to 19:86:1 However, many well designed wellness programs are failing to live up to their potential!

Blowing Smoke

Part IV Even Healthy Employees Get Sick

Truth Be Told Each and every year: 69% of employees will get a cold, flu, and/or other respiratory infection; 30% will sustain a minor injury; 24% will have a non-respiratory infection; 12% will have a digestive disorder.

Newsflash! These conditions can be selfmanaged and will go away on their own without any medical intervention! However, you need to have a results-oriented medical selfcare program in place.

I Don t Feel So Good Less than 10% of U.S. companies currently have a medical self-care initiative in place. Of those that do, most are so poorly designed they won t produce the desired outcome!

Part V The Violent Torpedo Of Truth

Unnecessary ER Visits 123 million ER visits in 2008. 83 million tests 43 million x-rays and 18 million CT scans. Typical cost per visit: $1,265 (2008). 30% of all ER visits are unnecessary.

Unnecessary Physician Visits 1.2 billion visits in 2007. Average cost: $120 (2003). Seven in 10 visits result in at least one prescription 2.7 billion overall. 30% of all physician visits are entirely unnecessary.

Part VI Welcome To The Revolution

Nine Words Collecting & Contacting Recognizing & Reacting Preparing & Performing

Summit Agenda: Day One Making The Business Case Phase I: Collecting & Contacting Phase II: Recognizing & Reacting Phase III: Preparing & Performing How To Communicate Critical Messages

Summit Agenda: Day Two Calculating ROI Case Studies Of Self-Care In Practice Linking Self-Care Initiatives To Your Benefit Plan The Future Of Medical Self-Care