Insurance and Prevention: What We're Doing Wrong

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By Rick McCartney, CEO of iRH

 

It seems like every day my phone’s newsfeed is flooded with articles about the crisis of health insurance. Opinions about subsidy payments being abruptly stopped and whether or not the current system is “failing” are aired, but nothing seems to really be getting to the point. People are getting sicker, and living longer.

In this kind of environment, healthcare, and a related party - health insurance companies, are crunched. We can talk all day about different payor systems, or pricing models, but if we continue to live longer and sicker lives, the whole system is doomed no matter how many payors are involved, or how we monetize that system.

We really need to take a step back and figure out how to change course. These days, it seems like the conventional wisdom is that prevention isn’t possible, and wellness doesn’t work. Therefore, we are spinning our wheels arguing about the things we think can change, or be corrected. This is a waste of time. We need to figure out how to support people in leading healthier lives, and this is not an easy problem to solve.

The solution isn’t a pill. It isn’t an app. It isn’t a health coach. It isn’t a provider. All the education in the world won’t change habits.

All related stakeholders, from insurers to employers, government to food and device industries, need to start to support healthy behaviors, and stop rewarding illness.

Your doctor rewards illness. The fastest way to get her attention is to call the office and say you need a sick visit. Most insurance companies require that sick visits be available within 24 hours. They think this will adequately support their subscribers. They are wrong.

How many offices do you think offer wellness check ups within 24 hours? If you can find one, it is probably about to close its doors because business is so bad. How about a session with a nutritionist? A personal trainer to help you learn those resistance exercises we are all supposed to be doing?

Our systems reinforce bad behavior, and then complain that they can’t afford to keep up, and need more money to keep rewarding the same bad behaviors. This approach is wrong. It won’t work because it isn’t designed to work.

The feedback cycle will not stop until we change our approach.

We need to look at what behaviors we want people to engage in, and find the best ways to make them repeat.

Medications are great, when you get the right medication to the right patient at the right time, in the right dose, for the right reason. If you use them as bandaids for lifestyle issues, then that is not the right time or reason, and the provider and patient will be frustrated.

Pizza is awesome. It tastes good right away, and you can often get a great nap in afterwards with a content and full feeling. You could eat it every day because a frozen pizza is affordable, and eating vegetables would cost 3x as much. This is a sad reality too many people live- it’s a matter of access, financial incentives, and support from relationships and health resources. This is wrong.

What do we do about it?

I propose that if insurance companies want to control prices, and stop eliciting cringes and flinches from everyone under the sun, they need to start reinforcing the right healthy behaviors.

They can accomplish this by partnering with experts in human behavior , technology, the food industry , and community resources for health and fitness. These should be the first line defense - a strong offense. Make these things easy to engage in, instead of making people jump through hoops.

If you only pay attention when people are sick, you need to stop being surprised by everyone showing up sick. Don’t reward sickness. Reward health.