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What’s Hot In The Employer Health World?

Prevention.  Also, prevention, prevention, prevention, prevention,prevention, prevention,prevention, prevention, prevention, and prevention.  Finally, prevention, prevention, prevention, spam, prevention,prevention, prevention,prevention, prevention,prevention, prevention, prevention, prevention.

I’m overstating it, but this was the major theme of the Employer Health and Human Capital Congress which I attended yesterday outside of Washington, DC.  It’s a major event for benefits professionals and in spite of the pending snowpocalypse, was very well attended.  I moderated a panel about how people need help navigating the health care system.  But the gap between all the talk about prevention and the reality that a lot of people are going to get sick no matter what was the talk of this group.

George McGregor (Southern California VEBA), Joanne Jones (Genzyme), Dr. Val Jones (Better Health Blog), me.

I was honored to have such a diverse panel.

First, there was George McGregor, the head of a multi-employer health care trust in Southern California.  He serves nearly 100,000 employees of school districts and their families, and spends about a half a billion dollars a year on health care.  Second, there was Joanne Jones, Senior Director of Benefits at Genzyme, a multi-billion dollar pharmaceutical company.  And finally, Val Jones, MD, uber-health care blogger, who is now practicing in an exceedingly interesting new primary care practice.

This made for quite a combination of perspectives on what happens to people when they get sick.

Once someone gets sick they are faced with a health care system loaded with obstacles to their care.  For starters, their doctors will all be strapped for time.  It’s not just because they have to see so many patients to keep up with lower reimbursements.  Part of the problem, as Val put it, is that while doctors train so hard to be good at diagnosing and treating illness, they’re asked to spend probably a third of their time on requirements from public and private insurers.  Work for which they aren’t trained and at which they aren’t very good.  All this time not spent with or thinking about patients helps create quality problems like incorrect diagnoses and poor treatment choices.  It certainly leaves patients feeling uncertain about their care.

Joanne talked about how this plays out at Genzyme.  As a leading pharmaceutical company in Boston, maybe the world’s leading medical city, employees are regularly around to terrific doctors who work with Genzyme.  And so there has developed a sort of informal social network at the company, as employees figure out how to best approach these doctors to ask questions about their medical problems or those of family members.  It’s like those doctors are used as a patch on a broken system.

George emphasized how important it is for patients to do what Genzyme’s employees do: actively participate in their care.  He told the story of an employee of his who had been diagnosed with metastatic bone cancer.  After extensive therapy, she was given a very bad prognosis.  But then, with George’s help (he, like Joanne, had implemented Best Doctors as a benefit) she found out that her “bone cancer” was actually metastatic breast cancer.  She had gone through years of unnecessary treatment for a disease she never had in the first place.  As I’ve blogged about many times before, and as is becoming increasingly apparent with published studies, it happens a lot.  As many as 20% of patients end up with the wrong diagnosis.

Now, there’s something interesting that seems to always happen at discussions like these.

People very quickly start talking about their personal experiences.  A lot of the stories sound just like George’s colleague.  Yesterday, a number of audience members raised their hands not to ask questions but just to share their own stories or those of their colleagues.  I suppose there aren’t many places where people get to share this kind of suffering, and I can tell you, there’s a lot of it out there.  Benefits professionals like those in the audience yesterday see this problem almost as closely as doctors and nurses.  They know the employees who struggle so badly to figure out what to do when they’re sick.  And they know the hurt that comes with being powerless to help someone get out of such trouble.

So, yes, prevention is good.  If you don’t get sick, you won’t face these problems.  But in truth, lots of us will get sick, no matter what we do.  Solutions to the troubles with health care based on trying to take care of populations not individuals too often miss the point so many people talk about.  Which is that health care happens when a patient goes to their doctor looking for help.  We must break down the barriers between doctors and patients that have, as Val showed, become so high.  We need to make it easier for patients to take advantage of all of the judgment and training and skill of the doctor.  It’s what the patient is there for, and for those of us paying for health care, it’s what we are here for, too.

*This blog post was originally published at See First Blog*


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One Response to “What’s Hot In The Employer Health World?”

  1. Your closing statement, “It’s what the patient is there for, and for those of us paying for health care, it’s what we are here for, too”, is sincere. Yet, most of the public, and indeed many physicians, do not view payors as being compassionate advocates for their health. In fact, they are often perceived as barriers to getting health care. In my practice, we waste hours each week trying to figure out which medications an insurance company will cover for a particular patient. There are lots of phone calls and forms, denials and more paperwork, which takes time and effort that could be used instead to help a sick patient.

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