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How Lessons From a Lifelong Athlete Translate to Ways We Can Reduce Healthcare Costs

Just like competing in a triathlon, improving the healthcare system requires structure, strategy, and planning.

 

Thomas-Risse-Utah-Mountains

I've spent my entire career working in the healthcare industry, and I know there's no easy fix to bringing down costs. But I believe we can learn a lot from the strategy involved in my hobby—triathlons. 

It can be overwhelming when you realize what’s expected from you on race day. When I competed in the IRONMAN in Kona, Hawaii, I was facing a 2.4-mile swim, 112-mile bike ride, and 26.2-mile run. It may seem like a lot, but it’s the preparation leading to that day that’s the real challenge. It’s the months of thoughtful training and dedication. It’s the ability to balance your day-to-day life with workouts, nutrition, rest, and mental focus.  

Just like competing in a triathlon, improving the healthcare system requires structure, strategy, and planning. As a not-for-profit wholly owned subsidiary of Intermountain Healthcare, our goal at SelectHealth is to improve the health trajectory of the individuals we serve, including offering solutions that help people live the healthiest lives possible.   

I’ve seen the healthcare industry from many angles—from medical groups to hospitals, to integrated health systems—and I feel empowered by the SelectHealth commitment to improve health. I believe that if we are transparent about the factors that impact our healthcare costs and promote some of the proven methods we’ve seen that are making a difference, we’ll have greater success toward making systemic change. Here are five approaches I’ve identified in the effort to reduce healthcare costs:

1. Educate stakeholders about the benefits of improving health

Chronic health conditions, like heart disease, obesity, and diabetes, are the leading drivers of healthcare costs in this country. In fact, the Centers for Disease Control and Prevention says we spend 90 percent of our dollars treating them. Genetics, environment, socioeconomic aspects, and personal behaviors are all contributing factors to many conditions. But our most successful efforts at helping to manage or even prevent some conditions involve focusing on the risk factors individuals can control, such as smoking, weight management, alcohol consumption, or exercise.  

So how do we design a healthcare system that promotes and rewards people in a way that helps them live the healthiest lives possible? The key to getting them invested in their own health starts with awareness. I’m a firm believer that you can’t accomplish anything if you’re not willing to work at it. But first you, as an individual, need to know what to work on.  

Our education efforts extend to employers as well. At SelectHealth, each Large Employer receives a yearend survey of aggregated data related to employee health, which includes details such as the average number of employees considered at a healthy weight, overweight, or obese and the percentage who smoke or have high cholesterol. The report does not identify specific employees, but rather gives a broad overview about the group. We feel it’s important to share how many employees are participating in key screenings, like those for cervical, colon, and breast cancer, as a mechanism to identify cancer early so treatment is less invasive and survival rates are higher. This data allows the employer an opportunity to promote programs that are relevant to their workforce to support their broader health goals. 

We also want to bring the provider community into the conversation. They are at the frontlines of the effort to develop an overall strategy that addresses mental health integration, since mental and physical wellness are so closely tied. If a person is depressed, they may not seek care for a physical ailment. It’s imperative we reduce the mental health stigma that is present in much of our society, and if we work collaboratively toward solutions, we’ll increase our odds at helping people be healthier.

2. Provide more transparency on costs through digital tools

People want to know how much they are paying for a service, especially for their healthcare, and they aren’t afraid to shop around for it. We’re responding to this demand for cost transparency by providing patients with the tools they need to make informed decisions about their health and the financial implications it can pose. It’s a part of our commitment to help members feel empowered about their choices and yet another way we can make an impact on healthcare costs.  

Digital tools, like cost estimators, pull back the curtain and give members better insight into what bills to expect after a procedure or service. The SelectHealth medical cost estimator tool allows members to look up the price of a service and determine their out-of-pocket costs based on their own plan benefits and network. We placed the estimator behind a portal that’s tailored to a member’s profile, so they can get estimates that are specific to where they live and how much they’ve already spent on healthcare this year. It also allows members to find quality care in areas that are convenient to them.

3. Make healthcare more accessible

We are working to eliminate the barriers that prevent people from seeking treatment. Geographic disparities and stigmas associated with mental health conditions, for example, stop people from receiving the care they need and deserve. Telemedicine can play a critical role in providing reliable and cost-effective alternatives. Intermountain Healthcare’s Connect Care televideo service allows people to connect with a provider from the comfort of their own home within minutes at a very low cost. Such programs can be critical in a variety of circumstances—from those in remote areas, to those who are reluctant to travel to a doctor’s office, to those who are too busy to make an appointment.  

It’s all part of a broader mission to help people live healthier lives by strategically offering programs that allow them to utilize appropriate services, such as telemedicine, primary care doctors, and urgent care before a costly emergency room visit.

4. Prioritize wellness initiatives that engage members

If we truly want people to take an active role in their own health, then we need to be intentional about the programs we’re advancing. I find we’re more successful when we meet people where they are in their lives. What good is a gym membership reimbursement on some of our plans if you prefer to rock climb or meditate? I support our idea of active lifestyle reimbursements that don’t limit our wellness initiatives to one category, but rather allow for individuals to find what engages them.  

We also encourage our members to take advantage of our wellness programs, which include discounts on some alternative treatment modalities like massage therapy. Through these programs, we have the potential to reduce chronic conditions in a way that yields a substantial benefit. I’d like to think we’re just scratching the surface.

5. Challenge historical models through pioneering initiatives

In a world where healthcare costs continue to rise, we developed what we believe can be a model for the healthcare industry. We joined with Intermountain Healthcare to create SelectHealth Share, a three-year rate guarantee program that sets premium increases at 2.5 percent. Its success is built on bringing employees and employers together to partner with the health plan and providers to engage individuals in healthy activities including fitness fairs and wellness testing.  

So far, we’ve been able to offer early adopters three additional years of rate guarantee or six years of low increases that are substantially below the marketplace. We’ve doubled our enrollment in SelectHealth Share, but I’d love to see more people join. Our main challenge is that people say, “I like the guaranteed low renewal rate, but I don’t want to change anything I do.” That’s like saying I’d like to do an IRONMAN, but I don’t want to train.

These efforts aren’t easy, and I realize that. But the reality is there are payoffs. When we bring everyone together, get them invested in the mission, and educate them about the potential benefits, it both improves their health and lowers their costs. Not unlike training for a triathlon, changing health outcomes means being committed to structure, strategy, and planning.

       Related: Why Putting Communities First Drives Growth

 

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The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns.

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Post Author

Thomas Risse
Thomas Risse is the Chief Financial Officer for SelectHealth, Intermountain Healthcare's branded health plan. Thomas's career in Healthcare has included experience with Integrated Delivery Systems, Medical Groups, Health Plans, Hospitals, in California, Washington and Hawaii markets, in both for-profit and not-for-profit companies.