Gary Mangiofico, PhD, is an academic director and executive professor of organizational theory and management at the Pepperdine Graziadio Business School (https://bschool.pepperdine.edu/) . He has taught at the school since 2002, and brings more than 20 years of experience leading strategic development, operations management, turnaround operations as a CEO, COO, and general management executive. In addition, he is also COO and senior vice president (SVP) for Pathmakers, SVP for Apria Healthcare Group, and CEO for CPC Alhambra Hospital.
The Triple Aim will be within reach when there is greater stakeholder engagement and systemic ownership. A good start is for more employers to provide more American workers with access to high-quality wellness programs that can impact chronic disease with population health strategies.
In a fascinating LinkedIn post titled, “Who’s Responsible For Healthcare's Biggest Problems? 'Not Me.',” ​former Permanente Medical Group Chief Executive Officer and Exxecutive Director Robert Pearl, MD, observes that there is a lot of finger pointing at the “culprits” to blame for America’s failures to improve clinical outcomes and contain spending. Pearl concludes, “We are all responsible for the healthcare crisis we’re in today. The sooner we all accept this reality, the quicker we can rid the medical system of its burgeoning waste, rising disease burden and skyrocketing costs.”
I spent a lot of time turning that over in my mind as it pertains to the Triple Aim: improving the patient experience of care; improving the health of populations; and reducing the per capita cost of healthcare. Too often, in my opinion, stakeholders are eager to point solely to managed care organizations as being responsible for systemic successes or failures.
To Pearl’s point, I believe the Triple Aim will be within reach when there is greater stakeholder engagement and systemic ownership. A good start is for more employers to provide more American workers with access to high-quality wellness programs that can impact chronic disease with population health strategies. This can be done in partnership with their health insurance benefits provider, which has a stake in population health as well.
More than half of Americans under age 65—roughly 158 million people—have health insurance through an employer. Chronic conditions are major drivers in the year-over-year increases in employee health benefit costs. Consider, for example, prediabetes and diabetes. Medical expenditures for individuals with type 2 diabetes are approximately 2.3 times higher than what expenditures would be in the absence of diabetes, according to the American Diabetes Association (ADA).
We have had disease state management programs for populations of varying kinds for over 25 years. However, the incentives to provide them to a population have not been aligned with the transactional nature of healthcare reimbursement and delivery. So, who is the steward for efforts to combat the diabetes epidemic?
While the National Diabetes Prevention Program, a partnership of public and private organizations working to prevent or delay type 2 diabetes, is proven to be effective, a recent study in the American Journal of Preventive Medicine found only 4.2% of at-risk study participants reported ever being referred to a 12-month diabetes prevention program (DPP), and only 2.4% reported ever participating.
Clearly, the healthcare system needs to improve identification, recruitment, and retention of high-risk adults into DPPs. But employers can play an important role as well. There is growing evidence that employer-sponsored wellness programs may help reduce prevalence and risk of chronic disease as well as the costs associated with those conditions. A recent Quest Diagnostics study presented at the recent ADA 79th Scientific Sessions found that individuals at risk of developing type 2 diabetes who take part in an employer-sponsored wellness program with digital interventions can reduce their risk of developing the chronic disease for up to 8 years. Sixty-two percent of participants lost weight after the DPP, with 31% losing 5% or more of body weight, and levels for all biometric markers in the risk model—including for glycated hemoglobin, high-density lipoproteins (HDL, or "good" cholesterol), fasting glucose, and triglycerides—improved across all study cohorts.
Imagine how much closer we would be to realizing the Triple Aim if more employers provided employees and family members the opportunity to participate in wellness programs for chronic conditions like cardiovascular disease, smoking-related health problems, asthma, and other conditions, when they are at the early and potentially reversible stage.
In the last few years, employers have gained more insight on which types of employer-sponsored wellness programs are effective: those that identify employees at risk of disease before those diseases progress and help those employees to a path to wellness. Essentially, it is the same strategy that care organizations utilize to prevent illnesses or diseases: investing in preventive services at little or no cost to keep individuals healthy. Imagine the benefit if this became the standard of practice among employers and their healthcare partners!
Robert Mecklenburg, MD, medical director of the Center for Health Care Solutions at Virginia Mason Medical Center and a well-recognized health policy expert, noted that, “If other employers follow the example of the three collaboratives [Triple Aim pillars] in their local markets, the pace of health care reform will greatly accelerate.”
We cannot finger point our way out of the medical system malaise. Employers must partner with care organizations and embrace the Triple Aim goals as their own.