By Thomas Emerick

First Posted at Cracking Health Costs on 3/25/2013

Tom Emerick, Host of Cracking Health Care Costs

Tom Emerick, Host of Cracking Health Care Costs

As readers of Cracking Health Costs know, this blog has covered the failures of company-sponsored wellness/prevention programs to save money.

What is desperately needed is a new set of goals for wellness/prevention.  In benefit plans today, about 6-8% of members – the so-called “outliers” — are spending 80% of plan dollars.  Only a tiny fraction of that spending may be preventable through wellness. After all wellness does not prevent aging, nor does it change people’s genetics, nor does paying people incentives cure their addictions.

What is absolutely certain is no matter how a company does wellness and prevention, its employees and covered family members are going to have major diseases anyway.

Of those 6-8% of outliers, up to 20% of them are completely misdiagnosed and up to about 40% of them have utterly wrong or suboptimal treatment plans, something that wearing a pedometer or eating more broccoli is not going to address.

Instead of focusing on the small likelihood that at some point in the future a heart attack (already only about a 1 in 500 shot in your employee population) might be prevented through a wellness program, shouldn’t benefits managers be focused on the here-and-now:

1.  Steps to ensure the “outliers” have the right diagnoses.

2.  When outliers need major surgery send them to elite health systems that get the treatment plan right and provide best care.

These two simple steps could save plans huge dollars and provide their members the better quality care.  All this takes is a new way of thinking by benefit managers.