A Little History…
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I attended a conference in Chicago last week that discussed a lot of high falutin’ health care issues — bio-technology, IT, the future of Medicare, and the like, but it was the presentation by Dr. Alan Guttmacher from the Human Genome Research Institute at the NIH who offered the most interesting wrinkle. And get this, it wasn’t about the Genome Mapping project — which as he pointed out was a monstrous undertaking, took many years to complete, and came in under budget and on time. No, I thought the most interesting part of his presentation was his commentary on the value and importance of collecting family history data to anticipate and deal with health status, health risks and the treatment of disease.
He said, basically, that if every American filled out the “Family Portrait” information using the forms that can be found at http://www.familyhistory.hhs.gov and shared this information with their caregivers, the improvement in health care screening protocols, common disease management, and preventive medicine would be enormous. His basic point was that we don’t have to figure out everything that could or can be done to take advantage of the human genome mapping project to be able to take advantage of what the genes of our family members — and their consequent medical histories — can tell us about ourselves and our own health risks. It was pretty powerful stuff — so much so that at a minimum, the Baker family will be downloading the forms and filling them in and making them available to our clinicians. I’m also going to chat with my team at Harvard Pilgrim about how we as an employer — and as a health plan — could promote wider use and distribution of this very simple, but highly effective tool for managing health and wellness.
Bio-tech — pretty cool — no doubt about that. But this family history stuff is what really got my attention. I hope it can get yours, too.
I’m a big believer in economic incentives. For your employees, you might consider offering a discount from his or her health insurance premium for completing the family history forms and incorporating them into the individual’s medical record. Discounts (or one time payments) could also be offered for completing a Health Risk Assessment and, perhaps, a living will or advance medical directive. Conversely, a higher premium might be in order for smoking. Employers could incorporate a similar approach into their health insurance benefits. The bottom line is that incentives matter, and we should be doing everything possible to push individual (and provider) behavior in a positive direction.
In regards to what Barry posted, there is a precedent for employers setting higher premiums based on employee behaviors, specifically smoking. According to information published by The Healthcare Financial Management Association, supermarket chain Safeway charges employees that smoke roughly $750 in additional premium costs per year. In 2006, Safeway reported an 11% decrease in healthcare expenditures, which they link in large part to this and other innovative approaches to providing employee benefits. In fact, the State of California specifically cites Safeway as the inspiration behind the state’s proposed Healthy Actions Programs, part of California’s own healthcare reform bill. The Healthy Actions Programs “reward people who take advantage of preventative health programs - like smoking cessation, diabetes management, weight reduction…” The proposed healthcare bill would require these incentives be offered through all state and private insurance policies, and would require that the plans include premium reductions as incentives for meeting certain health-related goals.
It will be interesting to see the large-scale reaction to initiatives such as these, that allow employers the ability to discourage certain personal behaviors of their employees. Some may worry that it would open the door for further restrictions, such as to impose diet and exercise regulations. Scotts Miracle Gro is currently facing a lawsuit by an employee who was terminated for being a smoker. Health insurance costs were cited by Scotts as a driving factor in their decision to let the employee go. Maybe the ruling in this case will shed some light upon what lies ahead for these initiatives.
About the Family Health Portraits, I hope that one day they may be expanded to include a major syndrome or two, such as the metabolic syndrome [MSX], so strongly involved in Type 2 diabetes.
A case showing the importance of this is a colleague of mine who may well be heading towards pre-diabetes. Evidence: 35″ waist, Hispanic American, desk job, with PCOS, or polycystic ovary syndome, which is often associated with MSX. Her family members also have MSX symptoms, including hypertension, high triglycerides, PCOS, and one case of diabetes in a great-aunt.
But this evidence of a genetic propensity towards diabetes would not be highlighted by protocols that mainly focus on diabetes itself, in parents and grandparents–all of whom, in my colleague’s case, have jobs demanding activity. So none are diabetic. And thus, a diabetes-tendancy not being apparent, my desk-bound colleague is given pills by her HMO, but not offered nutritional advice.
Of course one problem with finding clues to familial MSX is that few people know if, for example, their relatives have high triglycerides. Not many know what the term even means. If only Bill Clinton, said to be “the metabolic syndrome’s poster child”*, would sometimes talk about diabetes science.
[*That was in an article by Robert A. Vogel, Texas Heart Institute Journal, 2006]