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Answering the Moral and Economic Call to Better Health Stewardship

A request came in to our company at 3:43am this morning from the employee of a group that just transitioned to our pharmacy services program. It was short but powerful:

“I’m a person who is fighting against diabetes. 2nd year fighting it and I heard about this program called Clinical Blueprints.”

I like to monitor requests from members and patients and this one stuck out to me this morning. I’m a person who is fighting against diabetes. Fighting is a really strong word. For this individual, the fight is serious enough that he is sending messages to us at 3:43am seeking help with his battle. Fortunately for him, his employer is stewarding their benefits investment, and his health, by putting a targeted program in that will actually help him.

Consider that diabetes is most likely not the only thing this individual is fighting. He may be fighting obesity. He may be fighting high blood pressure. He may be fighting sleeplessness or depression. He may be fighting to keep his job. At 3:43am this morning, his mind was on his fight with diabetes.

The CDC reports that over 38 million American adults suffer from diabetes – over 14% of the population. Generally speaking, we see an incidence of diabetes in our self-funded groups of about 10%. Over 22% of them don’t realize it or don’t report it. Fierce Healthcare reports that employers spend $20,000 per member on diabetes care annually and that diabetics spend 240% more on medical care than non-diabetics. That’s a pretty serious financial fight.

Statistics tell part of the macro story but probably don’t mean much to the individual who is wrestling with daily decisions like: should I pay my co-pay for insulin this month or buy groceries for my family? Should I take that extra shift or go to the appointment with my endocrinologist?

What other barriers besides cost might stand in the way? Access? Complexity? The report above states that costs for diabetics are growing at over 20% annually. Clearly money is being spent. But is it being spent in the right way to produce the best results?

We see many headlines highlighting our healthcare woes, high costs, and our need for additional regulation. Much of the finger pointing is at organizations that charge “too much” and vendors that “make too much.” There are certainly opportunities for efficiency and room to slim down some of the grabbing hands in the kitty. However, we all get lost in the broad sweep of a $4 trillion healthcare economy – a number so big that only an economist has any sense of what it really means.

Let the economists, politicians, and titanic enterprises, duke it out over the size and scope of the spoils. The only change to happen in that multi-trillion dollar stratosphere is one of reallocating the pie. At that scale, no one really wants to skinny it down.

Real stewardship happens at a lower denominator – the one we can actually influence. The fight is happening at 3:43am, in the home, amid the discomfort and fear of what it means to be in such a fight and whether or not anyone cares to help. There is an emerging playbook for this fight and it isn’t being executed in the hallowed halls of our capitals or the boardrooms of the titans working to carve the pie in their favor. It is happening in HR, Benefits, and Employee Health departments. It is happening in the self-funded plan.

The reality is that all of us holding seats of responsibility want to be good stewards. We want the money we invest in our employees to help them flourish. The world tells us we need to stay the course in the fixed world of our current healthcare and benefits system, however, good stewardship demands that we look outside of it and press the envelope of the known and the “safe.” After all, is it safe for employees to be fighting diabetes at 3:43am? Is it safe for members to ration their insulin for the first six months of the year as they try to reach a deductible?

Can business be a force for good? Is it supposed to? We think so. Good for the world. Good for our customers. Good for our employees. Good health stewardship is good business – morally and economically. It really is worth the fight.

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