B. W. Ruffner	- Download MP3-

When Richard Henry saw an advertisement for a wellness screening at a Bradley County, Tenn., church last month, he told his wife they should go.

“As you get older something like this can be very profitable because you could foresee a problem before it caused real trouble,” he said. “I think they did testing for strokes, osteoporosis, abdominal aorta, arterial disease.”

The couple, both in their 70s, got the $149 screenings in an afternoon at the Church of God of Prophesy in Cleveland. Mrs. Henry said their time and money were well spent for the “very thorough” examinations.

Staff Photo By Kelly Wegel -- Melanie Cofield, a medical technician, screens Kathryn Henry, of Cleveland, Tenn., for peripheral artery disease during a Life Line Screening event at Springplace Road Church of God of Prophecy in Cleveland. The test is similar to an ultrasound and looks for plaque buildup in the arteries.

Wellness screenings, increased emphasis on consumer-directed health care and shifting to electronic medical records are among strategies in use across the country to rein in spiraling spending growth in the $2 trillion health care industry.

Health care spending is expected to double by 2017 to $13,101 per person, up from $7,026 per person last year, the Centers for Medicare and Medicaid Services reported last week. Americans will spend about one dollar of every five on health care in the next decade, according to CMS predictions.

Many experts agree that fundamental change is needed to corral cost increases in what they describe as an expensive, inefficient system.

But the most efficient system would differ radically from the way health care services are provided and paid for today, said Dr. B.W. Ruffner, former dean at the University of Tennessee at Chattanooga’s College of Medicine.

“If you were to blow up the entire health care system and start from scratch, it wouldn’t look anything like what it’s morphed into in the last 100 years,” he said.

In the meantime, health service providers and insurers, businesses and their employees are experimenting with a variety of methods to hold down spending.

WELLNESS AT THE FOREFRONT

Wellness programs are a way of attacking “the demand side of health care,” Russ Blakely, an employee benefits consultant in Chattanooga, said.

“It’s the fact that the average person sees the doctor more often now, takes more prescriptions and utilizes health care much more so than we did 10 years ago,” Mr. Blakely said. “We have to address that.”

Many public and private employers offer wellness programs to do just that:

* In 2005, Unum added health resource centers to its Chattanooga work site, offering health screenings and working with employees to manage their health.

* TVA’s HealthCheck initiative provides up to $200 a year in benefits credits for employees who get health screenings and make healthy lifestyle changes.

* Dynatronics, a rehabilitation equipment company in Ooltewah, spends $16,000 a year for a corporate account with a local athletic club to offer all employees a discounted membership.

* Chattanooga Group in Hixson last year began offering free enrollment at a local health club for employees who go at least eight times a month. The company also pays a nurse practitioner to come in on Thursdays.

The cost is “minimal” compared to the expense of employees taking time off to visit a physician and file a claim, said Chris Ramsay, manager of people services for the company.

* Hamilton County’s Step ONE program, which stands for Optimize with Nutrition and Exercise, encourages restaurants to offer healthier and smaller portions and encourages residents to exercise daily.

Health insurers, especially, tout the benefits of screenings and wellness programs.

Cigna spokeswoman Ann Marie Raymond said about 1 million people are enrolled in Cigna’s wellness and disease management programs nationwide.

The return on investment for employers is significant, she said.

“For every $1 invested, there is a $1.50 to $2 medical cost savings,” Ms. Raymond said, and that doesn’t include productivity savings.

The state’s largest insurer, BlueCross BlueShield of Tennessee, reports a savings ratio of $3, said spokeswoman Mary Thompson.

But Dr. Ruffner noted that wellness programs don’t necessarily pay off in the short term.

“That might decrease the cost of health care 20 years from now,” he said.

Consumer-directed health care

Americans in general use health care services at a very high rate because they have little incentive not to, said Bill Cecil, health policy director for BlueCross.

“Consumers have been protected from the real cost of health care by their (workplace) benefit design,” he said. “They have only been exposed to a small portion of the costs.”

To encourage consumers to make wise health care choices, insurers increasingly are making cost and quality information about doctors and hospitals available to them.

Starting in April, BlueCross’ commercial customers can access information about 10,000 physicians across the state.

Publication of physician information is in line with a trend toward “consumer-directed health care,” and growing interest in high-deductible health plans that make individuals more aware of the true cost of health services.

“Consumer-directed health care forces the person to now be aware of what the costs are,” said Dr. Ken Patric, corporate medical director at BlueCross.

Doctors expressed concern that the quality indicators will be misleading or inaccurate.

Mortality rates for doctors who treat sicker patients may be higher, even if the care provided was top notch, said Rae Bond, executive director of the Chattanooga and Hamilton County Medical Society.

“Some of the best doctors who take care of the sickest patients may suffer in those ratings,” she said.

At a recent meeting with BlueCross, area physicians strongly protested widespread inaccuracies in their quality indicator ratings.

Insurers and employers large and small also are shifting more of the health care cost burden to individuals by moving to high-deductible health plans, Dr. Patric said.

Employers hope these plans compel their employees to make cost-aware choices, such as choosing cheaper generic drugs over name-brands. But for some patients, and their providers, the high-deductible plans can be problematic.

Carol Newton, chief financial officer at Memorial Hospital, said the hospital sees some patients with deductibles as high as $10,000.

“A lot of folks out there ... they don’t have $10,000, so a lot of times it puts a burden on them, or they can’t pay it at all,” she said. “It increases uncompensated care.”

Electronic health records

Electronic health records, which allow doctors to access medical records electronically, have promise as a cost-saver, doctors said.

“There’s going to be a hit in overhead to begin with, but it’s definitely going to be part of the solution,” Dr. Ruffner said.

BlueCross invested $25 million to launch the medical health records system Shared Health in 2005. The system, now with 2 million Tennesseans’ records, is geared toward increasing preventive care and reducing adverse medical reactions, BlueCross officials said.

A national health information technology system eventually could save $77 billion or more annually in efficiency savings alone, if the technology was adopted by most hospitals and doctors, according to researchers at RAND Corp.’s health division. RAND is a nonprofit, global police research institution.

But those savings would be evident only after a significant investment of time and money in implementing the system. Implementation could cost $8 billion per year, assuming that 90 percent of hospitals and doctors’ offices adopt the system, over 15 years, the researchers found.

FAST FACTS

* In 2006 health care expenditures topped $2 trillion for the first time, according to most recent census data.

* The Congressional Budget Office in January projected that total spending on health care will rise from 16 percent of the gross domestic product in 2007 to 25 percent in 2025 and 49 percent in 2082.

BY THE NUMBERS

* 44.4 million adults in the United States receive preventive physical exams (20.9 percent of population)

* 19.4 million women receive annual gynecological exams (17.7 percent of adult women)

* $5.2 billion is spent annually on preventive services and exams

Source: “Preventive Health Examinations and Preventive Gynecological Examinations in the United States ” September 2007

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