Wellness Programs Require Appropriate and Timely Use of Medical Laboratory Tests
Pathologists and clinical laboratory managers know that smoking, obesity and unnecessary utilization are major factors in the skyrocketing cost of healthcare. These are primary reasons behind the desired transition from reactive and acute care to a health system organized to deliver proactive care.
Consumer cooperation will be essential for this transition to succeed. Each year, the number of employer-funded or insurer-funded health and wellness programs increases. That trend is consistent with the federal government’s interest in promoting its own health and wellness programs as one way to lower the total cost of healthcare.
Pathologists know that an increased focus on wellness and proactive care means that physicians will need to order the right tests at specified intervals. This is necessary to detect disease at its earliest stages and to allow physicians to track their patients’ progress. For both reasons, the shift away from reactive care to proactive healthcare will contribute to significant increases in the utilization of medical laboratory tests.
Behavioral Economics Is a Factor in Patient Wellness Programs
Experience with these health and wellness programs is generating interest in the concept of “behavioral economics.” As a field of study, behavioral economics has been around for a long time. But its application to healthcare and patient participation in wellness may lead to positive financial incentives for patients who follow wellness protocols.
The idea is that our behavior as consumers—the decisions that we make everyday—can be influenced by the financial choices offered to us by our employers and by the businesses around us. Thus, given a choice of either unhealthy activities (e.g., smoking, eating badly, not exercising) coupled with an expensive health benefit plan, or an inexpensive, even zero cost, health plan that promotes healthy choices, behavioral economics theory predicts that consumers eventually choose the latter. That choice should lead to improved health while driving down the cost of healthcare.
Large Corporations See Benefits of Using Behavioral Economics
The American Recovery and Reinvestment Act of 2009 (ARRA) passed in February 2009 contains $120 million in funds for states to adopt wellness programs. Starting in 2014, workers can have their health coverage cost reduced by as much as 50% when they participate in an employer-sponsored wellness program and meet set benchmarks. It’s the monitoring of these benchmarks that are of interest to medical laboratories, because it involves a lot of clinical laboratory testing.
For example, Council 31 of the American Federation of State County and Municipal Employees (AFSCME), an Illinois labor union representing just 360 employees, presented two healthcare options to their members: a standard PPO plan that costs employees 3% of their salary, and a “health improvement plan” that is free for employees and only costs 1.5% of their salary for spouses.
Financially, the choice is clear, however, the free plan has requirements. Participants must sign up with a primary-care physician, undergo health-risk assessment, and participate in an annual health learning course.
If it seems intrusive, it is, by design. However, in order to receive the financial incentives associated with this health benefits approach, AFSCME employees are not required to improve their health, only participate in the program. AFSCME official’s hope that their employees’ health will improve by default.
“We’re using behavioral economics to incentivize people to improve their health,” said Hank Scheff, Director of Research and Employee Benefits at AFSCME Council 31 in an interview with Modern Healthcare.
What This Means for Clinical Pathology Laboratories
The point for pathologists and clinical lab executives is that most of these wellness and preventive care programs—funded through employers and health insurance plans—will require significant use of clinical laboratory tests. The physician will order these medical laboratory tests to establish the patient’s baseline condition at the start of the wellness program. The physician and patient will continue using selected clinical laboratory tests for ongoing monitoring. Comparing current lab results against historic lab results can detect trends that are positive and negative.
Wider use of behavioral economics in the design and administration of employer health benefit programs and health insurance plans is auspicious for pathologists and clinical laboratory managers. When wellness programs are more intelligently designed to include appropriate financial incentives that motivate the individual to participate in activities that improve health, then one consequence will be more appropriate utilization of clinical laboratory tests. In turn, that should mean that the patient will get the right medical laboratory test at the right time, for the right reason.