Aetna: Insights from Health Care Industry Leaders

The health dividend can best be defined as the return on investment you get by providing a level of benefits, incentives, programs, and services for your employees that yield higher productivity, a better health status, lower costs, and ultimately a happier workforce.

First, it shouldn't be a big bang. I think you have to introduce programs a bit at a time because it has to start with a level of education and communication from the senior most parts of the organization and a rollout over time as people get used to products and services. The second is, in the companies who get the best results out of these programs, we find that they're constantly tinkering and fixing the program, taking the data that they picked up from the last year or time period, whatever time period they're measuring, and using that data to better inform how they ought to move the program forward. Companies that implement consumer-directed health plans or wellness programs and leave them alone ultimately have them end up with higher trend rates and they'll ultimately end up failing as bad experiments.

Affordability needs to come in two parts: one is how we finance or pay for things, and two, what is the underlying investment. So, being from Detroit back in the 50s, you used to go in and buy a car by saying 'I can afford two hundred dollars a month' and you'd get any car. Today, when you buy an automobile, you go in and say 'I want this kind of car with these kind of features, how much does the car cost?' and then you decide how am I going to pay for it: is it going to be a trade-in, is it going to be cash, am I going to take a loan? And we need to do the same thing with health care. So affordability comes in two parts: one is what is the underlying investment, and how do we make sure that people are as healthy as they can be? That manages costs going forward, as productive as they can be, that manages the employer's cost of production all that much easier. So all the programs around how do we manage the investment in health care, the financing can come in a bunch of different flavors. And I know in our organization, in a number of organizations we work with, we actually means-test the employees' contribution to premiums based on their salary. So our lowest compensated employees in our organization, people that make less than forty-five thousand dollars a year, do not have to contribute any cost to the premium every month. We have a program, a policy that works with zero dollars out of pocket every month, whereas I pay 62 percent, and that's the way it should be. So there's a means testing that should happen as part of that. So there are multiple ways to finance it. I think we need to look at your own population and think about how you want, what kind of message do you want to have, how do you want to treat your employees?

We have a number of pilots going out inside our own organization. We've just opened up our own worksite clinic, we've connected it to our health club, it has a pharmacy, and we're watching how that works now. We have 7,000 employees on our campus, so it's a big enough population. You need 3,000 or more employees. The second program we have in place is virtual worksite clinics that we're now offering to employers, where we can bring people on site, use one of their meeting rooms to be able to provide services.

In consumer engagement, we've got a number of, we've instituted social networking capability where we're now beginning to experiment with ways of connecting our employees to other parts of social networks to see how they manage through that information. So we've got a number of new tools we're trying to see how it works. So you have to have, again, this sort of journey around educating them. You have to keep educating, educating, educating, educating, and then you have to make it economically meaningful for them to participate. So, you know, we have a program where we can contribute six hundred dollars a year to an employee's health savings account based on healthy behaviors around eating, exercise, smoking, those sorts of things, BMI. The combination of both education and incentive then will drive them to healthier behaviors. And last year we had a 3.3 percent health care costs trend in our own employee population, and for 2009 we gave them a pass on their health insurance premium.

I think the whole health information technology area and the investment we need to make in developing a health information technology network is important. It's not the technology that's in the way, it's the way people behave. I buy my stuff from drugstore.com, I can watch my toothpaste come from Kansas City all the way to my front door, and when it arrives at my front door it actually beeps on my BlackBerry, and I know when I get home that night my toothpaste is going to be there. And when I donated a kidney to my son, I had to carry my echocardiogram from one doctor's office to the other, because even though they're on the same EMR, they didn't use it, and so he was going to order another echocardiogram. So I can watch my toothpaste come from Kansas City to my front door every day, I can check where it is in flight wherever, and I've got to carry my echocardiogram from my nephrologist to my transplant surgeon in the same hospital with the same electronic medical record. So it's not the technology, it's how we use it and our acceptance of using it. So I think health information technology is an incredibly important aspect of how we do it. The second is this whole idea of social networking. I think people pay attention to people who are like them and have the same interests, and so the best way we're going to get people to engage is by connecting them with people that have the same interests, that are like them, and using that network to be able to communicate important messages.

Current budget deficit, where it is now versus where it will be by 2030. 90% of that change is related to entitlement funding for Medicare and Medicaid. And so if people think that our economic problems may get in the way of health care reform, health care is driving our economic problem. And most people don't understand the data that if we don't deal with the issues around Medicaid and Medicare, we're not going to, our budget will solve 90% of our budget problem by just taking care of those two issues. And then Social Security is the rest. Between those three entitlement programs, it's more than the budget deficit. And so we have to wrestle with them. So the seriousness that the administration is currently taking around health care reform is because they understand that data, and they know they have to wrestle with it. So we will see change. And the level of change, how draconian the government needs to get in order to affect change, is all going to be driven by our willingness to work together and accept the change that they're recommending and work to a better solution. Absent that, it will be done to us, because it's that significant an issue.