I have long been impressed with the preventive medicine efforts undertaken at the Cleveland Clinic under the leadership of CEO Toby Cosgrove. I was particularly impressed when the hospital began to refuse to hire smokers about five years ago (see: Want a Job at the Cleveland Clinic?: Smokers Need Not Apply). It's telling that relatively few hospitals have followed their lead in this matter, preferring a more passive approach to preventive medicine for their employees. In a recent article, Dr. Cosgrove discussed in some detail the success that the Cleveland Clinic has enjoyed with its preventive medicine programs (see: Healthcare's ‘Magic Bullet’ Still Working). Below is an excerpt from the article;
As a healthcare organization, we believe that we have to be a model of appropriate healthcare, which means building a culture of wellness, promoting personal responsibility, and rewarding healthy lifestyles. We no longer hire smokers, while providing free smoking cessation programs to current employees. We offer free Weight Watchers and gym memberships. We have weekly farmers markets on campus throughout the summer and fall. We’ve removed fried foods from our cafeteria and sugared drinks from our vending machines...[W]e offer discounts for physical activity or for enrollment in a disease management program. Our employee health plan covers more than 82,000 employees and their family members....When we floated this concept, we expected a flood of outrage. Instead, we have found tremendous participation – 55 percent of those eligible for a disease management program have signed up. As I pointed out at our 10th Annual Cleveland Clinic Obesity Summit earlier this month, the results have been impressive:
- Our organization’s body-mass index (BMI) has steadily decreased.....
- Prior to 2010, our health insurance costs were going up at 7.5 percent annually; it is now just under 3 percent, which saves us money and allows us to drive down the cost of care to our patients.
- We’ve seen a 20 percent reduction in hospitalization among of those in disease management programs, compared to those not in disease management program....
- Just 5 percent of our employees are smokers.
For me, one of the most interesting parts of this story is that health insurance costs for the Cleveland Clinic have declined by about 4.5% for its 82,000 employees. That's an impressive savings. Clearly much of it is related to the 20% reduction in hospitalization among those in disease management programs. Where, you may ask, are these savings allocated? According to Dr. Cosgrove, they are used to "drive down the cost of care [for the Cleveland Clinic] patients." What about passing the savings on to the employees who are leading healthier lives? Well, this might be viewed as unfair, discriminating against those who view participation in the disease management programs as intrusive or impinging on their right to privacy.
In a way, though, helping to reduce patient costs helps the Cleveland Clinic employees because it allows the organization to keep its costs in check, attract more patients, and increase the number of employees. Those employees who are cajoled into a healthier lifestyle (e.g., those who quit smoking under pressure) can perhaps learn to appreciate their healthier status in time. I am also enthusiastic about the idea of discounts on healthcare premiums for measured physical activity. It may just be wordplay but you are rewarding the active rather than penalizing the passive.