INSURANCE AGENTS OF CHANGE by Eric H. Schultz

Can there be any value that comes from skyrocketing medical costs? Perhaps the medical cost trend will force an important debate about the role of health insurance.

Often, discussions about insurance lead to discussions about cost and affordability. Initially, health plans and insurers introduced the idea of managed care as a means to control medical costs and improve health. Now, the health care community recognizes the importance of performance and cost “transparency” as a prerequisite to engaging consumers and providers as part of the cost and quality debate.

We all recognize the value of transparency. But, because it’s a strategy that’s in its infancy, how do we know it will have enough “teeth” to help tame the medical cost beast that threatens to undermine our collective objective of access, affordability and quality?

Why not do more and take a page out of the auto and life insurance industries? Why not consider rewarding individuals who make healthy decisions and lead healthier lives?

Smoking, poor weight management and poor chronic disease management are three factors that drive up health care costs. Why shouldn’t these choices, and others, be factored into health insurance rates and benefits, in a similar way that motor vehicle driving histories are factored into auto insurance rates? For example, is it fair for a 45-year-old man with diabetes who actively manages his disease and lives a healthy lifestyle to pay the same health insurance premium as a 45-year-old man with diabetes who smokes, is overweight and is making no effort to improve his health?

Linking cost to lifestyle may help us with the goal of reducing health care costs. But even more importantly, it will make us healthier and offer a better model for those who stand to benefit even more — the generation of children that are taking our lead.

Let’s face it, we are bombarded with daily pressures and choices that make it very easy to choose less-than-healthy decisions. Certainly, exercise and diets have been around for years and they haven’t stopped or even slowed our slide. What other short term incentives can we create that will activate our population into a healthier direction?

So the question at hand for each of us is: Can — and should — health insurance be a positive agent for driving healthier living and producing better outcomes?

Eric H. Schultz is the president and CEO of Fallon Community Health Plan.

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