Increasing the Value of Health Benefit Investment – Target Metabolic Syndrome

December 17, 2015

The average lifetime expenditure for healthcare is currently $316,000 and much of the cost is clearly linked to health habits. Poor health habits are strongly associated with illness and are strong predictors of future health care costs. For example, the lifetime costs for smokers are higher than those for nonsmokers, by about one-third. Also, people with low levels of physical activity visit the doctor more frequently than those who are physically active. When looking at any given organization’s population of employees, people with three or more of the following risk factors (smoking, obesity, hypertension, hypercholesterolemia and diabetes) have healthcare claims that are double those of people with no risk factors.   

To create value in our healthcare system, we first need to create a culture of health. Although steps are being made by the healthcare community to improve the coordination and efficiency of healthcare delivery, true healthcare value will be achieved only when combined with effective health promotion that creates better health.  Workplace wellness studies have been conducted since the late 1980s examining  the relationship between employee health risk and healthcare value.

Key findings have included:

  • Cost followed risk
  • The greatest reductions in average healthcare costs occurred in employees who moved from high-risk to low-risk status and the largest increase in costs occurred in employees who moved from low-risk to high-risk health status
  • The road to healthcare value must include the measures that bring better health to individuals that ultimately lead to lower medical costs

Metabolic syndrome is the term used to describe a group of metabolic risk factors that raise a person’s risk of heart disease, diabetes, stroke and other health problems. The five metabolic risk factors described by the term metabolic syndrome include a large waistline, high blood triglyceride levels, a low HDL (“good”) cholesterol level, high blood pressure and a high fasting blood sugar. The risk for heart disease, diabetes and stroke increases with the number of metabolic risk factors. The risk of having metabolic syndrome is closely linked to overweight and obesity and a lack of physical activity. According to the National Heart Lung and Blood Institute, metabolic syndrome may soon overtake smoking as the leading risk factor for heart disease.

About 20%-30% of employees have been found to have metabolic syndrome in studies of workplace settings

The risks associated with metabolic syndrome present a well-defined example of the impact that risk reduction can have on the value of an organizations healthcare benefit investment. In studies of workplace health promotion, measures that successfully eliminate the biometric, metabolic risks of the metabolic syndrome produce commensurate reductions in healthcare, pharmacy and short-term disability costs. Better health at lower cost means greater value. 

People with Metabolic Syndrome

  • have a risk of developing diabetes that is 2.5-3.5 times higher than average risk.
  • have a risk of developing heart disease or stroke that is 1.5-2.2 times higher than average risk.

Worksite health promotion programs hold great potential to mitigate the rising risk for poor health and increased healthcare costs experienced by individual employees and employee populations with metabolic syndrome. Yet, despite the potential impact on the value of the healthcare benefit investment, measures specifically targeting the metabolic syndrome continue to be largely under-utilized in the workplace. Programs that help employees achieve aggressive lifestyle modifications have been effective in improvement of the employees’ health risks, including those metabolic risks that make up the metabolic syndrome. Focused programming for employees with metabolic syndrome in reducing metabolic risks holds great potential as a high value health benefit investment; improved health and vitality with improved cost outcomes. 

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