Dr. Paul Lemanski proposes implementing incentives for healthy lifestyles.
By Peter Miller
The Glens Falls region is very fortunate to be served by several senior living and continuing care facilities offering a range of accommodations and services. One of the most distinguished is certainly The Glen at Hiland Meadows in Queensbury.
The Glen is a not-for-profit senior living community sponsored by two of the region’s most trusted names in senior care and services – The Eddy and The Glens Falls Home. With 74 one- and two-bedroom apartments and 18 two-bedroom cottages, The Glen provides independent living with delicious meals, fun-filled social activities, and no chores.
Each year, The Glen invites community leaders in for its annual Board of Directors/President’s luncheon, usually featuring a provocative talk by a distinguished authority from the healthcare field. The event on June 6 was no exception. The speaker was Dr. Paul Lemanski, assistant clinical professor of medicine at Albany Medical College, and internist at the Center for Preventive Medicine in Albany. Dr. Lemanski’s focus is on preventing cardiovascular disease through all proven means.
Dr Lemanski began by stating, “Americans today engage in behaviors that are hazardous to their health, and they expect modern medical science and high-tech, high-cost procedures and drugs to undo that which they insist on doing to themselves. Indeed the majority of illnesses that physicians currently see and treat are the consequences of unhealthy lifestyle choices.”
The American Heart Association made it simple to understand when it defined ideal cardiovascular health as the presence of four favorable health behaviors and three favorable health factors.
The four behaviors: no smoking for one year; normal body weight; 150 minutes per week of exercise such as walking; and healthy diet. The three factors: total cholesterol under 200; untreated blood pressure under 120/80; and the absence of diabetes. Less than 5% of the American population achieves these conditions.
Our current healthcare system is not working, and lives are in danger as a result. Dr. Lemanski believes one novel approach may help all of us implement the steps needed to lower risk: optimizing health through incentives.
“Diabetes is proof that an ounce of prevention is worth a pound of cure,” said Lemanski. Diabetes greatly increases the risk of heart attack and stroke. There are 20 million Americans with diabetes, at a cost of $92 billion per year, and another 40 million Americans with pre-diabetes (or metabolic syndrome).
“These 40 million are converting to diabetes at the rate of 11% per year! So in ten years, there will be 60 million diabetics in America – minus the ones who die. If we could prevent new cases of diabetes, we could save hundreds of billions of dollars in the next 10 years, as well as many preventable deaths and disabilities,” he speculated. “We know how to do it,” he added.
According to Lemanski, the overwhelming number of new cases will be Type 2, caused by an increase in body weight. Among those at risk, a 20 lb weight loss can decrease risk by astonishing 57%. How do we get pre-diabetic patients to lose 20 lbs and keep it off? The role of personal responsibility has been ignored by the healthcare system in mitigating healthcare costs, says Dr. Lemanski. The current system assumes that people will not change their lifestyle choices under any circumstances.
Lemanski suggests that it makes sense to allow people to pay into the system with changes in lifestyle that have been shown to reduce costs. In an era of tight money, why not pay with behavior change – not dollars. We need to find ways to incentivize behaviors that have been proven to prevent disease and lower healthcare costs. But how those incentives are structured is fundamental to their acceptance and success. Lemanski recommends offering the carrot before the stick, and focusing on changing those behaviors that have the most impact on death, disability, and costs, such as smoking.
At the Center for Preventive Medicine, a high protein, low carbohydrate, low saturated fat diet helps patients lose 20-25 lbs in 12 weeks. Once that weight is lost, a high Omega-3 Mediterranean diet is used for weight maintenance. In the past 10 years, over 4000 persons have participated in this 12-week program with significant reductions in blood pressure, blood sugar, triglycerides, and LDL cholesterol, and elevations in HDL. Those people who show such improvements could be rewarded with progressive reductions in the cost of health insurance or medications – as long as the weight loss is maintained.
A body mass index (BMI) greater than 30 increases risk for heart attacks, hypertension, elevated cholesterol, and other disorders, including cancer. Incentives for these people, who are more numerous than those with diabetes or metabolic syndrome, could have a dramatic on total medication use – even with modest weight loss. Fewer heart attacks, strokes, coronary bypass surgery, and coronary stents would result.
“Every group or company can have a greatest loser program for optimizing body weight,” said Lemanski, and company cafeterias could offer heart-healthy foods at modestly reduced costs to encourage weight loss and healthy diets.
In one diet-heart study, consuming a high Omega-3, Mediterranean diet decreased fatal and non-fatal heart attacks by 70%. By contrast, taking a statin drug gives you a relative risk reduction of 30-40%.
Lemanski suggests that we can find many ways to promote a heart-healthy lifestyle that would cost little. The population as a whole should get healthier without additional medication, high-tech procedures, or costs. In the current system, it is easier to take a pill, or have a procedure than to eat right, exercise daily and quit smoking and normalize body weight. “Pills and procedures are subsidized; healthy behaviors are not. That must change,” he said.
Without some new approach, a recent Johns Hopkins study estimates that by 2030, 50% of Americans will have a body mass index over 30, and 90% will have a BMI over Dr. Lemanski Continued…
26, costing $900 billion every year in obesity-related costs.
Lemanski acknowledges that there will be some who refuse to take responsibility for their unhealthy lifestyle choices. These behaviors will likely bring negative health consequences on themselves, and drive up the health insurance premiums of their neighbors.
He suggests that those smokers with metabolic syndrome and increased weight who do not agree to participate in the incentive program would, after period of perhaps 3 years, face paying an increased premium commensurate with their projected cost of care. It would be left to each individual to either change or pay a higher premium.
“Why should health insurance be any different than life insurance or car insurance – which are risk dependent. Why should everyone pay more? As the population becomes sicker, there are more people taking resources from the system than are paying into it and it becomes insolvent. The result is healthcare rationing and a denial of care.”
“Incentives for healthy lifestyles will likely start first with self-insured groups,” said Lemanski, “because they are not held to community ratings.” He cited the example of GE Power Systems, with which he worked to reduce cardiovascular death and disability in their workforce. “We developed a cardiovascular risk-reduction program (Heart Power) that featured proven measurements of cardiovascular risk, with feedback from each member’s personal physician, a cardiovascular nurse at the worksite, heart-healthy menu options at their cafeterias, and a state-of-the-art exercise facility. Its purpose was to find the heart attack waiting to happen, and prevent it. In this self-insured group, saving lives means saving money.”
“Heart-Power was a success,” he said, “because an employer put a focus on prevention, brought cardiovascular risk to the attention of their employees’ physicians, and brought risk intervention to the very worksite … but it had no incentives. How much more could be accomplished with targeted incentives for those at higher risk?”
“In this second decade of the 21st Century, America faces a challenge–the cost of healthcare has become prohibitive. Healthcare insurance has worked in the past, because there were many more healthy than unhealthy, and a reasonable premium could cover the expenses of those who became ill. But with more people embracing unhealthy behaviors over the last 30 years, the population has become less healthy, and the number who need treatment has increased dramatically. Preventing disease with changes in diet, exercise and lifestyle offers the hope of reversing this trend. Compelling evidence shows that low-tech, low-cost changes in behavior can prevent disease … but only when implemented. Properly structured incentives offer the best hope for implementing such change and achieving optimal prevention,” Dr. Lemanski concluded.
The Glen President’s Award goes annually to someone who has distinguished him or her self in community service. This year’s award was presented to Matt Rozelle, a history teacher at Hudson Falls, whose classes have been conducting oral histories with veterans since 2001 to preserve their memories and experiences for future generations. This has given today’s youths a unique perspective on our past and an appreciation of those who lived it. In 2009, Roselle’s students interviewed several residents at The Glen about their WWII experiences. Roselle was recognized as 2010 teacher of the year by the Organization of American Historians. Congratulations Matt Rozelle, winner of the 2012 Glen President’s Award.
For more information about The Glen at Hiland Meadows, call 832-7800. Or, stop by 39 Longview Drive, Queensbury, NY.