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Should Analytics Drive The Health Insurance Debate?

Our life expectancy has increased substantially over the past decade largely due to public health awareness such as anti-smoking awareness.  However, we generally have worse outcomes than other industrialized nations.  Should we be shifting our policy discussion and investments to public health and wellness, versus a reliance on advanced medical care and pharmaceuticals? 

The current health insurance issues demand public debate and common sense financial solutions.  All private casualty, health and disability insurance needs to be actuarially sound to serve the shareholders and policyholders.  Additionally, public insurance needs to be available to those who need it, however it also needs to be acceptable and affordable to federal, state and local taxpayers. 

The latest failures of lawmakers to address these issues highlight a simple fact.  We are not addressing the underlying causes, conditions and costs of an aging population brought about by decades of stressful and unhealthy lifestyles.  According to the Centers for Disease Control and Prevention (CDC), eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. Additionally, the indirect costs associated with preventable chronic diseases may exceed $1 trillion per year according to the Health and Medicine Division of the National Academies of Sciences (formerly the Institute of Medicine).

Given this overwhelming evidence of costs associated with chronic conditions, there should be significantly increased public and private investments to promote balancing work, family care, healthy diet and exercise.  In the same way that the anti-smoking campaign has proven successful in reducing tobacco use, it may be possible to reduce other chronic causes of disease and conditions such as diabetes.

Today, U.S. per capita health expenditures are more than twice the average of other countries in the Organization of Economic Cooperation and Development. The Health and Medicine Division of the National Academies of Sciences estimates that cutting the prevalence of adult obesity by 50 percent—roughly the same reduction across the population as was achieved through public health’s multipronged attack on smoking in the late 20th century—could cut annual U.S. medical care expenditures by $58 billion or more.

Therefore, should early analysis and planning of catastrophic or chronic cases be an essential part of any private casualty, health or disability program?  For example, if a person is seriously hurt at work, should everyone be pulling together (employee, family, healthcare professionals, employer and judicial system) to return the person to work in any capacity possible?  And if the person is unable to return to work in the short or long term future, then what resources are necessary for the person’s stable well-being?  A “mini” life care plan (LCP) is a good way to address the comprehensive set of issues for the successful resolution of Workers’ Compensation claims.  In order to successfully address the costs of any program, it is necessary to understand the key drivers of cost, i.e. catastrophic or chronic cases.  For more information about our benchmarking and predictive analytics to improve your programs, please contact us at This email address is being protected from spambots. You need JavaScript enabled to view it..

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