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HEALTHY
EATING

Can We Incentivize

Healthy Behavior? By Jayesh Shah, MD

Each individual should be responsible for under control, with a majority of
their own health and for shaping their own them continuing to keep them
future. Obesity is one of the biggest drivers of under control. The incentive sys-
preventable chronic diseases and associated tem succeeded in changing behav-
health care costs in the United States. Health ior. Cleveland Clinic also made
care costs in the U.S. are 20 percent more per changes such as removing un-
capita than the rest of the world. More people healthy options and reducing por-
are sick, making health care costs higher. tion sizes in their cafeteria. They
Many have chronic conditions because of did this by removing sugary
poor lifestyle choices (the problem of plenty). snacks and drinks from their
Even though people know maintaining a vending machines, adding an on-
healthy weight and eating healthy are impor- site fitness center and providing
tant, it is hard to put this thought into prac- yoga classes with other health-
tice. If we can incentivize healthy behavior, we boosting activities.
can control some chronic conditions and de- A few employers across the na-
crease health care costs. tion are following the program
“Healthy Choice” was started by the Cleve- designed by Cleveland Clinic, de-
land Clinic for its employees in 2010. The key veloping workplace wellness pro-
idea was to give employees incentives to avoid grams for their employees to
six chronic medical conditions and in return, decrease health care insurance
see a decrease in their insurance premium costs. Incentivizing employees by
rates. This program has been a huge success. decreasing their health insurance
Cleveland Clinic showed a flat-lining of premiums is in turn making em-
health care costs for the first few years, fol- ployees healthier and happier.
lowed by a 2 percent decrease last year. Can we implement Cleveland Clinic’s centives for physicians to participate in qual-
The six major chronic diseases responsible Healthy Choice program in all health care ity measures, is it possible for CMS to develop
for 75 percent of all health care costs are high systems throughout the U.S.? Can we incen- incentives for patients to follow healthy
cholesterol, high blood pressure, excess tivize patients and change their behaviors? At lifestyle choices? The future of healthcare will
weight, diabetes, asthma and tobacco use. In some point, with health care costs skyrocket- require the redesign of primary care and de-
the Cleveland Clinic program, workers saw a ing and the Medicare system not able to han- velopment of incentives for healthy behavior.
physician or a mid-level provider who moni- dle the cost, is it fair to ask citizens to pay
tored things such as weight and cholesterol. more for their healthcare if they do not Jayesh Shah, MD, a wound care
They also offered education and counseling choose to participate in healthy lifestyle specialist certified in Internal Medi-
for a healthy lifestyle. The Healthy Choice choices? Once consumers of healthcare buy cine and Undersea and Hyperbaric
program was voluntary, but because incen- into this incentive system, people’s behavior Medicine, is a member of the Board of Trustees
tives were huge (i.e. workers who met the goal will change and that will also change the food of the Texas Medical Association.
could save 28 percent in health insurance pre- industry. The food industry will ultimately
miums) many workers participated in the have to change and provide more healthy Cleveland Clinic program reference:
program. Since 2010, almost 66 percent of choices at affordable costs. http://www.mauldineconomics.com/front-
workers with one or more of the six major In the same way Centers for Medicare & linethoughts/how-to-rebuild-healthcare-
chronic conditions managed to get them Medicaid Services (CMS) has developed in- right

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