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Healthcare roundup: Being heart healthy, paying for outpatient care, and 4-day work weeks

Cardiovascular health can lead to longer life expectancy

By Jeff Levin-Scherz, MD, MBA | March 24, 2023

Our population health leader weighs in on the value of being heart healthy, the rising cost of outpatient hospital care and the benefits of a four-day workweek in this monthly update.
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It’s no surprise that those who eat and sleep well, exercise, and have ideal body weight, blood pressure and blood sugar levels are less likely to have heart attacks and strokes. We now have evidence that those who are heart healthy are also likely to live more years of life free of a wide variety of chronic diseases.

Researchers in a recent JAMA Internal Medicine study looked at the outcomes of over 135,000 adults in the U.K. Biobank study recruited from 2006 to 2010. They found that those with high scores on Life’s Essential 8 (key measures for cardiovascular health provided by the American Heart Association) have fewer heart attacks and strokes, and are also less likely to have diabetes, cancer or dementia. The Essential 8 scores individuals from zero to 100 in the following categories:

  • Diet
  • Physical activity
  • Tobacco exposure
  • Sleep
  • Body mass index
  • Non-high-density lipoprotein cholesterol (i.e., low-density lipoprotein and triglycerides)
  • Blood sugar
  • Blood pressure

The research showed that at age 50, men scoring high (above 80) lived 6.9 years longer free of disease than those with low scores (below 50), and women scoring high lived 9.4 years longer free of disease than those with low scores. 

Implications for employers

  • Lower cost interventions like promoting good nutrition, exercise and healthy sleep habits can prevent higher cost health conditions later in life. 
  • Effective medical care is often necessary for cardiovascular health. Even with proper diet and exercise many need to take medicines to control blood pressure, and some are genetically predisposed to have diabetes or obesity. 
  • Employers can encourage their employees to learn more about Life’s Essential 8 categories, which may support employees to improve their overall health.

Higher rates for outpatient hospital care costs employers and employees billions per year

Health insurance has long paid more for a service performed in a hospital outpatient department compared to the cost of the same service performed in an outpatient clinic or a physician’s office. This is not consistent with “paying for value.” This overpayment also encourages hospitals to further consolidate, resulting in a loss of competition as hospitals buy physician practices to obtain higher rates.

The Committee for a Responsible Budget reviewed claims data from employers with small, mid- and large-sized workforces and found that policies to encourage site-neutral payments in the commercial insurance market could reduce national health expenditures by $458 billion from 2024 to 2033. This could reduce premiums by $386 billion and patient cost sharing by $73 billion.

Implications for employers

  • Employers can encourage carriers to move to site-neutral payment and support proposed state or federal regulations that would require site-neutral payment.
  • Employers can consider programs to encourage use of free-standing ambulatory care centers instead of hospital outpatient facilities.
  • In the meantime, educating members about out-of-pocket cost savings can help direct some to seek care at less expensive sites.

U.K. study shows benefits of four-day workweek for employees and employers

Pretend it’s Friday. Can you imagine having the day off, every week?

In the U.K., 2,900 workers at 61 employers worked four-day weeks from June to December 2022. Fifty-six participating employers said they will continue the four-day workweek after the conclusion of the research. Companies reported higher revenue despite employees working fewer hours. Employees reported less burnout and more ability to care for family members. Fifteen percent said that “no amount of money” would entice them to return to a five-day workweek. These companies did not have an increase in new hiring during the six-month period. The Wall Street Journal and The Washington Post covered the story.

A few cautions are in order. Most of the companies involved in this pilot were small; two-thirds had 25 or fewer employees. Also, the research was sponsored by a group advocating for four-day workweeks. Furthermore, the practice could lead to disparities across industries. Four-day workweeks might be easier to implement for knowledge workers but limiting hours for service workers would be more difficult.

There are other efforts to decrease employee burnout. Several countries, including France, Ireland, Portugal and Italy, have legislated a right to disconnect where employees are not required to address emails or other communications outside of working hours. Similarly, a German employer implemented a Mail on Holiday program to delete emails received while on vacation.

Implications for employers

  • The pandemic made many companies rethink the workplace and how work gets done.  
  • The data suggest that increasing employee time off can positively affect employees without adverse impacts on business.
  • Employers with services workers could consider how to provide increased guaranteed time away from work.
  • Organizations in countries without legislation to protect employee burnout can set policies. Leaders can set examples to make employees feel comfortable disconnecting when they are off work.

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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