I remember being in school and thinking "Once I get through school, I'll have it made. I'll be rewarded handsomely for what I love doing, and all of my worries will be over." Imagine my surprise when I got out of school and hadn't a clue as to how to actually get paid for what I did. And to make matters worse, what I loved doing (seeing patients) wasn't what I was actually doing all day. I was doing what I hated paperwork! Such is the reality that virtually all doctors and many health care professionals encounter. I'll share with you what I did to make life easier during this process and show you how health care is once again becoming a consumer-driven market to be dominated by those with the products and services that consumers really want.


You Did WHAT?

            Constantly justifying a treatment strategy can be a bit unnerving, but reverse the role for a minute and you'll understand why. Imagine you had a Nordstrom's credit card and could use it as much as you wanted and that someone else would get the bill and pay it every month. Needless to say, Nordstrom's would be your favorite place to shop, and I doubt you would place much value on the items you "bought" there as if you had paid for them yourself and were personally invested in the transaction. So my question is:  Is this scenario any different than an obese smoker with a Blue Cross card? That is, what value does this person place on health care in the first place? Would that change if he or she was paying for it?

            I'll share a story that a friend of mine recently told me that crystallizes my point. On a recent trip to Antigua, my friend and his wife paid a taxi driver to show them the sights of the island. About an hour into the trip, his wife offered the driver a stick of gum out of courtesy as she and my friend were having one. The driver declined rather vigorously, which provoked my friend to ask why he had declined the gum. The driver told them that he and his family did not have insurance and that if he got a cavity and had to have his tooth fixed it would be very expensive, and he could not afford it. He also went on to say that he and his family (and most of the local culture) did not eat junk food or do anything from a diet and lifestyle behavior that would adversely affect their health for the same reasons. What a concept! Self-responsibility in its purest form.

            I believe the most dangerous thing in health care is an attitude of entitlement. The "fix-me-in-spite-of-myself" illusion that most of our culture believes is reality is exactly what is wrong with our system, as well as TV ads tempting this culture with "take this pill and fix it" ads just adds to the problem.

            Now, imagine being a self-funded company providing insurance benefits for this type of culture with 15% to 20% increases in premiums every year. You would be looking for justification tool.

            To revisit something I spoke about in the January-February issue, justification to these groups means outcome-based assessment and reassessment where defined, measurable progress supports your efforts and moves the patient towards a loftier goal. It also supports your movement towards a more integrated practice, as it makes no sense to "fix" a 400-pound patients' back without dealing with the obesity that most assuredly ' created the problem in the first place. With functional outcomes, you can easily justify a supervised exercise program for this individual as a complicating factor (I'll say!) to the injury and ongoing risk to re-injury.


A Return to Self-Responsibility

            I heard an economist on television say the other day that the good thing about $50/barrel oil is that it is forcing us to consider alternative fuel options.  He said that in the last year there has been more venture capital money invested into alternative fuel companies and research related to alternative fuel than in the past 10 years combined.

            I believe, and experience has taught me, that the same is true in health care. The good thing about rising health care costs is it forces corporations (the biggest stakeholders in health care) to consider other options, including wellness initiatives, to lower the trend lines regarding cost. Consider that on average about 80% of all health care costs are accounted for by about 12% to 15% of a corporate population. Clearly it makes sense to identify and educate that population. Because of the Americans with Disabilities Act, the corporation cannot know who these people are specifically, which creates an enormous need for third-party intervention or wellness providers.

            Opinion Leaders is the certification program for the LifeStrive Wellness Web Portal, which is a complete disease state management program and is now being made available to thousands of corporations across America through a "very large voluntary benefits company," creating for the first time a benefits company with a vested interest and the massive distribution to make this kind of health care widely available at the corporate level.


Viagra or Multivitamin

            No illusions here, we still live in a world where Medi-care will pay for Viagra but not the multivitamins they tell all Americans they need. Meaning we're still a reactionary system, but the change will come from those who have the means and motivation to change the system which is clearly the corporations. I believe this change will come in the form of programs like Health Savings Accounts (HAS) and Flex-Spending Accounts (FSA) as they are self-directed pre-tax dollars that puts the responsibility back on the individual and not on a third-party.

            Marketplaces of all kinds evolve in response to the different needs of each generation. This one is no different. The values, preferences and behaviors of consumers can be understood and shifts better predicted by breaking down what accounts for them into three elements:

            1) Life Stage

            2) Current Social and Economic Conditions

            3) Prior Collective Experience


            It is impossible to look at the factors of an aging population, 20+% increases in health care premiums, more two thousand dollar deductibles with health insurance and an ever-lower average health-index cannot arrive at the same conclusion, health care is quickly becoming a consumer-driven market again. The question is do you have what they want?


Richard Perryman, D.C. is the founder of Opinion Leaders, a new practice and fitness consulting organization specializing in the implementation of integrated, multidisciplinary operating systems into current health care facilities and fitness clubs. Dr. Perryman is also the founder of Health Coach Corporate Wellness Centers which has become a model for integrated, wellness-based practice delivering Web-based health assessment and promotion programs to over 500,000 individuals in Arizona and California through employee benefit programs and corporate wellness initiatives. You can contact Opinion Leaders at 800.818.7170.