Setting a Bad Example

It's a rare day that I don't have a conversation with someone who's trying to get a handle on a patient population, be it ACO participants or the chronically ill, because that's where it's all headed-taking population health to a grand scale to cut that fat off the national budget. But I've had very few discussions about problems with a very expensive and perplexing patient population-hospital employees.

Thomson Reuters released a pretty well-publicized report in September that showed hospital workers-and their dependents-are doing a dismal job of staying fit. Their illness burden is 8.6 percent higher than the U.S. workforce at large and they have higher rates of asthma, diabetes and other chronic conditions; they were 22 percent more likely to make an emergency department visit; the average annual health care costs for hospital workers and their dependents is $4,662, which is $538 higher than the general population.

The Thomson study comes on top of a number of smaller studies that show nurses, for one group, have higher rates of obesity and other chronic problems than the general population.

And this is all very sad. Hospitals and other care settings are high stress environments, notorious for difficult work hours, and filled with all kinds of health hazards. But health care expends a lot of energy counseling workers from other industries that those very conditions are not valid excuses for not managing their health. In fact, an absolutely enormous amount of energy has gone into population analytics, devising online and mobile consumer health services, developing carrot-and-stick incentive programs and other measures to basically force people into personal health management.

What prompted me to whip up this column was the time I spent standing outside my local coffee shop, watching the herd rumbling by, many of whom are wearing scrubs and punching in at nearby hospitals and long-term care facilities. Hospitals as well as federal and state governments are building out I.T. infrastructures to support programs designed to connect with high-cost, high-acuity populations, but apparently those very same programs don't resonate with the people designing and supporting them.

If we're going to enter a brave new world of e-health and personal responsibility, the dichotomy between the health care industry's message and the personal actions of its workforce is going to be a sticky wicket. If the industry cannot collectively practice what it preaches, who's going to listen to its sermon?