Eating Our Own Dogfood

At the last quarterly meeting, we spent a bit of time talking about and what we’re trying to do to promote health and wellness inside EI2. There was a lot of discussion, and we’ve gathered even more information from those of you who responded to the survey. Nearly half of you have signed up and completed the initial online questionnaire, or participated in the free health screenings here at Centergy, or both.

So far, feedback has varied all over the map from “Great! I can use this!” to “Why do you want to know my health details? That’s private!” Let me take some room to talk about our intentions.

Why are we doing this?

Georgia Tech’s core approach to healthcare benefits hasn’t changed in decades. Like most large organizations, we’re self-insured. (Blue Cross may handle your paperwork, but there’s not a magic pot of money at Blue Cross… that’s our money, and they just act as a middleman.) Through the Board of Regents, we have a huge pool of employees, so we average healthcare costs across everyone, and hope that the averaging works out to a reasonable cost per employee.

Lately, it hasn’t worked so well. As EI2’s Mark Braunstein will tell anyone who will listen, the American healthcare system evolved in a different era when medicine was low-technology and people were more or less healthy, until they encountered an infection or ailment that killed them. So you had decades of low costs, then a flurry of spending (moderate by today’s standards) near the end of life. Averaging worked.

The good news is, medicine has gotten a lot better. The bad news is, better medicine is way more expensive. It means that more and more of us live with expensive chronic conditions (diabetes, heart disease, HIV, you name it) for years. Even decades. Multiple surgical procedures, multiple expensive pharmaceuticals… averaging no longer works. More than 75 percent of the country’s $2.5 trillion medical care expense is spent on chronic conditions.

My father survived for 22 years after a near-fatal heart attack. Only a few years earlier, that wouldn’t have happened; he would have died, and I would have lost my father when I was 9 years old. But, thankfully, he lived to watch me grow up. And he consumed hundreds of thousands of dollars of care over those 22 years… the first decade at our own expense (self-employed), until he hit 65 and qualified for Medicare.

We’ve seen this with our clients. The largest uncontrolled expense faced by U.S. industry is healthcare costs. General Motors spends more on healthcare benefits than on steel. So you see employers — including Georgia Tech — nickel-and-diming their employees and retirees on benefits. Charging higher premiums. Asking for higher co-pays. Reducing the percentage of coverage on certain prescriptions or types of care. It’s all necessary, but it’s not enough.

The Board of Regents is following the lead of private industry and encouraging the use of HDHP/HSA… that mouthful stands for “High Deductible Health Plans/Health Savings Accounts.” My wife and I switched during open enrollment for this calendar year. More of you will probably switch in the future. This is a big deal. Because it brings market forces to bear onto the costs of chronic care.

Carrot and Stick

Broadly speaking, the first $3000 that my wife and I spend on healthcare is now our problem. So we have an incentive to shop around. Compare costs. Verify that suggested tests are really necessary. And — most important — to stay healthy.

Because there’s a carrot to go with the stick. We pay for that first $3000, plus our 10% co-payment if we exceed that, from a Health Savings Account. We deposit pre-tax money in that account from my monthly paycheck. And, if we don’t spend it, it’s ours. Unlike the more familiar FSA (Flexible Spending Account), those HSA dollars earn interest, year over year, until you need them for medical expenses. You never pay taxes on them (unless you withdraw money for non-medical purposes). And you take the account with you when you change employment or retire.

So staying healthy now means more tax-free dollars to pay bills later in life. And if you’ve looked at the numbers for Medicare, Medicaid, and Social Security lately… those dollars may come in awfully handy.

Which brings us back to myGThealth. Changes in behavior aren’t going to help if you have a permanent disability or an inherited condition like Tay-Sachs. But changes in behavior absolutely can change your odds of the big chronic conditions: diabetes, heart disease, emphysema, and even cancer.

Most of us know this. We see the Reader’s Digest headlines when we’re checking out at the grocery store:

  • The 5 Most Nutrition-Packed Foods
  • 8 Things Not to Do at the Gym
  • 4 More Reasons to Snack on Nuts
  • 6 Household Chores that Burn Major Calories

We’re bombarded with good advice. But it’s far more effective when it’s personalized, which is why conducts the online questionnaire and then presents you with your personal risks for various chronic diseases. And knowing that “I should lose some weight” is different than “I’m in the 80th percentile of high risk for heart disease. I really should lose some weight!” And it’s even more different when you learn that “If I continue the way I’m going in 10 years, there’s an 80% chance I’ll have diabetes and heart disease and die 15 years before my time.”

These are the sorts of experimental tools that health@EI2 is working on to make available to employers across the state. It’s important that we eat our own dog food. If we believe these tools are important, we should use them ourselves. And we’re serving as the test case for rolling out tools like this across all of Georgia Tech, and indeed, across the entire University System of Georgia.


This column is already running too long, but a few quick responses to questions we got from the survey last month:

My doctor already provides this service.
Great! If that’s working for you, stick with it. Some people aren’t as lucky with their personal physician… or don’t have a personal physician.

I don’t like the insinuations that we’re stupid and need this tool to get healthy.
Sorry that you feel that way. I don’t think you’re stupid. Use of is optional. But even your doctor has problems keeping up with the rapid changes in medicine. Maybe you could use some help anyway?

I was reminded of the “unsinkable” Titanic every time one of the presenters assured us the site is secure and confidential.
Our experimental partner, Medikeeper, is HIPAA-compliant, just like your doctor’s office or your hospital. There’s no way for Georgia Tech to find out any individual’s health information from their site. And if hackers are really interested in breaking into a site, they’re going to hack Piedmont Hospital, not (And if someone really wants to know about my failed eye surgery, they don’t need my medical records; they can read about it on my blog.) But concerns about privacy vary. If you don’t see a benefit that’s worth the (miniscule) risk, don’t use the site. It’s optional.

Unless it is an automatic repository that links to my physicians, etc. for all my electronic medical records, it’s just another website.
Understood. It’s early days yet for these tools. Stick with it, and I think we’ll be pleased with the level of integration available in just a few years. In fact, the Federal government is moving down the road of providing financial incentives to your physician and hospital to do just this — integrate with each other and with you through your personal health record.

I didn’t choose the HDHP/HSA option.
If you’re on one of the other healthcare benefit plans, you don’t get the direct financial benefit of saving tax-free dollars until retirement. But that’s no excuse not to get healthier!