Health Risk Management

Valerie Wong Fountain, CFA®, Managing Director, Head of Signature Access

Jerry Garner, Vice President, Senior Lifestyle Advisory Specialist

The ancient Roman poet, Virgil, wrote “The greatest wealth is health.” Health issues and health-related expenditures are quickly becoming significant personal and financial concerns for ultra-high net worth families.

If not properly planned for, management of an acute or ongoing health issue can be costly and expose individuals to increased risks that threaten not only health and quality of life, but also financial security. Out-of-pocket spending grew 3.9% in 2016 to $352.5 billion, faster than the growth of 2.8% in 2015. This was the fastest rate of growth since 2007 and exceeded the average annual rate of growth of 2% from 2008-15.1

Just as having a diversified financial portfolio can help mitigate the impact of market swings, a personalized approach focusing on one’s well-being may help mitigate health risks. For example, by reducing the need for treatment of preventable health problems, a patient may lower medical costs. In addition, by focusing on well-being, one may improve longevity and quality of life in retirement; and, by focusing proactively on health, a patient may catch diagnoses early and improve outcomes.

Key Factors Affecting Health Risk

 

FAMILY HISTORY

Accessing one’s family history is the foundation of a personalized health plan; yet, a report from the CDC found that only 33% of Americans have gathered their family health history.2 A range of diseases found in one’s family history can determine future health risk; these diseases can include cardiovascular disease, diabetes, Alzheimer’s, some cancers, genetic disorders, etc.

LIFESTYLE

Medical research has shown that lifestyle factors have a substantial effect on health risk. For example, people who are overweight have a two to three times higher risk of coronary artery disease and high blood pressure. They also have a 10 times higher chance of developing type 2 diabetes and an increased risk of dying from colon, breast and other cancers.3 Given these potential health risks, it is surprising that a Mayo Clinic study found that less than 3% of Americans meet the basic qualifications for a healthy lifestyle.4

MISDIAGNOSIS AND MEDICAL ERRORS

Patients face high incidences of misdiagnoses and medical errors, which increase health risk. According to the Institute of Medicine, most Americans will experience at least one inaccurate or delayed diagnosis in their lifetime with potentially devastating effects.5 An analysis by Johns Hopkins suggests that misdiagnoses and medical errors are the third leading cause of death in the U.S. after heart disease and cancer.6

INAPPROPRIATE OR UNNECESSARY TREATMENT

Undergoing unnecessary treatment or procedures may be harmful to the patient. One study found that 30% of common medical procedures, including cardiac bypass and hysterectomy, are performed without clinical evidence.7 And patients not receiving top-quality care supported by clinical evidence may increase the risk of complications and potentially lower their survival rate.8

MEDICALLY RELATED TRAVEL EMERGENCIES

When traveling, one faces risks with sudden illness, injuries, complications from a chronic diagnosis, and lost or forgotten medications. It is difficult to know which physicians and hospitals provide the highest quality care, especially overseas. Treatment in facilities with limited experience or expertise increases the chance of receiving inappropriate care, which in turn increases the risk of suboptimal outcomes. Advanced preparation can help mitigate this risk.

THE PILLARS OF AN EFFECTIVE HEALTH RISK MANAGEMENT STRATEGY

In order to manage health risk effectively, individuals should have a personalized risk management strategy. A health advisor, an independent advocate who helps individuals navigate the health care system, can assist with building this strategy. An advisor plays several roles, including researching conditions and treatments, physician referrals, scheduling expedited appointments and managing medical records.

THERE ARE FIVE BASIC PILLARS OF THIS STRATEGY:

 

Screening and preventive care: The strategy’s foundation should include:

• Assessing and monitoring family history and lifestyle-based risk factors

• Updating immunizations

• Biometric screening for high blood pressure, cholesterol, blood sugar, BMI and waist circumference

• Personalized screening for breast, colon and other cancers

Proactive care may lower the risk of developing many preventable diseases. It can also increase the likelihood that diseases are detected at the earliest stage, when they may be more treatable.

Access to reliable medical intelligence:

To make sound decisions, patients need to be fully informed about treatment options and their potential risks and benefits. They also need help finding the right specialists for complex health problems. Friends and family may be well-meaning but are not always the most objective source of information. Internet resources can be overwhelming, outdated and misleading. Even an experienced family physician may not know about the most current treatment approaches or the best specialists for complex diagnoses.

Access to expert, experienced physicians:

Quality of care and outcomes are directly affected by the experience and expertise of the treating physician. For example, one study found that surgeons who performed at least 50 surgeries a year had no complications over a five-year period.9 Training is another important consideration. A study found that American Board of Surgery Certified physicians achieved better cancer surgery outcomes than noncertified surgeons.10

Personalized care planning and support:

For the best outcomes, individuals need a proactive, personalized strategy focused on their needs and risk factors. The strategy should take into consideration:

• Family history

• Lifestyle

• Genetic risk factors

• Health and wellness goals

Medical information and care also need to be managed among all specialists to avoid inappropriate or redundant testing and treatment and to reduce the risk of misdiagnosis.

Access to care for medical travel emergencies:

Identifying and vetting the most qualified physicians and hospitals at each destination ahead of travel may lower the risk of inappropriate care in an emergency. Appropriate pre-trip preventive measures are also important. Travel protection should include medical travel insurance to guarantee payment for care and evacuation coverage.

A proactive, patient-centered approach can both mitigate the risks presented by disease and make personal health goals easier to achieve, leading to a better quality of life.

Contact your Morgan Stanley Advisor for an introduction to a private health advisor. From developing a personalized risk management strategy and navigating the health care system to scheduling appointments with medical experts, they can help you evaluate options and maximize personal health goals.

If you are interested in learning more about any of these articles or what our Family Office Resources team can offer, please contact your Advisor.

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1 2015 Employer Health Benefits Survey, Henry J. Kaiser Family Foundation, https://www.cms.gov/ Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/ downloads/highlights.pdf
2 Morbidity and Mortality Weekly Report, P W Yoon, ScD, M T Scheuner, M D, M Gwinn, M D, MJ Khoury, MD, PhD, Office of Genomics and Disease Prevention; C Jorgensen, DrPH, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion; S Hariri, PhD, S Lyn, MD, EIS officers, CDC, http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5344a5.htm
3 Disease Control Priorities in Developing Countries, Chapter 4 4, Walter C . Willett, Jeffrey P. Koplan, Rachel Nugent, Courtenay Dusenbury, Pekka Puska, and Thomas A. Gaziano, https:// www.ncbi.nlm.nih.gov/books/NBK11795/
4 Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in U.S. Adults, Paul D. Loprinzi, PhD, Adam Branscum, PhD, June Hanks, PhD, DPT, PT, Ellen Smit, PhD, Mayo Clinic Proceedings, http://www.mayoclinicproceedings.org/article/S0025-6196(16)00043-4/abstract
5 Improving Diagnosis in Health Care, Erin P. Balogh, Bryan T. Miller, and John R . Ball, Editors.
http://www.nap.edu/21794
6 Medical error — the third leading cause of death in the US, Martin A Makary, Michael Daniel, BMJ 2016;353:i2139, http://www.bmj.com/content/353/bmj.i2139.long
7 U.S. Health Care: Facts about Cost, Access and Quality, Dana P. Goldman, Elizabeth A, McGlynn, http://www.rand.org/content/dam/rand/pubs/corporate_pubs/2005/RAND_CP484.1.pdf
8 Nearly Two-Thirds of Ovarian Cancer Patients Not Receiving NCCN-Recommended Treatment, OncLive, http://www.onclive.com/publications/obtn/2013/june-2013/Nearly-Two-Thirds-of-Ovarian-Cancer-Patients-Not-Receiving-NCCN-Recommended-Treatment Worsening Trends in the Management and Treatment of Back Pain, John N. Mafi, MD; Ellen P. McCarthy, PhD, MPH; Roger B. Davis, ScD; Bruce E. Landon, MD, MBA, MSc, JAMA Internal Medicine, http://archinte.
jamanetwork.com/article.aspx?articleid=1722522 Proceedings from the National Summit on Overuse, The Joint Commission and the American Medical Association Convened Physician Consortium for Performance Improvement, 9/24/2012, http://www.jointcommission.org/assets/1/6/national_summit_overuse.pdf
9 Making the Cut: Why choosing the right surgeon matters even more than you know, Marshall Allen and Olga Pierce, ProPublica, https://www.propublica.org/article/surgery-risks-patientsafety- surgeon-matters
10 Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: A systematic review of the literature, Karl Y. Bilimoria, Joseph D. Phillips, Colin E. Rock, Amanda Hayman, Jay B. Prystowsky, David J. Bentrem, https://www.scholars.northwestern.edu/en/publications/effect-of-surgeon-training-specialization-and-experience-on-outco

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