What’s the Cost of Not Incentivizing Preventative Care?


When 50-year-old Michael Kelly recently ended up in a Dallas emergency room, he was told his diabetes was out of control and was now threatening his life.

He already knew he was diabetic—he was actually diagnosed 10 years earlier, but he says he simply wasn’t eating right or taking care of himself and didn’t realize the impact that would have on his condition.

Mr. Kelly was referred to the Baylor Diabetes Health and Wellness Institute (DHWI) in Southern Dallas, which offers free diabetes education classes.

It wasn’t necessarily a diagnosis that he needed, or a prescription. Kelly needed to learn exactly how to make good food choices, how to cook for his condition, and how to start a sustainable exercise program. He needed instruction and detail, not just the 30-second lecture, “Eat better and exercise.”

But in today’s healthcare system, we as providers are not reimbursed for detailed instruction when it comes to wellness and prevention. We’re not reimbursed for cooking or exercise classes. We’re not incentivized to provide real healthcare—only sick care.


Baylor can only afford to run one such institute right now because, although it’s arguably one of the most effective and efficient entities in our system, it’s a loss-leader financially.

When it comes to employee health, we as a self-insured organization have great incentive to keep our people out of the doctor’s office and hospital. We are in a sense “reimbursed” for taking the time to organize fitness activities, teach nutrition and stress reduction, and so we do.

And the results are impressive. Baylor has so far saved $2.44 for each dollar invested in our employee wellness program since we instituted it, and we expect to save $3.40 for each dollar invested this year.

When I was told Mr. Kelly’s story a few months ago, I wanted to meet him. He looks great, says he feels like a new man, and he credits the free cooking and exercise classes he took at the Diabetes Institute with saving his life.

If our healthcare system reimbursed prevention and wellness and we could build centers similar to the Diabetes Institute all over Texas or even the country, would two-thirds of Americans still be overweight or obese?

Would one-in-three Americans still be expected to develop diabetes in the next decade? Or could we as providers start preventing expensive and life-threatening, chronic conditions instead of just treating them?

Unless innovation in wellness and prevention is financially incentivized, we may never find out.

This blog post appeared first on D Magazine’s DHealthcare Daily.

About the author

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Joel Allison is a special advisor to the chairman of the Baylor Scott & White Holdings Board of Trustees. He was previously president and CEO of Baylor Scott & White Health. He's been a leader in the health care industry for more than four decades, and he's been on Modern Healthcare magazine’s annual “100 Most Influential People in Healthcare” list since 2004. He's a huge Baylor Bears fan, a fisherman and a proud grandfather of six.

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What’s the Cost of Not Incentivizing Preventative Care?