How Cummins is tackling health-care costs

COLUMBUS, Ind. -- Jeff Booher would be the first to admit he's not the kind of person you'd expect to see attending a class on how to cook food based entirely from plants.

The 23-year facility maintenance employee at Cummins Inc. has had coronary heart disease, high blood pressure and Type 2 diabetes. His health was not improving despite costly medications.

Sometimes it takes a crisis to bring about change. Booher and his wife, Mary Booher, now are enthusiastic devotees of Sandy Thomas, a Culinary Institute of America-trained chef who teaches plant-based cooking in a sparkling kitchen-classroom at Cummins' new 28,000-square-foot Live-Well Center health clinic here.

That's right -- classes in plant-based cooking are being offered in the Hoosier heartland by one of the world's largest diesel engine makers and the No. 33-ranked company on the Automotive News list of top 100 global parts suppliers.

Thomas' wholesome recipes have helped Booher get off some of those medications. 

"I'm off the blood pressure medicine totally," says Booher, who, along with his wife, has been faithfully attending cooking classes since the LiveWell Center opened last summer. "We like Chef Sandy. She's good." 

Cummins, long an innovator in technology and corporate best practices, is trying a new approach to tackle one of the business world's knottiest problems -- the skyrocketing cost of U.S. health care. 

The LiveWell Center offers not only easy-access traditional health care services, but also advice to help employees and their families lead healthier lives. The clinic, staffed by 46 health care professionals, offers services including traditional primary care medicine, radiology, a medical lab, physical therapy, massage, acupuncture, chiropractic, optometry, mental health and, perhaps most unconventionally, the cooking classes.

Booher's case represents just the sort of outcome Cummins CEO Tom Linebarger was hoping for when he hired Dexter Shurney, a nationally recognized expert in preventive medicine, who would ultimately help him build a radical health clinic based on preventing diseases rather than simply treating them. 

Says Linebarger: "We've had some amazing stories of people who have gone in and learned to make more vegetables, people who have diabetes who have gone on a strictly vegan diet and have learned a new way of cooking."

Like many employers, Cummins finds health care costs troublesome.

"We've been frustrated for many years that the cost of health care keeps rising but the outcomes don't go up in proportion," says Linebarger, a personable executive who puts in a vigorous physical workout five or six days a week and has given up eating red meat.

"Our primary focus for the wellness center is how we get better outcomes. Dr. Shurney and I have faith as we get better outcomes, we'll reduce Cummins' long-term costs." 

Shurney believes the best way to fight diseases is to not get them in the first place. 

"The reason lifestyle is such an important issue is 75 percent of all our chronic diseases are due to lifestyle issues. If you're really not addressing lifestyle, you're not going to move the needle in terms of health. If you want to get off your medications, come to the center. 

"We can reverse Type 2 diabetes with lifestyle. We have patients that were on insulin and oral hypoglycemics that are no longer taking insulin." 

The LiveWell Center already has created quite a buzz. Shurney says companies and institutions such as Subaru, Caterpillar, Genentech, Purdue University and the University of Pittsburgh have expressed interest in the Cummins experiment.

There's good reason. Health care costs for large corporations will rise more than 5 percent in 2017, nearly triple the rate of the rest of the economy, according to a survey by the National Business Group on Health in Washington, D.C., a group of 425 large employers.

At Cummins, some new anti-cholesterol drugs can cost as much as $14,000 per year per employee.

Says Steve Wojcik, vice president of public policy at the group: "Over the last two to three years, it's been pretty steady -- 5 percent is much faster than the overall growth in the economy and growth in wages. So it's still a problem in trying to afford health care for employees and their dependents."

In its annual survey of health care costs, Aon Hewitt estimated the average per-employee health care cost is projected to be $13,917 for 2016. That includes employer contribution to premium, employee contribution to premium and employee out-of-pocket expense.

Cummins will not reveal how much it spent to build the clinic, which serves 9,000 Cummins employees and their dependents in the greater Columbus area -- about 17,000 people in all.

The clinic is run on Cummins' behalf by Premise Health, a company based in Franklin, Tenn., that operates more than 500 on-site health centers for companies and organizations around the country. 

Cummins' Linebarger says it's too early to tell what effect the LiveWell Center might have on costs, and the company declined to say what it spends annually per employee. 

But some experts believe Cummins is onto something big. 

Jim Lando, a deputy U.S. surgeon general, visited the LiveWell Center not long after it opened in June. "I went there because I heard they were doing something really special there. 

"Cummins is a thought leader in a lot of different areas. I was impressed with the commitment of the CEO. He put his money where his mouth is," says Lando, an expert on preventive health. "They put a lot of effort and money into developing that with the expectation they would see a return on investment on the other side. That takes a lot of vision." 

He described Cummins' inclusion of the lifestyle component as "revolutionary." 

Gloria Sachdev, CEO of Employers' Forum of Indiana, says most employer-run on-site clinics take a "more traditional approach" to treating illness: "What Cummins is doing is more avant garde."

About 10 years ago, Linebarger and his predecessor, Tim Solso, began talking about ways to reduce Cummins' health care costs without making the company a less attractive place to work.

"When I first got into this, health care costs were going up 12 percent a year," says Linebarger. "Tim felt that employees were part of our stakeholder group. We want them to have good pay and good benefits. Good benefits are part of that picture, particularly in the U.S., where there isn't universal health care."

If expenses continued increasing at that 12 percent annual growth rate, Linebarger says, "We would have been out of the health care business in the future. We want to reduce our increases to 5 percent a year."

After Solso, now lead independent board director at General Motors, retired in 2011, Linebarger carried on the benchmarking and research they had started together. He studied best practices at places such as the Cleveland Clinic and Mayo Clinic.

"We decided there were lots of opportunities for us if the medical system was run to serve our employees instead of set up to serve insurance companies and Medicare," says Linebarger.

It was when Shurney came into the picture that Linebarger decided to expand his vision to include the LiveWell Center.

Shurney, who had been medical director at Vanderbilt University in Nashville, introduced the lifestyle component to the clinic and helped design it.

Shurney says he was amazed at Linebarger's deep understanding of health issues: "Imagine that: Here is the CEO of a diesel engine manufacturer, and he knew more about health care than many of the CEOs of health care companies and hospitals." 

Linebarger's commitment is what helped persuade Shurney to move to Columbus from Vanderbilt, where he had been happy. 

Shurney admits the teaching kitchen was one of the most difficult elements to get approval for from Cummins financial management. But he believes it's paying off already. 

"We got an email from a patient who was saving $700 a month on medications," he says. 

"If you're going from somebody who is not eating any green vegetables to being a vegan, that takes a certain level of commitment and is often motivated by some kind of health crisis. The alternative is to take a lot of pills. Each of them has side effects. Healthy eating, exercise and good mental health -- the only side effects they have are good side effects." 

Cummins will measure the satisfaction of patients using the Net Promoter Score, a customer loyalty metric the company has been using for the last decade to measure interactions with customers. 

The verdict is already in for Jeff and Mary Booher, who have lost 5 and 12 pounds since starting cooking classes. 

Says Jeff Booher: "It's just amazing how much better I feel."