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Ken Thorpe’s presentation on the effectiveness of prevention to lower healthcare costs and improve employee productivity
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Truth #1: A substantial cause of rising health care spending is preventable or poorly managed chronic disease
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Two-thirds of the rise in health care spending is due to the rise in treated chronic diseases. Many cases could
be prevented. Most could be
better managed.One-third of the rise alone is due to obesity
2
99% of Medicare expenditures are spent
treating patients with one of more chronic diseases
Source: Health Affairs, AHRQ, other calculations
Truth #2: The U.S. spends very little on prevention, despite behavioral and environmental factors accounting for 70 percent of
U.S. deaths
97 % - 9% - Medical Care and
Biomedical Research
1% - 3%- Prevention
Causes of Avoidable Mortality
30% - Other Contributors (genetics, health care, etc.)
70% - Behavioral and Environmental Factors
3Source: Institute of Medicine, Health Affairs, Journal of American Medical Association (JAMA)
U.S. Investment in Prevention
Truth #3: Americans strongly support prevention in health reform, above many proposals regarding coverage
When given the below choices and asked how important each proposal is on a scale from zero to ten (where zero means not at all important and ten means very important), seventy percent rank investing in more prevention between 8 and 10, with prevention receiving a higher score than any other proposal.
Percent ranking importance of 8-10
Invest in more prevention to help people stay healthy and reduce diseases such as diabetes, cancer and heart disease
70%
Provide tax credits to small businesses to help small businesses provide affordable health insurance to their employees
66%
Prohibit insurance companies from denying coverage because of age, medical history or pre-existing condition
66%
Require all Americans to have health insurance while providing financial assistance to those who cannot afford it
52%
Require all businesses to provide health care for their employees or contribute to a fund to help pay for their coverage
50%
Give all Americans a choice of keeping their current insurance or joining a national insurance pool with a choice of private and public plans administered by the government
43%
Support Among Americans for Policy Solutions in Health Reform
4Source: Robert Wood Johnson Foundation and Trust for America’s Health
70% of Americans
rank investing in prevention
as the number one health
reform priority, above
proposals regarding
coverage or affordability
Truth #4: We can improve health and reduce overall spending by preventing risk factors like obesity, a risk factor for many costly
chronic diseases
Being obese or overweight increases the risk of
developing the following serious and costly conditions:
Type 2 diabetesCoronary heart diseaseHypertension (high blood pressure)CancerStrokeDyslipidemia (for example, high total cholesterol or high levels of triglycerides) OsteoarthritisLiver and gallbladder diseaseSleep apnea and respiratory problems
5Source: Centers for Disease Control and Prevention (CDC)
%
10%
20%
30%
40%
50%
60%
70%
22.930.5 32.2
56
64.5 66.3
1988-1994 1999-2000 2003-2004
Age-adjusted* prevalence of overweight and obesity among U.S. adults among U.S. adults, age
20 years and over
Overweight or obese (BMI greater than or equal to 25.0)
Obese (BMI greater than or equal to 30.0)
Obese Overweight Normal$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000143,899
118,400107,013
Truth #5: Some costs can be avoided altogether by averting disease through reducing or eliminating risk factors
Projected Lifetime Medicare Health Care Expenditures for a Cohort of Seventy-Year-Olds, 2004 Dollars
$36,886 = difference in lifetime Medicare spending between obese and normal weight American senior citizens
FACT:
Medicare will spend about 34% more on an elderly obese person over their lifetime* than on someone of normal weight, even though they will live about as long.
*Lifetime costs refer to costs incurred between Medicare enrollment and death
6Source: Health Affairs
Goal:Manage Disease to Avoid
Complications and Disease Progression
Goal:Find and Treat Disease in Its Earliest Stages to Stop
Its Progression
Truth #6: Prevention is often defined inaccurately and incompletely, focusing on a specific category rather than the
comprehensive definition
Prevention Encompasses Three Major Areas with Specific Goals
Goal:Reduce or Eliminate
Risk Factors and Avert Disease
Primary Prevention Secondary Prevention Tertiary Prevention
Vaccines
Eating healthy
Getting exercise
Avoiding unhealthy behaviors
Risk-based screenings
Following treatment
recommendations
Health coaching
Blood tests and other
monitoringTransitional
care
Care coordination
models
Taking steps to reduce
risks
7
Most people define prevention as this category only, even though it
encompasses all three
Truth #7: Many Americans are not receiving the preventive care they need, resulting in preventable cases that can lead to costly
complications
8Source: NIH, CDC
7 million are
UNDIAGNOSED
4 million are diagnosed
but NOT TREATED
7.8 million are treated
but NOT SUCCESSFULLY CONTROLLED
5.2 million have their
disease CONTROLLED
18.8 million have
diabetes that is NOT
CONTROLLED
Example: Diabetes Prevention in United States
57 million Americans have PRE-DIABETES
24 million Americans
have DIABETES
13 million of those are
TREATED
17 million of those are DIAGNOSED
Goal: Reduce or Eliminate Risk
Factors and Avert Disease
Goal: Find and Treat Disease in Its Earliest Stages to
Stop Its Progression
Goal:Manage Disease to
Avoid Complications and Disease Progression
Goal:Manage Disease to
Avoid Complications and Disease Progression
Goal:Avert Onset of
Diabetes or Costs due to Untreated or
Uncontrolled Disease
Truth #8: To be most effective, prevention must be comprehensive
Primary
Secondary
Examples of existing policy proposalsType of prevention
Grants for community-based wellness programs
Economic incentives to individuals and employers to promote wellness
“Right Choices” program
Care coordination programs (i.e., medication therapy management (MTM),transitional care)
Low or nominal co-pays for prescription drugs to manage chronic conditions
TertiaryCommunity health teams (CHTs)
Community health teams (CHTs)
Community health teams (CHTs)
Immunizations
Reducing cost-sharing on preventive services in Medicare A & B
Accountable health organizations (AHOs)
Accountable health organizations (AHOs)
9
Truth #9: Programs exist that are demonstrating cost savings through prevention
10
Seniors enrolled in a Medicare Advantage plan that provides a
health club membership.
Participants who visited a health club
at least twice a week incurred $1,252 less in
health expenses per year, on average, than those who visited less than
once a week.
Example of Primary Prevention: Healthways Silver Sneakers Program
Source: CDC For more information visit: http://www.cdc.gov/pcd/issues/2008/jan/07_0148.htm
Participants receive access to a state-of-the-
art fitness center, customized fitness classes designed exclusively for
older adults and health education
seminars and events that promote the benefits of a
healthy lifestyle.
Total Individual Annual Savings:$1,252
Target Population Summary Cost Savings
Example of Secondary Prevention: Caterpillar, Inc. Healthy Balance
Over a 3-year period, average per person claims costs were $16,121 lower for
participants than non-participants.
Employees (80,000) and others covered by
Caterpillar health plans (120,000 total).
The employee wellness program utilizes health
risk assessments to detect health risks early
and then creates a customized
disease prevention or
management health plan for each employee.
Truth #9: Programs exist that are demonstrating cost savings through prevention
Target Population Summary Cost Savings
Source: The Health Project, C. Everett Koop For more information visit: http://healthproject.stanford.edu/koop/work.html
Total Annual Claims Savings: $16,121
Example of Tertiary Prevention: The Diabetes Ten Cities Challenge
Diabetic employees, dependents and retirees of the city government.
Participants receive voluntary health benefit,
waiver for diabetes medications and supplies co-pays and a specially-
trained pharmacist "coach".
Average annual savings of almost $1,100 in total
health care costs per patient.
12Source: American Pharmacists Association Foundation
Truth #9: Programs exist that are demonstrating cost savings through prevention
For more information visit: http: http://www.diabetestencitychallenge.com
Total Individual Annual Savings:$1,101
Target Population Summary Cost Savings
Sources
13
Truth #1:
Truth #2:
Truth #3:
Truth #4:
Two-thirds of the rise in health care spending from 1987-2006 is due to the rise in the prevalence of treated chronic diseaseSource: Thorpe K. “The Rise In Health Care Spending And What To Do About It.” Health Affairs. 2005. Also, Thorpe K, Florence CS, Joski P. “Which Medical Conditions Account For The Rise In Health Care Spending?” Updated by Author using Medical Expenditures Panel Survey. AHRQ. 2007. Accessed at: http://www.meps.ahrq.gov/mepsweb/index.jsp.
99 cents of every dollar spent in Medicare is spent treating patients with chronic disease
U.S. Investment in Prevention, Causes of Avoidable MortalitySource: Institute of Medicine. 200 3. The Future of the Public’s Health in the 21stCentury. Washington, D.C.: The National Academies Press . Citing: McGinnis JM, Williams-Russo P, Knickman JR. 2 002. “The Case for More Active Policy Attention to Health Promotion.” Health Affairs 21:78 -93 and McGinnis GM, Foege WH. 1993. “Actual Causes of Death in the United States .” JAMA 27 0(18): 2207-2212.
Americans strongly support prevention in health reform, above many proposals regarding coverageSource: June 2009 Survey. Robert Wood Johnson Foundation and Trust for America’s Health. Accessed at http://healthyamericans.org/assets/files/health-reform-poll-memo.pdf
Obesity rates have increased sharply and contribute to the rising rate of associated chronic diseasesSource: National Center for Health Statistics. “Prevalence of Overweight and Obesity Among Adults: United States, 2003-2004. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm
Source: Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. September 2004.
14
Truth #5:
Truth #7:
Truth #9:
Projected Lifetime Medicare Health Care Expenditures for a Cohort of Seventy-Year-Olds, 2004 Dollars
Source: Darius N. Lakdawalla, Dana P. Goldman, and Baoping Shang. “The Health And Cost Consequences Of Obesity Among The Future Elderly.” Health Affairs. September 2005. Accessed at: http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.r30v1
2 in 3 adults are obese or overweight
1 in 12 Americans have diabetes
Primary Prevention: Healthways Silver Sneakers
Secondary Prevention: Caterpillar, Inc. Healthy Balance
Tertiary Prevention: The Diabetes Ten Cities Challenge
Source: “Statistics related to Overweight and Obesity” Weight Control Intervention Network, NIH Accessed at: http://win.niddk.nih.gov/statistics/
Source: “Number of People with Diabetes Increases to 24 Million” CDC http://www.cdc.gov/media/pressrel/2008/r080624.htm
Source: “Managed-Medicare Health Club Benefit and Reduced Health Care Costs Among Older Adults” CDC Accessed at: http://www.cdc.gov/pcd/issues/2008/jan/07_0148.htm
Source: C. Everett Koop. “The Health Project.” Accessed at: http://healthproject.stanford.edu/koop/work.html
Source: American Pharmacists Association Foundation, Accessed at: http://www.diabetestencitychallenge.com/
Sources Continued