A white paper released Thursday by the Bipartisan Policy Center calls for increasing the evidence base for what works in preventive health. It also calls for incentivizing prevention and public-health measures and challenging physicians to work more closely with community organizations to improve the public's health.
During a panel discussion following the report's release, Dr. Darshak Sanghavi, director of the Center for Medicare and Medicaid Innovation's preventive and population health models group, highlighted a new CMS initiative that will pursue some of the efforts called for in the BPC paper.
The CMS' new Million Hearts Cardiovascular Disease Risk Reduction Model will reward physicians who significantly reduce stroke and heart-attack risk for a panel of patients, Sanghavi said, adding that the program will “marry” financial provider incentives with long-term patient outcomes.
The strategy is to identify a patient's personal risk for a stroke or heart attack, and then have the patient and his or her physician co-create a plan to lower that risk.
“We're going to pay for that in Medicare,” Sanghavi explained.
Another preventive-health example highlighted in the report and by the panel was the work of Hennepin Health, an accountable care organization run by Minnesota's Hennepin County, which provides places for previously homeless patients to live, thereby reducing emergency department visits.
Jeff Levi, a member of the task force that wrote the report, and executive director of Trust for America's Health, related how county healthcare costs went down when high users of health services were directed to social services for housing and employment.
Dr. Bill Dietz, another task force member and director of George Washington University's Global Center for Prevention and Wellness, said that healthcare and government budget decision makers need to know the cost of interventions, but that information is often missing. It's not enough to know what's working, Dietz said. The cost of successful interventions must be made public as well.
Dr. Georges Benjamin, executive director of the American Public Health Association, said the report sends the right message at the right time.
“The findings are right on the mark,” Benjamin said, adding that the BPC paper should spark dialogue about the time it takes to see a return on investment for preventive and public-health efforts.
“There is an enormous return on investment,” Benjamin added. “Some of it is money, some of it is better health, and it doesn't always take 20 years to see."
As an example, preventive measures like reducing children's exposure to lead has both short- and long-term returns, Benjamin said. In the short-term, removing lead from children's environment boosts their educational achievements and reduces the need for special education for children exposed to high lead levels. In the long-term, lead exposure is linked to behavioral problems which often place youth in the path of the criminal justice system. Public-health measures to eliminate lead can address both health problems and long-term costs, he said.
Benjamin said he welcomed the BPC's call for more financial analysis because it will help put an end to “foolish economic arguments” about how living longer eventually increases healthcare costs.
“People have said 'All we do is put off the inevitable,' but then why do anything at all?” Benjamin argued. “We really haven't looked at the economics of it in meaningful way. Yes, you live longer, but if you do it right, you've had a better quality of life.”
That side of the economic ledger includes being able to work longer with fewer sick days and not needing as many long-term healthcare services later in life, Benjamin said.
“What the bipartisan committee also said was that there are some vehicles out there already that we can maximize and leverage what we get out of them,” he said. “For me, the take-home message is that we need to move on this as quickly as we can.”