Chronic disease treatment accounts for more than 80% of U.S. healthcare costs. With the intent of preventing rather than treating those conditions to improve care and lower costs, the Bipartisan Policy Center has released its white paper “A Prevention Prescription for Improving Health and Health Care in America” outlining its strategies for a healthier nation.
The report identifies two ways to improve preventive care: reimbursing physicians for counseling patients on improving their health; and strengthening healthcare providers' connections to non-medical, community-based organizations.
Prevention was defined in the report as a strategy to avoid illness by keeping people healthy and “averting the progression of disease.” Such strategies could include clinical interventions like cancer screenings or vaccinations, and community-based interventions such as the YMCA's weight-management program for people described as “pre-diabetic.”
The Bipartisan Policy Center's task force, which included Dr. William Dietz with the George Washington University Milken Institute of Public Health, and Dr. Matt Longjohn, national health officer for YMCA of the USA, came up with the prevention plan, which also involves building the evidence base for prevention.
The BPC panel recommended public health research, funded by the Centers for Disease Control and Prevention or the National Institutes of Health, to conduct an economic analysis of the interventions being studied, and for public health journals to push for economic analysis in the prevention-strategy studies they publish.
The task force also called for the Center for Medicare and Medicaid Innovation to invest in an accountable health community, or AHC model that would create a population-health framework on top of the existing healthcare delivery infrastructure. It also recommended that the CMS develop mechanisms for addressing the “wrong pocket” issue where recipients receive downstream benefits and savings created by someone else's investment in prevention and wellness efforts.
The Robert Wood Johnson Foundation concept of a “Culture of Health” was a principle the task force embraced. This concept was described in the BPC report as one in which an entire population attains the best health possible and in which “all sectors of society, value good health and work together to build healthy communities and lifestyles; and in which everyone, regardless of economic, social, or geographic differences has access to community environments that promote health and wellness, and to high-quality, efficient, and affordable healthcare.”
Integrating prevention into healthcare delivery will require reforms that incentivize health promotion over disease treatment and develop financial incentives and policy changes that are self-sustaining and have a long-term focus, the BPC said in its report.
“The ability to identify effective prevention strategies and measure their impact is obviously critical,” the task force stated in the report. “Both to ensure that scarce resources are deployed to deliver optimal results and to convince public and private decision-makers, from state comptrollers to CEOs to mayors and federal legislators, that upfront investments in prevention pay off in ways that they value, either in terms of improved health outcomes, lower costs, or both.”
The report cited an asthma program initiated by the Nemours Children's Health System in Delaware in which parents were taught how to manage their children's asthma by replacing mattresses, curtains and carpets that contributed to asthma attacks, and how to work with schools to improve the environment outside of their homes.
Successful statewide prevention initiatives cited in the report included Oregon's Medicaid reform effort and Vermont's promotion of the patient-centered medical home, which it said has generated a 15.8% return on investment among patients with commercial health insurance and an 8.2% ROI among the state's Medicaid population.
While the report did not predict how much savings the BPC's strategy could generate, it cited how an accountable care organization in Hennepin County, Minn., reduced average per-patient costs by 30%, and how the YMCA program for pre-diabetics, conducted in partnership with the American Medical Association could produce savings of $1.3 billion over 10 years.
The BPC intends to take its plan before “targeted stakeholders and decision-makers” over the next 12 months to advance its recommendations.
“Galvanizing a national effort to prevent chronic disease is imperative,” BPC's Senior Adviser and former Senate Majority Leader Dr. Bill Frist said in a news release (PDF). “These recommendations will help develop new financing mechanisms and integrated programs and services that will shift America's healthcare system toward disease prevention and wellness.”