Truth #1: A substantial cause of rising health care spending is preventable or poorly managed chronic disease<br />99% of ...
Truth #2: The U.S. spends very little on prevention, despite behavioral and environmental factors accounting for 70 percen...
Truth #3: Americans strongly support prevention in health reform, above many proposals regarding coverage<br />Support Amo...
Truth #4: We can improve health and reduce overall spending by preventing risk factors like obesity, a risk factor for man...
Coronary heart disease
Hypertension (high blood pressure)
Cancer
Stroke
Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
Osteoarthritis
Liver and gallbladder disease
Sleep apnea and respiratory problems</li></ul>Age-adjusted* prevalence of overweight and obesity among U.S. adults among U...
Truth #5: Some costs can be avoided altogether by averting disease through reducing or eliminating risk factors<br />Proje...
Truth #6: Prevention is often defined inaccurately and incompletely, focusing on a specificcategory rather than the compre...
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The Truth About Prevention

Ken Thorpe’s presentation on the effectiveness of prevention to lower healthcare costs and improve employee productivity
Published on: Mar 4, 2016
Source: www.slideshare.net


Transcripts - The Truth About Prevention

  • 1.
  • 2. Truth #1: A substantial cause of rising health care spending is preventable or poorly managed chronic disease<br />99% of Medicare expenditures are spent treating patients with one of more chronic diseases<br />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.<br />2/3<br />1/3<br />One-third of the rise alone is due to obesity<br />2<br />Source: Health Affairs, AHRQ, other calculations<br />
  • 3. Truth #2: The U.S. spends very little on prevention, despite behavioral and environmental factors accounting for 70 percent of U.S. deaths<br />U.S. Investment in Prevention<br />Causes of Avoidable Mortality<br />30% - Other Contributors (genetics, health care, etc.)<br />70% - Behavioral and Environmental Factors<br />1% - 3%- Prevention<br />97 % - 9% - Medical Care and Biomedical Research<br />3<br />Source: Institute of Medicine, Health Affairs, Journal of American Medical Association (JAMA)<br />
  • 4. Truth #3: Americans strongly support prevention in health reform, above many proposals regarding coverage<br />Support Among Americans for Policy Solutions in Health Reform<br />70% of Americans rank investing in prevention as the number one health reform priority, above proposals regarding coverage or affordability<br /> 4<br />Source: Robert Wood Johnson Foundation and Trust for America’s Health<br />
  • 5. Truth #4: We can improve health and reduce overall spending by preventing risk factors like obesity, a risk factor for many costly chronic diseases<br />Being obese or overweight increases the risk of developing the following serious and costly conditions:<br /><ul><li>Type 2 diabetes
  • 6. Coronary heart disease
  • 7. Hypertension (high blood pressure)
  • 8. Cancer
  • 9. Stroke
  • 10. Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
  • 11. Osteoarthritis
  • 12. Liver and gallbladder disease
  • 13. Sleep apnea and respiratory problems</li></ul>Age-adjusted* prevalence of overweight and obesity among U.S. adults among U.S. adults, age 20 years and over<br />Overweight or obese (BMI greater than or equal to 25.0)<br />Obese (BMI greater than or equal to 30.0)<br />1988-1994<br />1999-2000<br />2003-2004<br />5<br />Source: Centers for Disease Control and Prevention (CDC)<br />
  • 14. Truth #5: Some costs can be avoided altogether by averting disease through reducing or eliminating risk factors<br />Projected Lifetime Medicare Health Care Expenditures for a Cohort of Seventy-Year-Olds, 2004 Dollars<br />FACT:<br />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.<br />*Lifetime costs refer to costs incurred between Medicare enrollment and death<br />$36,886 = difference in lifetime Medicare spending between obese and normal weight American senior citizens <br />6<br />Source: Health Affairs<br />
  • 15. Truth #6: Prevention is often defined inaccurately and incompletely, focusing on a specificcategory rather than the comprehensive definition<br />Prevention Encompasses Three Major Areas with Specific Goals<br />Primary Prevention<br />Secondary Prevention<br />Tertiary Prevention<br />Goal:<br />Manage Disease to Avoid Complications and Disease Progression<br />Goal:<br />Find and Treat Disease in Its Earliest Stages to Stop Its Progression<br />Goal:<br />Reduce or Eliminate Risk Factors and Avert Disease<br />Following treatment recommendations<br />Risk-based screenings<br />Eating healthy<br />Blood tests and other monitoring<br />Health coaching<br />Getting exercise<br />Transitional care<br />Avoiding unhealthy behaviors<br />Taking steps to reduce risks<br />Care coordination models<br />Most people define prevention as this category only, even though it encompasses all three<br />Vaccines<br />7<br />
  • 16. Truth #7: Many Americans are not receiving the preventive care they need, resulting in preventable cases that can lead to costly complications<br />Example: Diabetes Prevention in United States<br />5.2 million have their disease CONTROLLED<br />57 million Americanshave PRE-DIABETES<br />24 million Americans have DIABETES<br />13 million of those are TREATED<br />17 million of those are DIAGNOSED<br />Goal: Reduce or Eliminate Risk Factors and Avert Disease<br />7 million<br />are <br />UNDIAGNOSED<br />4 million<br />are diagnosed <br />but NOT TREATED<br />7.8 million<br />are treated <br />but NOT SUCCESSFULLY <br />CONTROLLED<br />18.8 million have diabetes that is NOT CONTROLLED<br />Goal: Find and Treat Disease in Its Earliest Stages to Stop Its Progression<br />Goal:<br />Manage Disease to Avoid Complications and Disease Progression<br />Goal:<br />Manage Disease to Avoid Complications and Disease Progression<br />Goal:<br />Avert Onset of Diabetes or Costs due to Untreated or Uncontrolled Disease<br />8<br />Source: NIH, CDC<br />
  • 17. Truth #8: To be most effective, prevention must be comprehensive <br />Examples of existing policy proposals<br />Type of prevention<br />Community health teams (CHTs)<br />Economic incentives to individuals and employers to promote wellness<br />Grants for community-based wellness programs<br />Immunizations<br />Primary<br />Community health teams (CHTs)<br />Accountable health organizations (AHOs)<br />Reducing cost-sharing on preventive services in Medicare A & B<br />“Right Choices” program<br />Secondary<br />Community health teams (CHTs)<br />Accountable health organizations (AHOs)<br />Care coordination programs (i.e., medication therapy management (MTM),transitional care)<br />Low or nominal co-pays for prescription drugs to manage chronic conditions<br />Tertiary<br />9<br />
  • 18. Truth #9: Programs exist that are demonstrating <br />cost savings through prevention<br />Example of Primary Prevention: Healthways Silver Sneakers Program<br />Cost Savings<br />Target Population<br />Summary<br />Seniors enrolled in a Medicare Advantage plan that provides a health club membership.<br />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. <br />Participants receive access to a state-of-the-art fitness center, customized fitness classes designed exclusively for <br />older adults and <br />health education seminars and events that promote the benefits of a healthy lifestyle.<br />Total Individual Annual Savings:<br />$1,252<br />10<br />Source: CDC<br />For more information visit: http://www.cdc.gov/pcd/issues/2008/jan/07_0148.htm<br />
  • 19. Truth #9: Programs exist that are demonstrating <br />cost savings through prevention<br />Example of Secondary Prevention: Caterpillar, Inc. Healthy Balance<br />Cost Savings<br />Target Population<br />Summary<br />Over a 3-year period, average per person claims costs were $16,121 lower for participants than non-participants. <br />Employees (80,000) and others covered by Caterpillar health plans (120,000 total).<br />The employee wellness program utilizes health risk assessments to detect health risks early and then creates a customized <br />disease <br />prevention or management health plan for each employee.<br />Total Annual Claims Savings:<br />$16,121<br />Source: The Health Project, C. Everett Koop<br />For more information visit: http://healthproject.stanford.edu/koop/work.html<br />
  • 20. Truth #9: Programs exist that are demonstrating <br />cost savings through prevention<br />Example of Tertiary Prevention: The Diabetes Ten Cities Challenge<br />Cost Savings<br />Target Population<br />Summary<br />Average annual savings of almost $1,100 in total health care costs per patient.<br />Participants receive voluntary health benefit, waiver for diabetes medications and supplies co-pays and a specially-trained pharmacist "coach".<br />Diabetic employees, dependents and retirees of the city government.<br />Total Individual <br />Annual Savings:<br />$1,101<br />12<br />Source: American Pharmacists Association Foundation<br />For more information visit: http: http://www.diabetestencitychallenge.com<br />
  • 21. Sources<br />Truth #1: <br />Two-thirds of the rise in health care spending from 1987-2006 is due to the rise in the prevalence of treated chronic disease<br />Source: 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.<br />99 cents of every dollar spent in Medicare is spent treating patients with chronic disease<br />Source: Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. September 2004.<br />Truth #2:<br />U.S. Investment in Prevention, Causes of Avoidable Mortality<br />Source: 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.<br />Truth #3:<br />Americans strongly support prevention in health reform, above many proposals regarding coverage<br />Source: 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 <br />Truth #4:<br />Obesity rates have increased sharply and contribute to the rising rate of associated chronic diseases<br />Source: 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<br />13<br />
  • 22. Sources Continued<br />Truth #5:<br />Projected Lifetime Medicare Health Care Expenditures for a Cohort of Seventy-Year-Olds, 2004 Dollars<br />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<br />Truth #7:<br />2 in 3 adults are obese or overweight<br />Source: “Statistics related to Overweight and Obesity” Weight Control Intervention Network, NIH Accessed at: http://win.niddk.nih.gov/statistics/<br />1 in 12 Americans have diabetes<br />Source: “Number of People with Diabetes Increases to 24 Million” CDC http://www.cdc.gov/media/pressrel/2008/r080624.htm<br />Truth #9:<br />Primary Prevention: Healthways Silver Sneakers<br />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<br />Secondary Prevention: Caterpillar, Inc. Healthy Balance<br />Source: C. Everett Koop. “The Health Project.” Accessed at: http://healthproject.stanford.edu/koop/work.html<br />Tertiary Prevention: The Diabetes Ten Cities Challenge<br />Source: American Pharmacists Association Foundation, Accessed at: http://www.diabetestencitychallenge.com/<br />14<br />

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