Disease Prevention

Substantial federal funding needs to be invested in prevention of preventable disease, particularly chronic illnesses. We cannot expect to sustainably constrain health care cost growth if obesity and chronic disease rates continue to escalate. For instance, the number of diabetes cases grew by 40% over the past decade. Spending for diabetes accounted for 38% of the increase in health care spending between 1987 and 2001, hyperlipidemia for 22% and heart disease for 41%. According to the Centers for Disease Control and Prevention (CDC), more than one-third of adults in the U.S. are obese, and two-thirds are either obese or overweight – which is roughly double the obesity rate of 20 years ago. One study found that obesity accounted for 27% of the rise in per capita healthcare spending between 1987 and 2001.

Current Congressional Budget Office (CBO) scoring conventions fail to reflect the health system savings that would be generated by targeted investment in disease prevention despite the World Health Organization calculation that at least 80% of all heart disease, stroke, and type II diabetes and up to 40% of cancer could be prevented if people ate healthier, exercised, and stopped using tobacco.

The truth that substantial savings will result from sustained investment in disease prevention is further supported by more than 15 years of extensive private sector experience in designing and implementing disease prevention and wellness programs that have generated significant returns on investment. A study by the National Business Group on Health found that employers can receive a three-to-one return on investment as a result of implementing comprehensive prevention and health improvement programs. Federal policy should be informed by these lessons of successful private sector experience.

An enhanced federal focus on prevention and chronic care should:

  1. Establish a national strategic plan for chronic disease prevention and preventive services. The Secretary of HHS should establish a new office dedicated to chronic disease prevention. This office should ensure both inter-agency and intra-agency coordination and collaboration, and develop and implement a national strategic plan to prevent chronic disease that focuses on both the public health and clinical components of disease prevention.The plan should be developed in consultation with a wide array of private sector stakeholders including, but not limited to, patient groups, provider organizations, small and large employers, educators, and payers with the goal of identifying promising private sector practices and opportunities for public-private sector partnerships. The resulting plan should include measurable goals and objectives, and be updated every two years.

  2. Collect data and regularly report progress toward health goals. The Secretary should develop a process to measure the number of individuals with key chronic conditions who receive coverage through federal health programs, identify and collect demographic and de-identified health data to detect and monitor trends in key health status indicators, such as number of primary care visits and percent of individuals with the chronic conditions who receive recommended services, among others. The Secretary should use the data to report on progress toward the goals identified in the chronic disease prevention strategic plan to appropriate congressional committees and the public every two years.

  3. Establish a new federally-sponsored, national public health campaign to turn the tide on obesity. This campaign must be equal in commitment, scale, and intensity to the campaign that led to a dramatic decline in smoking. Campaigns that focus on early intervention targeted at schools and in the community hold promise in stemming this growing public health threat. In addition to promoting better health, studies suggest that slowing the rise in obesity would result in considerable cost savings – over $400 billion over 10 years according to a Commonwealth Fund report – while beginning to turn it back could yield even larger benefits.

  4. Establish federal funding for comprehensive coordinated national anti-smoking campaign.

  5. Provide incentives, such as challenge grants, for state and local public health departments, schools, and communitybased organizations to implement health promotion programs based on proven best practices. Federal grant funding can be used to help public schools create more healthy environments for children – including improving nutritional standards, increased financial support for physical education, as well as providing school-based health screening programs and access to clinical services. In addition, standards for federal programs – such as the school lunch program – should be strengthened to assure better nutritional quality. Finally, federal grant funding should help promote healthier communities as well as make needed investments in comprehensive wellnessand educational campaigns that promote healthy lifestyles.

  6. Create tax or other incentives for employers to help support adoption of evidence-based wellness and health promotion programs. Legislation has been introduced in Congress that would provide a tax credit for employers that offer qualified wellness programs – that is, programs that meet standards consistent with evidence-based research and best practices. Employer-sponsored wellness programs that seek to engage employees in taking charge of their health and health care by offering comprehensive screening services and encouraging healthy lifestyles hold promise in improving employees’ health and productivity and can be part of a comprehensive, national strategy to improve overall health and reduce costs.

  7. Create incentives in federal and private health plan programs to support active patient involvement in preventing chronic disease. These incentives should encourage health plan efforts to improve health education and literacy, make preventive care more convenient and improve compliance through preventive care reminder programs. The program should also reward patient efforts to seek preventive care such as elimination of cost sharing for recommended preventive services.

  8. Increase financial support for the nation’s essential public health infrastructure. State and local health departments are the front lines in the battle to achieve healthier behaviors and better treatment of chronic disease. Yet this infrastructure is badly in need of additional resources to meet the growing challenge.

  9. Provide federal financial support for the formation and development of community-based prevention treatment and resources. These resources are designed to integrate public health and primary prevention initiatives (diet, exercise, weight loss, smoking cessation, depression screening and treatment) with the more traditional health care treatment of children and adults in a community.1

  10. Ensure coverage of preventive services such as those recommended by the U.S. Preventive Services Taskforce or other appropriate entities in federally-funded or federally-supported health programs (i.e. Medicare, Medicaid, SCHIP, health plans participating in FEHBP, and any newlycreated federal program).

  11. Reduce or eliminate cost-sharing(co-payments and deductibles) for recommended preventive services in federally-funded or supported health programs.2 Cost-sharing discourages utilization of medical services. While this may make sense in some cases, it does not make sense for prevention. Early detection improves patient outcomes and reduces the need for costly interventions, so patients should be encouraged to seek preventive services.

Endnotes

  1. An example of such a resource is the Diabetes Prevention Program (DPP) lifestyle intervention program at YMCA locations. A formal curriculum was developed to train community workers to deliver a group-based adaptation of the DPP model at YMCAs. People who were at risk of developing diabetes who participated in the DPP program at a YMCA lost an average of six percent of their body weight and kept the weight off for a year. They also reduced their cholesterol levels. More than 40 million U.S. families living within three miles of a YMCA and if the DPP program was implemented across the country, Dr. Ronald Ackerman of the Indiana University School of Medicine estimates the need for adult diabetes management could be reduced by 113 million member months by 2020.

  2. Throughout this paper, the term “federally-funded or supported health insurance programs” refers to Medicare, Medicaid, SCHIP, health Plans participating in FEHBP, and any newly-created federal programs.

Substantial federal funding needs to be invested in prevention of preventable disease, particularly chronic illnesses. We cannot expect to sustainably constrain health care cost growth if obesity and chronic disease rates continue to escalate. For instance, the number of diabetes cases grew by 40% over the past decade. Spending for diabetes accounted for 38% of the increase in health care spending between 1987 and 2001, hyperlipidemia for 22% and heart disease for 41%. According to the Centers for Disease Control and Prevention (CDC), more than one-third of adults in the U.S. are obese, and two-thirds are either obese or overweight – which is roughly double the obesity rate of 20 years ago. One study found that obesity accounted for 27% of the rise in per capita healthcare spending between 1987 and 2001.

Current Congressional Budget Office (CBO) scoring conventions fail to reflect the health system savings that would be generated by targeted investment in disease prevention despite the World Health Organization calculation that at least 80% of all heart disease, stroke, and type II diabetes and up to 40% of cancer could be prevented if people ate healthier, exercised, and stopped using tobacco.

The truth that substantial savings will result from sustained investment in disease prevention is further supported by more than 15 years of extensive private sector experience in designing and implementing disease prevention and wellness programs that have generated significant returns on investment. A study by the National Business Group on Health found that employers can receive a three-to-one return on investment as a result of implementing comprehensive prevention and health improvement programs. Federal policy should be informed by these lessons of successful private sector experience.

An enhanced federal focus on prevention and chronic care should:

  1. Establish a national strategic plan for chronic disease prevention and preventive services. The Secretary of HHS should establish a new office dedicated to chronic disease prevention. This office should ensure both inter-agency and intra-agency coordination and collaboration, and develop and implement a national strategic plan to prevent chronic disease that focuses on both the public health and clinical components of disease prevention.The plan should be developed in consultation with a wide array of private sector stakeholders including, but not limited to, patient groups, provider organizations, small and large employers, educators, and payers with the goal of identifying promising private sector practices and opportunities for public-private sector partnerships. The resulting plan should include measurable goals and objectives, and be updated every two years.

  2. Collect data and regularly report progress toward health goals. The Secretary should develop a process to measure the number of individuals with key chronic conditions who receive coverage through federal health programs, identify and collect demographic and de-identified health data to detect and monitor trends in key health status indicators, such as number of primary care visits and percent of individuals with the chronic conditions who receive recommended services, among others. The Secretary should use the data to report on progress toward the goals identified in the chronic disease prevention strategic plan to appropriate congressional committees and the public every two years.

  3. Establish a new federally-sponsored, national public health campaign to turn the tide on obesity. This campaign must be equal in commitment, scale, and intensity to the campaign that led to a dramatic decline in smoking. Campaigns that focus on early intervention targeted at schools and in the community hold promise in stemming this growing public health threat. In addition to promoting better health, studies suggest that slowing the rise in obesity would result in considerable cost savings – over $400 billion over 10 years according to a Commonwealth Fund report – while beginning to turn it back could yield even larger benefits.

  4. Establish federal funding for comprehensive coordinated national anti-smoking campaign.

  5. Provide incentives, such as challenge grants, for state and local public health departments, schools, and communitybased organizations to implement health promotion programs based on proven best practices. Federal grant funding can be used to help public schools create more healthy environments for children – including improving nutritional standards, increased financial support for physical education, as well as providing school-based health screening programs and access to clinical services. In addition, standards for federal programs – such as the school lunch program – should be strengthened to assure better nutritional quality. Finally, federal grant funding should help promote healthier communities as well as make needed investments in comprehensive wellnessand educational campaigns that promote healthy lifestyles.

  6. Create tax or other incentives for employers to help support adoption of evidence-based wellness and health promotion programs. Legislation has been introduced in Congress that would provide a tax credit for employers that offer qualified wellness programs – that is, programs that meet standards consistent with evidence-based research and best practices. Employer-sponsored wellness programs that seek to engage employees in taking charge of their health and health care by offering comprehensive screening services and encouraging healthy lifestyles hold promise in improving employees’ health and productivity and can be part of a comprehensive, national strategy to improve overall health and reduce costs.

  7. Create incentives in federal and private health plan programs to support active patient involvement in preventing chronic disease. These incentives should encourage health plan efforts to improve health education and literacy, make preventive care more convenient and improve compliance through preventive care reminder programs. The program should also reward patient efforts to seek preventive care such as elimination of cost sharing for recommended preventive services.

  8. Increase financial support for the nation’s essential public health infrastructure. State and local health departments are the front lines in the battle to achieve healthier behaviors and better treatment of chronic disease. Yet this infrastructure is badly in need of additional resources to meet the growing challenge.

  9. Provide federal financial support for the formation and development of community-based prevention treatment and resources. These resources are designed to integrate public health and primary prevention initiatives (diet, exercise, weight loss, smoking cessation, depression screening and treatment) with the more traditional health care treatment of children and adults in a community.1

  10. Ensure coverage of preventive services such as those recommended by the U.S. Preventive Services Taskforce or other appropriate entities in federally-funded or federally-supported health programs (i.e. Medicare, Medicaid, SCHIP, health plans participating in FEHBP, and any newlycreated federal program).

  11. Reduce or eliminate cost-sharing(co-payments and deductibles) for recommended preventive services in federally-funded or supported health programs.2 Cost-sharing discourages utilization of medical services. While this may make sense in some cases, it does not make sense for prevention. Early detection improves patient outcomes and reduces the need for costly interventions, so patients should be encouraged to seek preventive services.

Endnotes

  1. An example of such a resource is the Diabetes Prevention Program (DPP) lifestyle intervention program at YMCA locations. A formal curriculum was developed to train community workers to deliver a group-based adaptation of the DPP model at YMCAs. People who were at risk of developing diabetes who participated in the DPP program at a YMCA lost an average of six percent of their body weight and kept the weight off for a year. They also reduced their cholesterol levels. More than 40 million U.S. families living within three miles of a YMCA and if the DPP program was implemented across the country, Dr. Ronald Ackerman of the Indiana University School of Medicine estimates the need for adult diabetes management could be reduced by 113 million member months by 2020.

  2. Throughout this paper, the term “federally-funded or supported health insurance programs” refers to Medicare, Medicaid, SCHIP, health Plans participating in FEHBP, and any newly-created federal programs.

Contents

Disease Prevention

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