effective approaches for managing obesity and chronic disease
TRANSCRIPT
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Effective Approaches for Managing
Obesity and Chronic Disease
Kenneth E. Thorpe, Ph.D
Emory University
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Key Drivers of Rising Health
Care Spending Doubling of obesity since the mid-1980s
accounts for 10% of the rise in spending
Lack of effective care coordination in manyprivate plans and Medicaid. No carecoordination so far in traditional Medicare
Low rates of disease detection for someconditions (diabetes only 72% of totaldiabetes is diagnosed and treated)
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Opportunities
Medicare will spend about $500 billionover the next decade on potentiallypreventable hospital readmissions
Medicaid faces the same set of issues,particularly with dual eligibles
Build effective care coordination into theessential benefits in the exchanges
Medicaid medical homes section 2703
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California
Rising rates of chronic diseaseexdiabetes. In 2000 7% of adults werediabetics compared to over 9 percent
today
Obesity adds nearly $16 billion a year tothe cost of health care in California alone.
At current trends this could rise to about$40 billion within the next ten years
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Trends in Smoking and Obesity in the United States
Sources: Cigarette consumption data per adult per year are extracted from Tobacco Situation andOutlook Report Yearbook. U.S. Department of Agriculture, October 2007. Obesity data based onmeasured body mass index in NHANES from 1960 to 2010.
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Conditions 1987 2009 Change
Mental Disorders 4.9% 14.3% 9.4%
Cancer3.6% 6.2% 2.6%
Heart Disease7.4% 9.6% 2.2%
Arthritis7.2% 14.7% 7.5%
Hyperlipidemia1.3% 19.3% 18.0%
Diabetes 3.9% 8.7% 4.8%
Hypertension13.1% 24.3% 11.2%
Trends in Treated Prevalence, Adults, 1987 - 2009
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5
6
7
8
9
6 3 6 5 6 7 6 9 7 1 7 3 7 5 7 7 7 9 8 1 8 3 8 5 8 7 8 9 9 1 9 3 9 5 9 7 9 9 0 1 0 3 0 5
0
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15
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Trends in the Prevalence and Incidence of
Diagnosed Diabetes and in Prevalence of
Obesity
Prevalence
* (Percent)
Incidence*(Per 1000)
Obesity*(Percent)
Year* Prevalence for all ages; incidence for 18-79 years; and obesity for20 years
* Data modeled by joinpoint regression(Source: Narayan)
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2.4%2.6%
3.8%
3.0%
0.0%
0.5%
1.0%
1.5%
2.0%2.5%
3.0%
3.5%
4.0%
Normal Overweight Obese Total
Percent
Real Per Capita Growth of Healthcare Spending, 1987-2009.
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Percent of Change in Total Health Care SpendingAssociated with Obesity, Increased Treatment Intensityand Both Obesity and Treatment Intensity, 1987-2007
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Costs of Obesity
Higher job absenteeism: $4.3 billion annually inU.S.
Recent estimates show much higher than
previously estimated: $2,741 higher annual health care costs per
obese adult
Aggregate national costs per year: $190 billion(20.6% of US national health
expenditures)
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Chart 1. Percent Distribution of Medicare Beneficiaries by Number of Chronic ConditionsTreated
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Chart 2. Percent Distribution of Medicare Spending by Number of Chronic Conditions Treated
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The Challenge
To develop a comprehensive approach that:
Averts rising incidence of chronic illness Betterdetect existing chronic disease
More effectively manage chronically ill
patients to keep healthy
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The Challenge
Not all chronic conditions arepotentially preventable!
Many cardiovascular relatedconditions potentially are (T2diabetes, hypertension) others likely
are not (Parkinsons, Alzheimers,others )
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Averting Disease
Identify evidence-based lifestyleinterventions and develop culturaladaptations within the US
Diabetes prevention program
Medicare coverage (none today)
Essential benefits
Medicaid
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Current Medicare Coverage for Obesity
Intensive behavioral therapy (IBT) For one year, provided patients lose 6.6 lb in six months
(~3% body weight, based on clinical trials)
Bariatric surgery For BMI 35 with one weight-related comorbidity
Pharmacotherapy is excluded from Medicare Part Dcoverage, resulting in a significant treatment gap Despite recent FDA approval of pharmacotherapy that can produce
10% to 15% weight loss
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Options for Medicare
Intensive lifestyle programs like the diabetes preventionprogram could be added (much broader than current IBTcoverage)
Pharmacotherapy-induced weight loss of 10% to 15%could produce significant savings for Medicare ifcovered
The combination of lifestyle change and
pharmacotherapy is generally more successful thaneither treatment alone
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Managing Chronic Disease
What works?
Transitional care
Comprehensive medication management
Health coaching
Team based care
Ability to refer at risk patients to evidencebased lifestyle programs
Huge potential in Medicare, Medicaid andinternationally