the truth about prevention

Truth #1: A substantial cause of rising health care spending is preventable or poorly managed chronic disease

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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.One-third of the rise alone is due to obesity

2

99% of Medicare expenditures are spent

treating patients with one of more chronic diseases

Source: Health Affairs, AHRQ, other calculations

Truth #2: The U.S. spends very little on prevention, despite behavioral and environmental factors accounting for 70 percent of

U.S. deaths

97 % - 9% - Medical Care and

Biomedical Research

1% - 3%- Prevention

Causes of Avoidable Mortality

30% - Other Contributors (genetics, health care, etc.)

70% - Behavioral and Environmental Factors

3Source: Institute of Medicine, Health Affairs, Journal of American Medical Association (JAMA)

U.S. Investment in Prevention

Truth #3: Americans strongly support prevention in health reform, above many proposals regarding coverage

When given the below choices and asked how important each proposal is on a scale from zero to ten (where zero means not at all important and ten means very important), seventy percent rank investing in more prevention between 8 and 10, with prevention receiving a higher score than any other proposal.

Percent ranking importance of 8-10

Invest in more prevention to help people stay healthy and reduce diseases such as diabetes, cancer and heart disease

70%

Provide tax credits to small businesses to help small businesses provide affordable health insurance to their employees

66%

Prohibit insurance companies from denying coverage because of age, medical history or pre-existing condition

66%

Require all Americans to have health insurance while providing financial assistance to those who cannot afford it

52%

Require all businesses to provide health care for their employees or contribute to a fund to help pay for their coverage

50%

Give all Americans a choice of keeping their current insurance or joining a national insurance pool with a choice of private and public plans administered by the government

43%

Support Among Americans for Policy Solutions in Health Reform

4Source: Robert Wood Johnson Foundation and Trust for America’s Health

70% of Americans

rank investing in prevention

as the number one health

reform priority, above

proposals regarding

coverage or affordability

Truth #4: We can improve health and reduce overall spending by preventing risk factors like obesity, a risk factor for many costly

chronic diseases

Being obese or overweight increases the risk of

developing the following serious and costly conditions:

Type 2 diabetesCoronary heart diseaseHypertension (high blood pressure)CancerStrokeDyslipidemia (for example, high total cholesterol or high levels of triglycerides) OsteoarthritisLiver and gallbladder diseaseSleep apnea and respiratory problems

5Source: Centers for Disease Control and Prevention (CDC)

%

10%

20%

30%

40%

50%

60%

70%

22.930.5 32.2

56

64.5 66.3

1988-1994 1999-2000 2003-2004

Age-adjusted* prevalence of overweight and obesity among U.S. adults among U.S. adults, age

20 years and over

Overweight or obese (BMI greater than or equal to 25.0)

Obese (BMI greater than or equal to 30.0)

Obese Overweight Normal$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000143,899

118,400107,013

Truth #5: Some costs can be avoided altogether by averting disease through reducing or eliminating risk factors

Projected Lifetime Medicare Health Care Expenditures for a Cohort of Seventy-Year-Olds, 2004 Dollars

$36,886 = difference in lifetime Medicare spending between obese and normal weight American senior citizens

FACT:

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.

*Lifetime costs refer to costs incurred between Medicare enrollment and death

6Source: Health Affairs

Goal:Manage Disease to Avoid

Complications and Disease Progression

Goal:Find and Treat Disease in Its Earliest Stages to Stop

Its Progression

Truth #6: Prevention is often defined inaccurately and incompletely, focusing on a specific category rather than the

comprehensive definition

Prevention Encompasses Three Major Areas with Specific Goals

Goal:Reduce or Eliminate

Risk Factors and Avert Disease

Primary Prevention Secondary Prevention Tertiary Prevention

Vaccines

Eating healthy

Getting exercise

Avoiding unhealthy behaviors

Risk-based screenings

Following treatment

recommendations

Health coaching

Blood tests and other

monitoringTransitional

care

Care coordination

models

Taking steps to reduce

risks

7

Most people define prevention as this category only, even though it

encompasses all three

Truth #7: Many Americans are not receiving the preventive care they need, resulting in preventable cases that can lead to costly

complications

8Source: NIH, CDC

7 million are

UNDIAGNOSED

4 million are diagnosed

but NOT TREATED

7.8 million are treated

but NOT SUCCESSFULLY CONTROLLED

5.2 million have their

disease CONTROLLED

18.8 million have

diabetes that is NOT

CONTROLLED

Example: Diabetes Prevention in United States

57 million Americans have PRE-DIABETES

24 million Americans

have DIABETES

13 million of those are

TREATED

17 million of those are DIAGNOSED

Goal: Reduce or Eliminate Risk

Factors and Avert Disease

Goal: Find and Treat Disease in Its Earliest Stages to

Stop Its Progression

Goal:Manage Disease to

Avoid Complications and Disease Progression

Goal:Manage Disease to

Avoid Complications and Disease Progression

Goal:Avert Onset of

Diabetes or Costs due to Untreated or

Uncontrolled Disease

Truth #8: To be most effective, prevention must be comprehensive

Primary

Secondary

Examples of existing policy proposalsType of prevention

Grants for community-based wellness programs

Economic incentives to individuals and employers to promote wellness

“Right Choices” program

Care coordination programs (i.e., medication therapy management (MTM),transitional care)

Low or nominal co-pays for prescription drugs to manage chronic conditions

TertiaryCommunity health teams (CHTs)

Community health teams (CHTs)

Community health teams (CHTs)

Immunizations

Reducing cost-sharing on preventive services in Medicare A & B

Accountable health organizations (AHOs)

Accountable health organizations (AHOs)

9

Truth #9: Programs exist that are demonstrating cost savings through prevention

10

Seniors enrolled in a Medicare Advantage plan that provides a

health club membership.

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.

Example of Primary Prevention: Healthways Silver Sneakers Program

Source: CDC For more information visit: http://www.cdc.gov/pcd/issues/2008/jan/07_0148.htm

Participants receive access to a state-of-the-

art fitness center, customized fitness classes designed exclusively for

older adults and health education

seminars and events that promote the benefits of a

healthy lifestyle.

Total Individual Annual Savings:$1,252

Target Population Summary Cost Savings

Example of Secondary Prevention: Caterpillar, Inc. Healthy Balance

Over a 3-year period, average per person claims costs were $16,121 lower for

participants than non-participants.

Employees (80,000) and others covered by

Caterpillar health plans (120,000 total).

The employee wellness program utilizes health

risk assessments to detect health risks early

and then creates a customized

disease prevention or

management health plan for each employee.



Source: The Health Project, C. Everett Koop For more information visit: http://healthproject.stanford.edu/koop/work.html

Total Annual Claims Savings: $16,121

http://www.cat.com/

Example of Tertiary Prevention: The Diabetes Ten Cities Challenge

Diabetic employees, dependents and retirees of the city government.

Participants receive voluntary health benefit,

waiver for diabetes medications and supplies co-pays and a specially-

trained pharmacist "coach".

Average annual savings of almost $1,100 in total

health care costs per patient.

12Source: American Pharmacists Association Foundation


For more information visit: http: http://www.diabetestencitychallenge.com

Total Individual Annual Savings:$1,101


Sources

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Truth #1:

Truth #2:

Truth #3:

Truth #4:

Two-thirds of the rise in health care spending from 1987-2006 is due to the rise in the prevalence of treated chronic diseaseSource: 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.

99 cents of every dollar spent in Medicare is spent treating patients with chronic disease

U.S. Investment in Prevention, Causes of Avoidable MortalitySource: 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.

Americans strongly support prevention in health reform, above many proposals regarding coverageSource: 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

Obesity rates have increased sharply and contribute to the rising rate of associated chronic diseasesSource: 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

Source: Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. September 2004.

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Truth #5:

Truth #7:

Truth #9:

Projected Lifetime Medicare Health Care Expenditures for a Cohort of Seventy-Year-Olds, 2004 Dollars

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

2 in 3 adults are obese or overweight

1 in 12 Americans have diabetes

Primary Prevention: Healthways Silver Sneakers

Secondary Prevention: Caterpillar, Inc. Healthy Balance

Tertiary Prevention: The Diabetes Ten Cities Challenge

Source: “Statistics related to Overweight and Obesity” Weight Control Intervention Network, NIH Accessed at: http://win.niddk.nih.gov/statistics/

Source: “Number of People with Diabetes Increases to 24 Million” CDC http://www.cdc.gov/media/pressrel/2008/r080624.htm

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

Source: C. Everett Koop. “The Health Project.” Accessed at: http://healthproject.stanford.edu/koop/work.html

Source: American Pharmacists Association Foundation, Accessed at: http://www.diabetestencitychallenge.com/

Sources Continued

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