The power of prevention

We know volume is not the same as value. Americans spend over $3 trillion a year on health care but have shorter life expectancies and higher rates of infant mortality and diabetes than our global peers.

It turns out our behaviors – shaped by our physical and social environments – are the primary determinants of health and well-being. And when it comes to health, the old trope is true: An ounce of prevention is worth a pound of cure.

Prevention can reduce the risk factors that lead to chronic diseases, slow their progression, improve overall health and reduce health care spending. Taking a prevention-first approach reaps benefits in the workplace as well: An unhealthy population leads to higher rates of absenteeism and presentism. In fact, the annual costs related to lost productivity due to absenteeism totaled $84 billion in 2013, according to the Gallup-Healthways Well-Being Index.

In order to refocus on wellness, over the past year, the Bipartisan Policy Center convened a Prevention Task Force to determine how to change our nation’s health conversation so we are taking actions to promote wellness rather than focusing solely on providing reactive medical treatment after a person gets sick.

Today, the task force is releasing recommendations for achieving this goal, which include better connecting clinical providers and community organizations, and creating incentives to make preventive care a priority. As senior advisers to the task force, we strongly endorse the two-part framework today’s report outlines to more fully integrate prevention into the nation’s approach to health and health care.

First, we must document the ways prevention works to build healthier communities. We often hear stories about how changes in health policy can result in healthier individuals, but we need data to back up the anecdotes. With data in hand, health care providers, insurers, federal, state and local governments and non-profit organizations can determine what community-level interventions produce statistically significant results and provide value for the investment.

The YMCA’s Diabetes Prevention Program is a working example. YMCA-trained lifestyle coaches administer a one-year, group-based intervention promoting healthy eating and physical activity for individuals with pre-diabetes. Program results found participants lost 5 percent to 7 percent of their body weight, significantly reducing their likelihood of developing type-2 diabetes. These data incentivized 30 different commercial health plans to cover the cost of the YMCA program because the costs of the program were far less than the cost of covering a diabetic patient.

To further the creation of evidence-based solutions like the YMCA program, we recommend that the federal government – including the Centers for Disease Control and Prevention, National Institutes of Health, Centers for Medicare and Medicaid Services and Congress, as well as other public and private stakeholders – support research and programs that include robust economic analyses to explore how public health interventions and prevention strategies have worked. For instance, clinical and public health funding opportunity announcements could require economic models and federal programs, such as the CDC’s Community Preventative Services Task Force, which reviews and identifies successful community interventions, to be adequately funded.

Second, we also encourage stakeholders to find near-term opportunities to embed prevention in broader health care delivery system reforms.

Our current fee-for-service system does not offer specific compensation for health care providers helping patients to make changes to improve their health. It also has few structural or financial mechanisms to connect health care providers to their broader communities. This is unsustainable because diet, exercise, smoking, substance abuse, violence and environmental conditions have a greater influence on health than treatments and pills.

Thankfully, the U.S. health care system is in the early phases of a transformational shift from fee-for-service to value-based care. There is now a growing awareness of the link between high rates of chronic disease and rising health care costs. The Affordable Care Act created the Center for Medicare and Medicaid Innovation to test innovative payment and patient care models to identify ways to improve quality while slowing cost growth.

We have already seen new accountable care organizations pioneer more holistic approaches to wellness. In Hennepin County, Minnesota, an accountable care organization links clinical and social services by providing beneficiaries with care coordinators, while implementing electronic health records across all the organization’s service entities. This approach can reach individuals before they walk through the doors of their doctor’s office or the emergency room. It can begin to address some of the key indicators of health outcomes, such as levels of physical activity, diet and tobacco use. We recommend the CMS integrate population health care quality measures into the next iteration of accountable care organizations.

We also encourage the Center for Medicare and Medicaid Innovation to invest in a robust demonstration of an accountable health community model, a newer variation of the accountable care organization that is explicitly focused on the health outcomes for a population within a geographic area using community-based interventions. This could establish a concrete framework for improving population health while leveraging the existing delivery-system infrastructure. 

Over the next year, the task force will continue to engage targeted stakeholders and decision-makers in the public and private sectors in hopes of bringing about fundamental changes in the way we deliver health and value it. We hope these conversations will help bridge the gap between health care in the clinical setting and the powerful tools in our communities.

We need a more integrated, prevention-centric approach to health and health care if we truly want to help Americans enjoy longer, healthier and more productive lives. Changing the system won’t be easy and it won’t happen overnight. But better health, better health care and lower health costs are goals we all can embrace for the good health of the country.