Prevention Delivers Value - 4 recommendations

By Robin Schepper

Americans spend twice as much on healthcare as citizens of other developed countries, with chronic diseases dominating healthcare costs. In fact, 86 percent of U.S. healthcare costs are attributed to chronic disease. In the healthcare field, we continue to discuss how our system is shifting to value over volume, but how does that connect to reducing healthcare costs and reducing chronic disease?

The simple answer is prevention. Prevention delivers value. Often prevention is defined by clinical prevention like mammograms, immunizations and colonoscopies, but slowly the healthcare community is recognizing that prevention also includes efforts to improve the lifestyle habits that contribute to chronic disease like improving nutrition and increasing physical activity.

How do we increase the uptake of prevention? In May, the Bipartisan Policy Center released a report called A Prescription for Improving Health and Health Care in America. The report outlines many policy recommendations for institutions like the Centers for Medicare and Medicaid Services (CMS), Congress and the Centers for Disease Control (CDC). But in listening to the panel of speakers and reading the report, I saw some opportunities for the healthcare sector to advocate for prevention.

Federal institutions need more evidence that prevention works. The current evidence base around prevention is fragmented and needs more metrics to analyze costs. Federal policy makers need the evidence to support efforts that prioritize value. How can healthcare companies aggregate evidence, optimally with at least 10,000 participants, to show how preventative programs like diabetes prevention, heart health, decreasing obesity and metabolic syndrome, etc. are making an impact in the commercial sector?

The current healthcare fee-for-service model does not encourage prevention or reward physicians for counseling patients on preventative changes to improve health. At the BPC event, the Centers for Medicaid and Medicare Innovation described a new innovation grant called The Million Hearts®: Cardiovascular Disease Risk Reduction Model that meets the Million Hearts’ goal to prevent one million heart attacks and strokes and CMS’ objective to identify and spread better models of care delivery and payment. The new tool gives each patient a personalized 10-year-risk percentage. Providers are reimbursed for a pooled risk calculator of age, gender, blood pressure, cholesterol level, smoking status and a few other inputs instead of the typical fee for service on just blood pressure and cholesterol. What innovations can the healthcare industry do to replicate these effort and test interventions that look at an individual holistically and identify ways that prevention could benefit them?

Preventing chronic diseases before they start or progress offers potential cost-savings. Companies like Welltok are using the CaféWell Health Optimization platform to deliver programs that can help prevent chronic disease. Diabetes Prevention programs like Omada, offer pre-diabetic individuals an intensive intervention that could keep them off the rolls of the current 29 million diabetics in this country. Investing early in helping one of the 79 million pre-diabetics in this country is much cheaper than treating an individual that contracts diabetes. What other interventions can the healthcare industry offer and finance to decrease the onset of chronic disease?

Make prevention a key part of health care delivery. Prevention can be more than just averting chronic disease. How can the healthcare industry prioritize prevention? The CaféWell Health Optimization platform offers health itineraries that match individuals’ goals and offers programs like Wildflower Health to keep the next generation of Americans healthier. Wildflower Health’s mobile platform called Due Date Plus supports pregnant women while reducing pregnancy complications, low birth weights and C-Sections. What interventions can help individuals who are healthy, stay healthy and how can the industry help those who need a little more support to get on the right track?

This report and the infographic do a great job outlining the current challenges to implementing prevention as well as the structural barriers and social, environmental and economic factors keeping the federal government from enacting and financing prevention. I believe we can learn from these insights, but ultimately we need to lead by example and show how the healthcare industry already values prevention and share some of our lessons with the federal government. Together, we can scale up prevention and really show how we have shifted to value over prevention.

Original article appeared in the Institute for HealthCare Consumerism's Population Health Management community in July 2015.