The Healthcare Imperative Lowering Costs and Improving Outcomes: Workshop Series Summary (2010) / Chapter Skim
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6 Missed Prevention Opportunities
6 Missed Prevention Opportunities
Pages 219-238
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From page 219... ...
, has resulted in targeted prevention of additional complications and hospitalizations. In this concluding session of the May workshop, the speakers reframed the discussion by exploring how changing demographic trends in the population's health status and underinvestment in population health contribute to missed prevention opportunities, and focusing not simply on the potential costs of missed prevention opportunities but on the added value of increasing the delivery of preventive efforts to patients.
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From page 220... ...
Flottemesch of HealthPartners Research Foundation suggests that preventive services at the primary and secondary levels yields mixed results in terms of net medical savings to the healthcare system, highlighting the importance of expanding the conversation on prevention beyond costs alone to include value and benefits not captured by pure dollars. Although primary preventive services, such as daily aspirin use and alcohol and tobacco use screenings, could have yielded net savings of nearly $1.5 billion in his analysis, the use of secondary preventive services, such as mammograms and depression screenings, actually results in net costs of almost $2 billion.
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From page 221... ...
Defining Prevention The classic categories of prevention include primary prevention, controlling modifiable risk factors to avert the occurrence of disease; secondary prevention, the early detection of disease before it manifests clinical symptoms; and tertiary prevention, the control of existing diseases to prevent more serious complications. These distinctions are important, but a source of confusion is failing to differentiate between clinical and community- or population-based settings for prevention.
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From page 222... ...
Prevention can also occur in the community, often with greater effectiveness, to help the general public adopt healthier lifestyles and reduce harmful exposures that precipitate diseases and injuries. Worksite wellness programs, school policies, information technology and other resources for self-care at home, nutrient labeling at restaurants and supermarkets, media and advertising countermarketing messages, changes to the built environment to facilitate exercise, legislation (e.g., indoor smoking bans)
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From page 223... ...
The price paid for inadequate emphasis on prevention includes the costs of excess medical care for avertable diseases and complications, as well as the deleterious economic effects of illness on a healthy workforce, corporate competitiveness, children's education, mental health, and community well-being. The Milken Institute estimates that chronic illnesses cost the economy $4 in lost productivity for every $1 spent on health care (DeVol et al., 2007)
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Reputable review panels, such as the U.S. Preventive Services Task Force, have identified a core set of clinical preventive services of established effectiveness.
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From page 225... ...
The evidence identifies a cadre of effective preventive services, in the clinical and community setting, that can help optimize value and reduce the burden of chronic diseases for the current population and the generation to come. The long-term human and economic consequences of diseases that need not occur constitute the ultimate price paid for inadequate emphasis on prevention.
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One undisputed fact is that clinical preventive services are currently underused (CDC, 2008b; National Commission on Prevention Priorities, 2007)
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From page 227... ...
22 MISSED PREVENTION OPPORTUNITIES TABLE 6-3 Evidence-Based Package of 20 Clinical Preventive Services Clinical Preventive Type of Service Prevention Description and Target Population Tetanus- Primary Immunize adults every 10 years diphtheria booster Folic acid use Primary Counsel women of childbearing age routinely on the use of folic acid supplements to prevent birth defects Chlamydia Primary Screen sexually active women under age 25 routinely screening Pneumococcal Primary Immunize adults age 65 and older against pneumococcal immunization disease with one dose Osteoporosis Primary Screen routinely women age 65 and older and age 60 and screening older at increased risk for osteoporosis and discuss the benefits and harms of treatment options Influenza Primary Immunize adults age 50 and older against influenza once immunization annually Obesity Primary Screen adults age 18 and older routinely for obesity and offer screening high-intensity counseling about diet, exercise, or both together with behavioral interventions for at least 1 year Cholesterol Primary Screen routinely for lipid disorders among men age 35 and screening older and women age 45 and older and treat with lipid lowering drugs to prevent cardiovascular disease Alcohol Primary Screen adults age 18 and older routinely to identify those screening whose alcohol use places them at increased risk and provide brief counseling with follow-up Tobacco Primary Screen adults age 18 and older for tobacco use, provide brief counseling, offer medication, and make referrals for more intensive counseling Hypertension Primary Measure blood pressure routinely in all adults age 18 and screening older and treat with antihypertensive medication to prevent cardiovascular disease Childhood Primary Immunize children under age 5 against diphtheria, tetanus, immunizations pertussis, measles, mumps, rubella, polio, Haemophilus influenza type b, varicella, pneumococcal, and influenza Daily aspirin Primary Discuss daily aspirin use with men age 40 and older, women use age 50 and older, and others at increased risk to prevent heart disease Depression Secondary Screen adults age 18 and older for depression in clinical screening practices with systems in place to assure accurate diagnosis, treatment and follow-up continued
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From page 228... ...
Thus, the estimates provided here must be interpreted in the context of USPSTF or ACIP recommendations that strictly define each intervention and its target population as noted in Table 6-3. We use the NCPP models to estimate the per person medical costs and savings per year of intervention with the goal of determining the net impact upon 2006 healthcare expenditures of increasing delivery rates of our selected clinical preventative services to 90 percent from current levels.
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. Table 6-5 presents the costs, savings, and net impact upon personal healthcare expenditures of primary and secondary preventive services.
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. The remaining columns show the marginal impact of increasing current delivery rates to 90 percent from their current level.
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. Our analyses indicate that different types of evidence-based clinical preventive services have the potential for differential impacts depending upon current delivery rates and target populations.
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From page 232... ...
Pignone, M.D., M.P.H. University of North Carolina-Chapel Hill Rising healthcare costs, increasing numbers of uninsured, and the increasing burden of chronic illness in the United States compel policy makers to identify better means of improving the value of health care in the
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From page 233... ...
Opportunities for Tertiary Prevention Effective and cost-saving interventions have been developed for several individual chronic conditions, including diabetes, heart failure, and depression, as well as for patients in certain care situations, such as having been recently discharged from the hospital or living with terminal illnesses. Disease Management For example, Rubin examined diabetes disease management for a retrospective cohort of 7,000 patients enrolled in several health maintenance organizations (HMOs)
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From page 234... ...
. Tertiary Prevention Does Not Universally Produce Savings Despite these successful examples, not all evaluations of disease management or care coordination programs have found them to be effective or to produce cost savings.
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From page 235... ...
of that spending is potentially amenable to interventions (based on the proportion of spending on chronic conditions that is accounted for by pathology that would be amendable to effective tertiary prevention activities) , we can then base an estimate of potential savings on a relatively conservative assumption about program efficacy.
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From page 236... ...
2007. The boomers are coming: A total cost of care model of the impact of population aging on health care costs in the United States by major practice category.
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From page 237... ...
2008. Ef fectiveness of specialized palliative care: A systematic review.
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