I’d like to take a moment and applaud Koh and Sebelius for explaining in detail exactly how PPACA improves preventive care in the U.S. Educating Americans about available options and benefits is the first step to helping them establish and maintain healthy lifestyles (recent polls have shown that Americans are unclear about what provisions are actually included in the new health care law).

I’ve blogged before (see here and here) on several new prevention provisions in PPACA, but I’d like to call out a few additional highlights from Koh and Sebelius’ article:

• Workplace wellness. The Act authorizes funds for grants for small businesses to provide comprehensive workplace wellness programs and requires HHS to assess existing federal health and wellness initiatives and directs the CDC to survey worksite health policies and programs nationally. Well-designed, evidence-based workplace wellness programs are an important component of health care, as they are extremely effective and cost efficient health interventions. See here for examples of effective workplace wellness programs with a significant ROI.
• Emphasis on the important role communities play in healthy living. Like the workplace, communities are often the first point of intervention and have been extremely effective in improving health and lowering costs. Provisions are designed to strengthen partnerships between local or state governments and community groups. For example, new Community Transformation Grants promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities.
• Specifically addressing obesity and smoking cessation. The directives for the new health plans established after September 23, 2010, also include coverage, with no cost sharing, of tobacco-use counseling and evidence-based tobacco-cessation interventions, as well as obesity screening and counseling for adults and children. PPACA also appropriates funds for fiscal years 2010 through 2014 for demonstration projects to develop model programs for reducing childhood obesity. As adult and childhood obesity rates are skyrocketing to levels never seen before—if rates continue at their current pace, by 2018, 43 percent of the population will be obese—lowering the incidence of these two costly and risky behaviors is critical to improving the health of our nation.

Preventable hospital readmissions put patients at increased risk and drive up health spending, especially in Medicare. In fact, it’s predicted that preventable hospital readmissions that occur within a 30-day window will add $250 billion to Medicare spending over the next 10 years. That cost could be halved by implementing community health teams which include transitional care programs like those developed at the University of Pennsylvania and Colorado, as well as other care coordination practices.

A provision in PPACA, starting October 2012, will better incentivize hospitals to adopt increased care coordination practices. This provision would adjust payments for hospitals paid under the inpatient prospective payment system based on the dollar value of each hospital’s percentage of potentially preventable Medicare readmissions for the three conditions, with risk adjusted readmission measures that are currently endorsed by the National Quality Forum. The provision also provides the Secretary authority to expand the policy to additional conditions in future years and directs the Secretary to calculate and make publicly available information on all patient hospital readmission rates for certain conditions.

Hospitals are starting to implement simple practices, such as scheduling follow-up appointments for patients and calling patients to see how they’re feeling post discharge, and are looking into more formal transitional programs. As I’ve said before, transitional care models, such as Community Health Teams, have the potential to save $125 billion over 10 years in Medicare alone, making the investment well worth it.

• North Carolina implemented a Community Care program in 1998 and saved the state over $400 million in 2003 and 2004.
• In Illinois, medical home programs saved the state $220 million over 2008 and 2009, according to a recent study from the Robert Graham Center.

Care coordination programs (community health teams and accountable care organizations are two extremely effective models) reduce health care costs because they better prevent, detect and treat chronic conditions—the number one driver of health care spending. For example, the total (national) annual economic cost of diabetes in 2007 was estimated to be $174 billion, according to the American Diabetes Association: $58 billion resulting from indirect costs (e.g., increased absenteeism, reduced productivity, disease-related unemployment disability, and loss of productive capacity due to early mortality) and $116 billion for direct medical costs. The University of North Carolina found that the community care program saved the state about $3.3. million on asthma patients and about $2.1 million for patients with diabetes.

Care coordination is especially important in Medicare. Federal spending in 2008 in Medicare and Medicaid on patients with one or more chronic condition was $568.4 billion. To put it in perspective, that is more than six times the entire health care budget for the state of California. Fortunately, PPACA is expanding care coordination efforts in our health care system, such as the elimination of cost sharing for preventive services and the installment of a free annual wellness exam for seniors starting in 2011, but there is still room for change. We must continue to urge Congress and the Obama Administration to fully appropriate, as promised, all prevention efforts in PPACA.

Trust for America’s Health is collecting examples. Please send all examples to info@fightchronicdisease.org and PFCD will pass them along. Be sure to include where they’re from, contact information, etc.

“Prevention best medicine,” Chattanooga Times Free Press, August 17, 2010

I recently discussed the increased prevention and wellness benefits available to seniors starting January 1, 2011 and the creation of the National Prevention Council. Below are several provisions that will be enacted through the remainder of the year:

• Young adults. If they lack coverage, they can stay on their parents’ plans up until they turn 26.
•  Tax credits. As many as 4 million small businesses are eligible for tax credits of up to 35% of their health insurance costs.
• Preventive services. Consumers can obtain tests such as mammograms and colonoscopies without having to pay a share of the cost.
• High-risk coverage. People with pre-existing conditions or who are uninsured at least six months can get this coverage through a state or federal high-risk pool.

The next step is a major public education campaign to get people to take advantage of new preventive services.

Adults whose wellbeing was “struggling” or “suffering” were 64 percent more likely than adults with “thriving” wellbeing to have one or more new chronic conditions diagnosed in the past year. The study also found that adults with thriving wellbeing had 37 percent lower chronic disease burden costs than those whose wellbeing was “struggling” or “suffering,” an annual difference of $1,834.

From an economic perspective these numbers are jarring, because the increase in health care costs are absorbed not only by the individual, but by employers, communities and the federal budget. Chronic conditions account for 75 percent of federal health care spending and 133 million Americans live with at least one chronic condition. Employees with thriving wellbeing not only have lower health care costs, but generate cost savings through reduced indirect costs, such as absenteeism and presenteeism.

This data is further evidence that educating and incentivizing Americans to be “well” will not only improve quality of life, but have a profound effect on health care costs and long-term spending.

Starting in January, Medicare beneficiaries will receive, for free, all preventive services and screenings that receive an A or B recommendation for seniors from the U.S. Preventive Services Task Force, including mammograms and colorectal cancer screening, bone mass measurement and nutritional counseling for people at risk for lifestyle-related chronic diseases such as diabetes. While what tests and treatments a patient should receive is a decision to be made between the patient and his or her doctor and team of health care professionals, many preventive services are recommended for a wide audience. 

Medicare beneficiaries will also get a free annual wellness visit under PPACA. The annual wellness exam allows seniors to make a custom health plan with their primary care physician and also provides them with a key opportunity to learn about healthy behaviors and services, such as healthy eating and community exercise programs, not covered by Medicare. Educating seniors about healthy living is critical in preventing obesity, a chronic condition that often leads to other chronic disease, such as diabetes and hypertension, and further increases health spending. Research has shown that lifetime spending for older adults is $25,000- $37,000 lower among normal weight adults, compared to obese adults.

Eliminating cost sharing for seniors means more will get the preventive care they need, keeping them healthy and ultimately reducing federal health spending. The wellness visit and nutritional counseling (primary prevention) will help prevent future costs by preventing illness, while the screenings (secondary prevention) will help reduce  cost by early management of the disease. Today’s Washington Post article, “New health-care law provides free preventive care for many seniors,” discusses the benefits of the new provision at length. As announced last week by the White House, Medicare reforms in PPACA are already generating cost savings within the program, and these added preventive and care coordination efforts will generate further cost savings over time.