Today’s Wall Street Journal looked at the Massachusetts health care program, which they say “previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.”

There are many lessons to be learned from the Massachusetts model, as with other state reform efforts like that in Vermont, which may be the model that Obama and Congress should follow at a national level. For Massachusetts, the biggest lesson is that any attempt at universal coverage must also include cost controls at the beginning, and this is where the state is running into problems now.

As the Journal points out, Gov. Deval Patrick has set up a commission to figure out how to control costs. To quote the writers, “One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending.”

In fact, that’s not true. Well-designed programs implemented in multiple community settings have been proven to reduce costs and improve patient outcomes. That’s one of the reasons why “everyone” (including our President) is advocating for a greater focus on preventive care (and it should be noted that in most cases “prevention” means primary prevention efforts).

The key to making prevention—and many other elements of health care reform—a success is by working through public-private collaboration. Many of the most successful programs are implemented through employers and schools, but that trend is still relatively new.

This is clearly an area where Congress has indicated that it will look for cost-savings. My recommendation is that elements like these programs should be carefully coordinated in the design of health insurance benefits (e.g., no cost sharing for services clearly needed to manage and treat chronic disease) and in the redesign of our delivery system.

In his address to the nation on Tuesday night, President Obama said that the best way for the U.S. to “bend the curve” on the national deficit is through reducing health care costs, citing prevention as one of the ways to achieve that goal.

Crafting effective solutions to increases in health expenditures requires a clear understanding of where we spend our health care dollar and the factors accounting for rising spending. Chronic diseases have played a major role in the rise of U.S. health care costs. A multifaceted approach—reaching people where they live, play, work and go to school—will be critical to successful treatment, reduction and prevention of these conditions, and the key to successful programs is evidence-based design and delivery.

As the President and Congress form a health reform package, they should look at best practices to identify key design features of successful programs. Based on rigorous assessments of such programs, these features include:
• Financial incentives to participate in health risk appraisals;
• Reducing or eliminating cost sharing for preventive services;
• Carefully crafted individualized care plans with incentives to meet key objectives;
• The availability of health care personnel at the workplace; and
• Leadership from the top.

These types of well-designed programs, coupled with the broader use of primary prevention efforts in schools, workplaces, and communities and enhanced prevention in clinical settings, can reduce the growth in chronic disease and create substantial opportunities for cost savings.

Three studies came out last week highlighting the burden of chronic disease. The first, by the University of Oxford, found that being obese can shorten your lifespan and, in the case of morbidly obese patients, have the same effect as lifelong smoking, taking about 10 years off their expected lifespan. The second, a survey commissioned by the National Council on Aging, found that Americans with chronic health problem are delaying necessary care. The third, by Hewitt Associates, found that the number of companies taking action to combat chronic diseases among employees and their families jumped almost 30 percent over the past year.

These studies reiterate that Americans are being hit from both sides when it comes to chronic disease. Their health is suffering and, because of their disease burden, they can’t afford the care they need to adequately manage their chronic conditions.  It’s a crushing cycle.

What we can do, and what I’ve heard support for during the forums in Vermont and Iowa, is re-design our system to make it easier from a cost and time perspective for Americans to actively prevent illness and treat disease before it becomes acute and aggressive. This is not only the smart thing to do, but an area where we have great consensus between the parties and major health care stakeholders.

As promised, below are some further thoughts on the four areas outlined in my initial post from the Vermont forum. These are areas that, to me, seem to be clear and critical components of health reform at the national level.

• We have got to do a better job of preventing disease in the first place. About 30 percent of the growth in health care spending seen over the past twenty years is linked to a doubling in obesity rates. We need population-based and public health initiatives that will help to promote health in places where Americans spend their time: schools, workplaces, and communities.
• Unless we find better models to manage the chronically ill, we will not be able to bend the health care cost curve. About 75% of health care costs in the U.S. are associated with patients with one or more chronic conditions. We need a more holistic system that is truly focused on the patient. To make this work, we must extend care beyond the traditional doctor’s office. The community health teams in Vermont are a tremendous model for the rest of the country on how to make this work.
• We need universal coverage. When it comes to coverage, everyone has a first choice for how to do it; but everyone’s second choice is the status quo. If we want to improve health, and spend our health care resources more wisely, it doesn’t make any sense to have a group of Americans who don’t have regular access to care to help them stay healthy. We need to be willing to work together to find compromise, as Vermonters were able to do.
• The health care system must be made simpler. We spend way too much on administrative costs. We need to find ways to make things simpler, and more effective, for patients, providers, and others coming in contact with the system. Interoperable, affordable health IT systems must be a priority.

It was great to be back in Vermont today to see some old friends, and to talk about health care.

About 400 folks were there with me today at the White House regional forum on health care, and there was plenty of lively discussion about what we must do to make health care better in this country.

As I said at the forum today (see video and audio below), Vermont is a model health care system for the nation and there are four things that it seems clear we need to focus on in health reform at the national level:

• One, we have got to do a better job of preventing disease in the first place.
• Two, unless we find better models to manage the chronically ill, we will not be able to bend the health care cost curve.
• Three, we need universal coverage – the status quo is not a good “second option”.
• Four, the health care system must be made simpler.

When I have a bit more time, I hope to share some more thoughts on each of these areas.

Download the White House Forum on Health Care Audio
(MP3 Format)

Download the White House Forum on Health Care Video
(Real Media Format)

Over the next few months, health reform will surely continue to grab the national spotlight. As we enter into this critical phase, the intent of this blog is to transport this lively conversation and debate online.

The launch of this blog also coincides with another important milestone on the road to health reform – the Vermont Regional Health Summit, taking place today. I’m especially proud to be participating in this gathering of health care luminaries and stakeholders because Vermont has set the bar high for comprehensive health care reform.

As the first state in the country to recognize the link between chronic disease and cost-containment, Vermont established a model of universal coverage that built in provisions for disease prevention. With the bipartisan support essential to successful reform, Vermont policymakers are leading the charge for integrating these critical strategies into real health reform policies and lessons from their efforts should serve to inform future ideas.

Check back later this week for a post recapping the meeting in Vermont. If the inaugural health care summit in Detroit was any indication, today is sure to be an interesting – and hopefully, very substantive – discussion.