Tomorrow, President Obama will hit the 100-day milestone in his presidency. There’s no doubt that the President inherited some sizable problems when he arrived into office, especially in the realm of health care.

Here are some examples of what’s happened in his first 100 days to Americans’ health and the U.S. health care system, based on current trends: 

• Nearly a quarter of a million (217,000+) children born in the U.S. so far this year will be obese by their 4th birthday
• Two-thirds of a million (665,000+) Medicare enrollees have been re-admitted to hospitals within 30 days of undergoing treatment other than surgery, at a cost of $465 million to Medicare
• About ten times that amount — $465 billion – has been spent to treat patients with one or more chronic diseases (public and private spending)
• A total of $613 billion has been spent on health care (public and private spending)

The sense of urgency is just as great today as it was when Obama was sworn in. We urge the White House and Congress to keep working on solutions that address these deep, systemic issues as the next 100 days could make or break health care reform.

Sources:
Children and Obesity
http://archpedi.ama-assn.org/cgi/content/abstract/163/4/344
http://www.nytimes.com/2009/03/19/health/19birth.html
http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf
http://www.cnn.com/2009/HEALTH/04/07/obesity.preschool.children/
Medicare
http://content.nejm.org/cgi/content/full/360/14/1418?ijkey=3CQjS3yxXjOtY&keytype=ref&siteid=nejm
http://www.nytimes.com/2009/04/02/health/02hospital.html
National Health Expenditures
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
Cost of Chronic Diseases
http://www.cdc.gov/nccdphp/overview.htm

My many trips to DC of late have left me feeling that spring is a bit behind this year; like the late DC-spring, a few things of note in health reform that suggest that new growth is just around the corner…

Despite some small fireworks, Governor Sebelius made it over another hurdle yesterday to make it one step closer to becoming our new HHS secretary. I think many of us invested in the health reform are looking forward to getting senior leadership in place at HHS to make sure we have the best shot at passing meaningful health care reform this year.

I tuned in to yesterday’s Senate Finance Committee’s first health care reform roundtable discussion, which focused on delivery system reform. I think that it was telling – and important – that they started with this aspect of reform, because changing how care is delivered must be a central strategy both in improving quality and controlling costs.

As I have been saying for awhile now to folks in the media, as well as those on the Hill, efforts to prevent disease and delivery reform are areas that are not only critical to actually helping to improve Americans’ health and reduce health care costs – they are ones where we are going to see the most bipartisan agreement on how to move forward.

Such delivery system reforms are likely to move on a few fronts – especially with respect to coordination of care. For example, those at the hearing today talked about:

• The medical home model, which has strong support now from many groups
• The emerging concept of community health teams, as I described in my testimony before the Senate HELP committee in December of last year
• The need for better transitional care, as described by Mary Naylor and others at the hearing yesterday

I was pleased to see that almost all of those who spoke at the hearing mentioned chronic disease as the thing that we need to address rising costs and improve quality by emphasizing “up front” interventions that help patients better prevent, detect, and manage disease.

Mimi Hall of USA Today published a great article that describes the tremendous cost of chronic diseases and related conditions such as obesity, and how one community took action to address these concerns and in the process transformed the lifestyles – and health – of its residents.

Last Wednesday (April 8), I was fortunate enough to attend the most recent White House meeting on health reform with about 30 or so key stakeholders. I had two key reactions to the meeting as it progressed.

First, the sense of urgency to address issues around high health care costs, quality gaps and the uninsured was palpable. 

Most in the room understood that the solutions to addressing these issues were beyond the scope of any individual business, and that solutions would require more fundamental structural changes to the payment,  and delivery and public health/primary care system.

As I pointed out, there are two clear trends that require action through health reform: first, approximately 30% of the rise in spending over the past 15 to 20 years is associated with the persistent rise in obesity and related chronic disease. Second, 75 percent of overall health care spending is associated with chronically ill patients. 

I saw a lot of heads nodding in agreement that health care reform must address both of these issues.  Along these lines, participants left the room with a high level of consensus on possible policy pathways for addressing them.

There was less convergence of opinion on the other major discussion, which concerned expanding coverage to the uninsured. All recognized the substantial federal costs associated with making such coverage affordable, and the basic insurance package for the uninsured meaningful.  There was general agreement on the concept for universal coverage with a requirement that individuals purchase—though some disagreed—as long as coverage was “affordable”.

Several key politically contentious issues were identified including whether the insurance offerings would include a public plan, and how to finance the overall proposal. There were differences of opinion on these issues. On the other hand, given the severity of the problem , and the clear need for reform, there was hope that key stakeholders could find a means to compromise.

All recognize that no group will get its first choice across all these key issues. Fifteen years ago, the failure to compromise led most to their second choice—the status quo. 

I sensed some shifting in the sands, however, among the groups to make the status quo their third or fourth choice and instead find ways to compromise and address health care costs and the uninsured this year.

So stay tuned, it’s likely to be a wild ride!

This week the New England Journal of Medicine published a study on Medicare, which found that one in five Medicare patients end up back in the hospital within a month of discharge, costing billions of dollars a year. Many of these elderly patients have chronic illnesses that require continual care, but they don’t receive clear instructions for how to manage them or follow through on those instructions.

Another report issued this week, this time by HHS, collected data on the “Costs of Inaction” and illustrates the benefits of helping patients control their chronic illnesses. According to the report, which pulled the original data from AHRQ, if every state improved diabetes control to the level of the top four best performing states, “at least 39,000 fewer patients would have been admitted for uncontrolled diabetes in 2004, potentially saving $216.7 million.”

Both are yet more proof that we need a system with better support for patients and better incentives for providers to stay on top of chronic care. Adherence to treatment and disease management programs will become even more difficult for chronically ill Americans who have been hard hit by the current recession and are struggling to pay bills and mortgages, let alone focus on their treatment regimen, which is why this needs to be a clear priority in our health reform efforts.

I have a piece today in the Huffington Post that looks at the Massachusetts health reform model and offers another “real world” example that we can use when looking for lessons to influence our national health care reform efforts.

You can read it here: http://www.huffingtonpost.com/kenneth-thorpe/massachusetts-is-not-the_b_182265.html