Trust for America’s Health is circulating a letter to Congress in support of preserving the Prevention and Public Health Fund and is asking other organizations to sign on as well. To date, over 300 organizations have signed the letter. It reads:

As the Senate considers the Small Business Jobs and Credit Act (H.R. 5297), the undersigned organizations strongly urge you to oppose the use of the Prevention and Public Health Fund from the Affordable Care Act (ACA) as an offset for an amendment offered by Senator Johanns (No. 4531). Such an action would virtually eliminate the Fund, and mark a severe blow to this monumental commitment to prevention and public health under the Act.

The letter can be found here. For more information, visit www. healthyamericans.org/

http://www.marketwatch.com/story/story/print?guid=3C6E347A-2FAF-43EB-B2D4-67DA3634975D

As an advocate of prevention, wellness and early interventions, I discuss the rising rates of obesity prevalence in the U.S. often. As obesity rates among all ages continue to increase, we are faced with an obesity epidemic that is lowering the quality of life for millions of Americans and driving up health care costs in the U.S. Today’s New York Times article, “Obesity Rates Keep Rising, Troubling Health Officials,” discusses the growing epidemic at length.

There is no shortage of data that show obesity is a growing public health threat with a very large price tag. Research I completed last year for America’s Health Rankings found that if obesity continues to increase at current rates, U.S. spending on health care costs attributable to obesity is expected to quadruple by 2018 to $344 billion. By 2018, obesity will account for more than 21 percent of health care spending. These most recent data from the CDC, as reported in the press today, unfortunately provide additional evidence that my future projections of a persistent rise in obesity and chronic disease are on target.

There are actions we can take to start chipping away at this trend. We can link payments to the quality of care and improved health outcomes, expand coverage of comprehensive primary care, and change the delivery system to better accommodate discussions about preventive care, appropriate diet and exercise regimens that can help patients to avoid obesity. A new randomized trial published last week in the Annals of Internal Medicine show that structured diet and exercise interventions result in an average weight loss of 7 percent among obese adults. If applied nationally, this would save billions of dollars we spend to treat obesity related chronic disease. As I’ve mentioned before, community health teams can also play a role in improving reimbursement for weight loss counseling, nutritional counseling and other specialists. For additional policy solutions, take a look at PFCD’s “Recommendations on Reversing Obesity Trends with Health Reform.”

Key to solving this crisis is creating a culture of wellness and prevention. We must create wide-spread awareness of this growing problem. We must learn how to live healthy, active lives, and our health care system needs to incentivize Americans to do so. It should pay for not only preventive measures (which it does now, under the PPACA), but also early interventions to avoid costly consequences due to inaction. Through cultural recognition of the problem and proven policy action we can reverse this costly trend. We need to be more aggressive on the policy front as well. There are proven interventions that we could replicate and scale nationally—both to prevent disease and more effectively manage chronic illness. These approaches would improve health and have the potential for saving hundreds of billions of dollars going forward.

The Obama Administration released a report Monday, showing significant savings in Medicare due to  PPACA reforms. The report shows Medicare will save approximately $8 billion by the end of next year, and as much as $575 billion over the rest of the decade. These are significant savings and evidence that PPACA is a strong foundation on which to build more quality and cost-savings measures into our current health care system.

We can build on this foundation through increased care coordination and chronic disease prevention efforts. The lack of prevention and care coordination in Medicare currently allow inefficiencies and preventable, costly disease to drive up costs. Below are three areas of potential savings that will generate additional cost savings and improve health outcomes for our seniors.

• Preventable hospital readmissions within a 30 day window total $250 billion in added Medicare spending over the next 10 years. That cost could be halved by implementing community health teams, transitional care programs like those developed at the University of Pennsylvania and Colorado as well as other care coordination practices.
• Increased care coordination in Medicare has the potential to significantly reduce health spending. Using transitional care models, such as Community Health Teams, have the potential to save $125 billion over 10 years in Medicare alone.
• Within Medicare alone, just three obesity-associated chronic conditions—diabetes, hypertension, and high cholesterol—accounted for more than 16 percent of the rise in spending between 1987 and 2006. Enrolling just one cohort of 60-64 year olds into proven diet, exercise and nutrition programs would save the federal government nearly $40 Billion over a 10-15 year period! This is an investment that we cannot afford to wait on.

A recent New York Times article, “Tobacco Funds Shrink as Obesity Fight Intensifies,” included my thoughts on tobacco cessation and obesity prevention and I would like to expand on those thoughts for a moment.

Tobacco use and obesity are both public health threats that drive up health care spending in the US. Reducing tobacco use and obesity prevalence are both key to lowering health costs and saving lives.

Fortunately tobacco rates have been decreasing over the past several decades. The same cannot be said for obesity prevalence in the US, which is on the rise. Research I completed last year for America’s Health Rankings found that by 2018, 103 million American adults — or 43 percent of the population — will be considered obese. US spending on health care costs attributable to obesity will quadruple—to $344 billion — over that same period.

Chronic disease, such as diabetes, hypertension, heart disease and cancer, is responsible for 75 percent of health care costs in the US. Tobacco use and obesity are risk factors for several of these costly chronic conditions and both must be addressed adequately. We need  more prevention funding to support early interventions, community health programs and public education about the dangers of these risky health behaviors. Only through sustained prevention funding will we lower health care costs, save lives and create a culture of wellness.

Yesterday marked the start of the final two weeks before the 2010 August Congressional recess begins. With all the legislative activity thus far this year, it’s hard to believe August is just around the corner and election season is fast approaching. I applaud Congress and the Obama Administration for their strong implementation efforts and wish them a restful recess in their home states.

While things will slow down a bit in Washington over the next month, I hope the nation continues talking about the implementation process and health care reform. As you know, I’m a strong advocate for disease prevention and wellness and here are a few data points I keep coming back to that make a strong case for increased access to preventive services, coordinated care and a strong public health education program.

• Increased care coordination in Medicare has the potential to significantly reduce health spending. Using transitional care models, such as Community Health Teams, have the potential to save $125 billion over 10 years in Medicare alone.
• The total 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.
• If obesity continues to increase at current rates, US spending on health care costs attributable to obesity is expected to quadruple by 2018 to $344 billion.

When Congress returns from recess in a few short weeks, I encourage them to pick up this conversation where they left off and continue to move full steam ahead with implementation.

There’s been a lot of coverage recently on preventive coverage. But a New York Times article today, “For Chronic Care, Your Employer May Be Able to Help,” looks at a different kind of preventive care: workplace wellness programs. The article discusses workplace wellness and the strengths and weaknesses of various programs. I thought I would reiterate something I’ve said in a past post, regarding the three central concepts that make for a successful workplace wellness program:

Participation is key and should be the metric for “reward.”  We know from the literature, when wellness programs are done right, improved health outcomes – and sometimes even lower costs – will follow from participation.

Participation is up to the individual. Not all employees may be in a position to, or want, to take advantage of wellness benefits either because of an underlying illness or condition. For those who have an underlying condition, they should not be penalized for not participating.

The rewards of participation are shared over time. Even those that choose not to participate may see benefit from lower health costs as others’ participation leads to better health outcomes and lower claims on health benefits. Any savings associated with participation in wellness programs thus accrue to everyone – and this should be recognized.

It’s hard to ignore the growing body of evidence that workplace wellness programs are effective interventions that help employees improve their health and reduce health care costs for employees and employers alike. The New York Times mentions several successful programs, but here are a few additional examples:

• At Citibank a comprehensive health management program showed a return on investment of $4.70 for every $1.00 in cost.
• A similar comprehensive program at Johnson & Johnson reduced health risks, including high cholesterol levels, cigarette smoking, and high blood pressure, and saved the company up to $8.8 million annually.
• The Diabetes 10 City Challenge targets diabetic employees, dependents and retirees of the city government, who then receive a voluntary health benefit, waiver for diabetes medications and supplies co-pays and a specially-trained pharmacist “coach”. As a result of the intervention, each individual sees an average annual savings of over $1,000 in total health care costs.

High cholesterol – for adults, typically a gateway condition to chronic diseases such as heart disease and hypertension – is now affecting Americans at even younger ages. According to new data from the CDC, up to one quarter of young adults (men aged 20 to 35 years; women aged 20 to 45 years) in the U.S. have elevated cholesterol levels, and less than half of this demographic undergoes recommended cholesterol screenings.

We already knew that chronic conditions once thought of as adult-onset only, such as diabetes and obesity, are now being found among children and young adults, and at alarming rates – so while unsettling, this new research may seem to follow a trend. However, what it  means is that our health care system is not effectively preventing chronic disease risk factors, or identifying them at onset when they can be effectively treated. This is not only concerning for our national health index, but also for increasing national health care costs, which high cholesterol plays a role in driving. Within the Medicare program, just three obesity-associated chronic conditions—diabetes, hypertension, and high cholesterol—accounted for more than 16 percent of the rise in spending between 1987 and 2006. Imagine how much it will cost to treat these young adults with high cholesterol over a lifetime?

Increased access to preventive care and better care coordination are key components of any solution to reduce high cholesterol and other chronic disease risk factors. The PPACA includes some important provisions, such as the elimination of payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests, as well as and regular wellness visits for infants and children. Getting rid of cost-sharing is a long-overdue step in the right direction. The next step is a major public education campaign to get people to take advantage of these clinical preventive services.

First Lady Michelle Obama and Dr. Jill Biden recorded a video message on provisions in the PPACA,which require insurance plans to pay the entire cost of recommended, preventive services starting in September. View the video here.

CMS is accepting comments until August 24th on a proposed rule on implementation of new Medicare preventive health benefits. Trust for America’s Health has posted the CMS announcement here: http://healthyamericans.org/assets/files/CMS_Fact_Sheet.pdf.

Instructions on how to submit comments are also on the TFAH Web site: http://healthyamericans.org/assets/files/CMS_Fee.pdf