Prevention, Intervention, and Innovation: The Triple Solution
for Lower Cost, Higher Quality Healthcare
Adapted from Mike Pucci’s “Changing the Debate
on Healthcare Costs in the US: The Triple Solution for Lower Cost,
Better Quality Healthcare.” You can learn more about this
topic at the upcoming CPAT luncheon seminar on July 18th and 19th.
Rising healthcare costs rank high on the list of concerns for
many Californians and often, the response to rising costs tends
to focus on the components of care – cutting reimbursement,
price controls, and limits on access for patients in public programs
when it should be focusing on the real cost-drivers.
In the United States, chronic diseases account for $3 out of
every $4 spent on healthcare, even though they are increasingly
preventable and largely treatable.(1) Part of the reason the cost
is so high is that little attention is directed at curbing healthcare
costs by addressing chronic disease itself. To make a significant
impact in both healthcare costs and the quality of care provided,
reform efforts must focus on how to best limit the growth and
burden of chronic disease.
To manage healthcare costs effectively and improve the quality
of care and health outcomes, we must focus our attention and resources
on three areas:
1) Prevention (particularly addressing critical
issues around obesity and tobacco use),
2) Intervention (managing chronic disease to
avoid costly complications), and
3) Innovation (developing new treatments for
costly unmet medical needs, like Alzheimer’s disease and
stroke).
Prevention
The first key to lowering healthcare costs is preventing people
from getting sick in the first place. According to the Centers
for Disease Control and Prevention, “chronic diseases—such
as cardiovascular disease (primarily heart disease and stroke),
cancer, and diabetes—are among the most prevalent, costly,
and preventable of all health problems.” Yet, prevention
accounts for only three percent of healthcare spending.(2) Lowering
the prevalence of just a few key high-cost diseases a modest amount
could have a significant impact overall.
However, this requires that incentives in the healthcare system
must focus on keeping people well rather than treating people
after they get sick. Support for programs that encourage active
lifestyles, healthy choices, smoking cessation, cancer screenings,
vaccination, and other preventive measures will go a long way
to lowering costs overall.
Intervention
Even with increased prevention efforts, people will of course
still get sick. When they do, ensuring that they receive and adhere
to appropriate treatment to minimize the potential for more costly
complications can lower healthcare costs. Both the tools and knowledge
to manage many chronic diseases and greatly reduce many of their
severe, costly co-morbidities already exist. However, the tools
and knowledge are not always used effectively and consistently.
For example, despite the ability to treat type-2 diabetes effectively,
an estimated two out of three Americans with type-2 diabetes are
not in control of their blood sugar.(3)
While most agree that helping people manage chronic diseases
to avoid costly complications makes sense, how best to achieve
those results is a challenge, particularly within a system that
aligns incentives toward treating complications instead of avoiding
them.
Innovation
While many chronic diseases can be managed more effectively, better
treatments are still needed to meet the needs of patients with
diseases that have very few, if any, effective prevention measures
or treatment alternatives. Alzheimer’s disease is one of
the best examples of a costly and devastating unmet medical need.
Today, Alzheimer’s costs more than $100 billion a year,
and as society ages, the incidence of Alzheimer’s is expected
to triple or quadruple over the next 30-40 years.(4) While there
are several drugs on the market designed to treat the symptoms
of Alzheimer’s, with close to 50 in clinical development,
available treatments are limited and no effective prevention measure
currently exists. A breakthrough for Alzheimer’s disease
holds tremendous potential. According to the Alzheimer’s
Association, delaying the onset of Alzheimer’s disease by
just five years could cut the number of people developing Alzheimer’s
in half. Other data has shown that effective interventions for
moderately to severely impaired patients that delay admissions
to nursing homes by just one month could save more than $1 billion
a year.(5)
Research-based pharmaceutical companies have numerous research
projects underway that hold the potential to improve health and
greatly reduce healthcare costs. Increasing awareness of the need
to strike a balance between controlling healthcare costs and supporting
investment to ensure continued innovation in healthcare is the
final necessary step to lowering costs and improving the quality
of healthcare.
Printed with author’s permission.
Footnotes:
1) Centers for Disease Control and Prevention, “Chronic
Disease Overview: Costs of Chronic Disease,” available at: http://www.cdc.gov/nccdphp/overview.htm
2) Centers for Disease Control and Prevention, “Effectiveness
in Disease and Injury Prevention Estimated National Spending on
Prevention.” Available at: www.cdc.gov/mmwr/preview/mmwrhtml/
00017286.htm
3) American Association of Endocrinologists, “State of
Diabetes in America.” Available at: www.stateofdiabetes.com
4) Alzheimer’s Association, Statistics. Available at: www.alz.org/AboutAD/statistics.asp
5) Leon, Chang, and Nuemann, “Alzheimer’s Disease
Care: Costs and Potential Savings,” Health Affairs, 17(6);206-16
(1998).
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