{"id":174,"date":"2014-01-21T12:40:39","date_gmt":"2014-01-21T17:40:39","guid":{"rendered":"http:\/\/leiferreport.com\/?p=174"},"modified":"2014-01-21T12:40:39","modified_gmt":"2014-01-21T17:40:39","slug":"panacea-ills-health-care","status":"publish","type":"post","link":"https:\/\/leifer.com\/?p=174","title":{"rendered":"A Panacea for the Ills of Health Care"},"content":{"rendered":"

\"iStock_000026356944Large\"<\/a>What if I told you that there was a panacea to our nation\u2019s health care crisis? Would you burst into laughter, stop reading, or simply conclude that I could not possibly understand the complexity of issues underlying our health system\u2019s dysfunction?\u00a0 After all, everyone knows that there are no silver bullets<\/i> in real life. <\/span><\/p>\n

Yet, that\u2019s exactly what I am going to propose \u2013 there is a panacea, we are simply choosing not embrace it. Before describing the cure, let\u2019s define the illness.<\/span><\/p>\n

In the most basic of terms, the U.S. spends far more than any other nation on health care services, yet \u201cenjoys\u201d some of the worst health outcomes. We live shorter lives, have ridiculously high rates of infant mortality, and succumb to a plethora of chronic, yet preventable diseases. Here are a few, quick stats:<\/span><\/p>\n

\u201cIn 2005, nearly half of all adults \u2013 133 million \u2013 had at least one chronic illness. In 2009-2010, more than one third (35.7%) of U.S. adults were obese, and 8.3% had diabetes. In 2005-2008, over 30 percent had high blood pressure.\u201d<\/span><\/p>\n

\u201cHealth care spending represented 17.9% of our gross domestic product (GDP) in 2010, and is expected to reach 20 percent by 2020. Three quarters of these costs go to treat chronic diseases, which in many cases are preventable.\u201d<\/span><\/p>\n

\u201cAccording to the IOM\u2019s 2012 report\u2026an estimated 80 percent of cases of heart disease and of type-2 diabetes, and 40 percent of cases of cancer, could be prevented by implementing public health interventions that increase physical activity and healthy eating and help reduce tobacco-use and excessive alcohol use.\u201d <\/span><\/p>\n

We Stand to Save as much as $1.1 trillion annually: <\/span><\/b><\/p>\n

According to a research published by the American Public Health Association, \u201cBy investing in prevention and treatment of the most common chronic diseases, the U.S. could decrease treatment costs by $218 billion per year and reduce the economic impact of disease by $1.1 trillion annually.\u201d<\/span><\/p>\n

Jim Fries’ Contribution:<\/span><\/b><\/h2>\n

These are not stunning, new revelations. The July 17, 1980, issue of the New England Journal of Medicine<\/i> featured a landmark article by Jim Fries, a professor of medicine at Stanford University. The article became one of the most frequently cited scientific references in the emerging field of wellness. Fries focused on the impact of chronic disease, which he described as follows: \u201cChronic illness now is responsible for more than 80 percent of all deaths and for an even higher fraction of cases of total disability.\u201d<\/span><\/p>\n

The power of Fries\u2019 article, however, lies in his conclusion: \u201cDisability and lowered quality of life due to the most prevalent chronic diseases are thus inescapably linked with eventual mortality. These chronic diseases are approached most effectively with a strategy of \u201cpostponement\u201d rather than cure. If the rate of progression is decreased, then the date of passage through the clinical threshold is postponed; if sufficiently postponed, the symptomatic threshold may not be crossed during a lifetime, and the disease is \u201cprevented.<\/span>\u201d<\/span><\/p>\n

Fries is stating that, while we cannot escape the human condition, by taking care of ourselves, we can stay vital, active, and healthy until the very twilight of our life. We can \u201ccompress morbidity\u201d \u2013 thus reducing the disease burden, costs, and impact on our quality of life. <\/span><\/p>\n

A Pittance of an Investment in Wellness:<\/span><\/b><\/h2>\n

So what level of investment are we making in prevention\/wellness? \u201cIn 2009, U.S. public health pending amounted to $76.2 billion \u2013 only 3.1 percent of the nation\u2019s overall healthcare expenditures<\/b> of $2.5 trillion.\u201d Granted, the Affordable Care Act (ACA) provides additional funding for prevention\/public health initiatives\u2013 but a few more billion dollars, though significant, pales by comparison to our burgeoning health care tab that now exceeds $2.8 trillion. <\/span><\/p>\n

Perhaps even more significantly, ACA may have stifled many embryonic efforts by providers to implement more robust wellness offerings. Like deer in headlights, most providers are responding to ACA by trying to eviscerate costs \u2013 not expand\u00a0wellness programs for which there is little to no direct reimbursement. <\/span><\/p>\n

Hospitals and the Wellness Sham:<\/span><\/b><\/h2>\n

Furthermore, while hospitals and health systems may preach wellness, few offer\u00a0comprehensive services designed to improve your health and well-being. Rather, they pay lip-service to this essential component of health care \u2013 viewing wellness more as a marketing opportunity than a true effort to do everything in their power to minimize unnecessary and costly utilization of their medical services.<\/span><\/p>\n

There\u2019s no surprise here, since the dominant reimbursement mechanism, fee for service, rewards the provision of medical services \u2013 not maximization of the health of a defined population. As a result, we pay a very dear price. <\/span><\/p>\n

From Sick-care System to a Positive Health System:<\/span><\/b><\/p>\n

It is possible to shift from a sick-care system that doles out interventions to manage the burden of chronic illness to a positive health system, focused on wellness\/well-being system, that minimizes unnecessary utilization by focusing on population health. However, it would require tremendous will on the part of numerous constituents to achieve such a powerful transformation.\u00a0 <\/span><\/span><\/span><\/p>\n

Far short of transformational change, there are nonetheless small seeds of hope in the form of new, evolving reimbursement and delivery models, such as ACOs and medical homes that stress population health management. Unfortunately, \u00a0the pace of adoption is glacial. For providers who have been burned in the past by assuming risk for a defined population, there\u2019s little enthusiasm for doing so again. <\/span><\/p>\n

Our Role in Changing the System:<\/span><\/b><\/p>\n

More than three decades ago, Jim Fries gave us one of the keys to healing American health care\u2026a silver bullet<\/i>. The question is whether we have the fortitude to change the health care paradigm, as well as accept the personal, stewardship responsibility for our health that is essential to success. If so, there\u2019s a role for each of us to play:<\/span><\/p>\n

Consumers\/patients<\/b><\/span>:\u00a0 We need to understand what it means to be prudent stewards of our health, and the health of our families. It is essential that we understand the role lifestyle choices make in determining our health, and how we might combat risk-factors that imperil our future. For many of us, we will need to have access to resources that will aid in this journey \u2013 particularly if we are socio-economically challenged, and thus find lifestyle change all the more difficult. As has been well-demonstrated, the social determinants of health play a profound role in wellness and well-being. <\/span><\/span><\/span><\/p>\n

Providers<\/b><\/span>: Health care executives need to take the moral high-ground and do the right things for the communities they serve. One\u00a0place to begin is with the development of\u00a0a strategic wellness plan illustrating how wellness initiatives\u00a0can be integrated into the very fabric of your hospital or health system’s care model. Once developed and implemented,\u00a0you can then\u00a0reasonably assert that you do everything possible to minimize unnecessary consumption of health care resources while maximizing the health and well-being of your patients.\u00a0\u00a0<\/span><\/span><\/span><\/p>\n

Insurers\/Payers<\/b><\/span>: There needs to be an unremitting pressure to partner\u00a0more fully\u00a0with providers on the assumption of risk for the health and well-being of a defined population\u2026thus accelerating the demise of fee-for-service medicine, and its replacement with a reimbursement mechanism that rewards wellness.<\/span><\/span><\/span><\/p>\n

Employers<\/b><\/span>:\u00a0 There needs to be broader adoption and implementation of wellness programs that incorporate proven mechanisms for elevating the health and well-being of an employed population. Such programs will likely involve potent incentives for lifestyle modification by those employees at risk. Expect the providers within your network to make two promises: 1) They will do everything in their power to help keep your employees healthy and out of their health system; 2) when medical care is needed, they will provide the highest\u00a0value care as measured by agreed upon standards of quality, safety, and costs. <\/span><\/span><\/span><\/p>\n

Government<\/b>:<\/span>\u00a0 There needs to be dramatically increased spending on proven prevention programs that can be administered at a local, state, or federal level. Furthermore, there need to be greater rewards under governmental reimbursement programs\u00a0for those providers who embrace risk and demonstrate their ability to reduce the morbidity of a defined population. <\/span><\/span><\/span><\/p>\n

Out on a Limb:<\/span><\/b><\/p>\n

Panacea, silver bullet, and transformational change \u2013 these are powerful, almost Pollyanna-ish words to use in a serious article about health system change. Yet I\u2019m convinced that this change represents our path to salvation, if we are willing to make the arduous journey. <\/span><\/p>\n

A blog will never do justice to a proper articulation of the wellness argument, but hopefully it is a start. I welcome your thoughts!<\/span><\/p>\n

\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

What if I told you that there was a panacea to our nation\u2019s health care crisis? Would you burst into laughter, stop reading, or simply conclude that I could not possibly understand the complexity of issues underlying our health system\u2019s dysfunction?\u00a0 After all, everyone knows that there are no silver bullets in real life. Yet, […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[9,10],"tags":[48,71,75,102,105,118],"class_list":["post-174","post","type-post","status-publish","format-standard","hentry","category-healthcare","category-healthcare-reform","tag-chronic-disease","tag-healthcare-costs","tag-health-care-transformation","tag-positive-health","tag-prevention","tag-wellness"],"_links":{"self":[{"href":"https:\/\/leifer.com\/index.php?rest_route=\/wp\/v2\/posts\/174","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/leifer.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/leifer.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/leifer.com\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/leifer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=174"}],"version-history":[{"count":0,"href":"https:\/\/leifer.com\/index.php?rest_route=\/wp\/v2\/posts\/174\/revisions"}],"wp:attachment":[{"href":"https:\/\/leifer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=174"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/leifer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=174"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/leifer.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=174"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}