Nearly half of Americans have at least one chronic illness, and patients with chronic diseases account for 75% of all health care spending. Yet according to estimates by the World Health Organization, three lifestyle interventions – not smoking, eating healthy and getting in shape – could prevent at least 80% of all heart disease, stroke, and type 2 diabetes, and more than 40% of cancer.

Why the disconnect? Partly, it’s due to barriers to care, many of which have been removed through the passage of the Affordable Care Act. The legislation eliminated cost sharing for preventive services, appropriated funds for additional wellness programs, and provided a new wellness exam and care plan for Medicare patients, a particularly vulnerable population. However, structured lifestyle intervention programs – like the diabetes prevention program –DPP-(or more broadly we should call it the chronic disease prevention program) – have shown that personal change requires more than a systemic emphasis on early wellness interventions. Effective prevention programs also focus on well designed diet, exercise and nutrition programs.

Well documented evidenced-based programs can absolutely help to encourage healthier lifestyles. The YMCAs have adapted the DPP protocol to a community setting at very low cost. Structured lifestyle interventions in the DPP have shown a 58%reduction in the incidence of diabetes, with cost savings within 2 years, if the direct costs of the intervention can be reduced to $250 - $300 per year. This program is widely adopted and can be implemented in many community settings. One way to reduce Medicare spending is to encourage enrollment of adults, at age 50 or earlier, to improve the health profile of incoming Medicare beneficiaries, reducing lifetime Medicare spending.

Research-based evidence shows that making changes in the way we practice care, such as transitional care, patient coaching, medication management and reconciliation, and community-based lifestyle change interventions like the adapted DPP model, produce better health outcomes and can reduce health spending. Natural behavioral shifts toward better health and wellness are going to take time. In the meantime, we can focus on supporting Americans through evidence-based programs that are proven to help them improve health. These evidence-based programs should be a major priority of federal funding to scale and replicate these effective models as expeditiously as possible.