Kenneth E. Thorpe

The prevention and wellness initiatives in PPACA are critical to the law’s success, in terms of reducing health care spending and improving health outcomes. There is an indisputable body of research that shows when prevention is done right (i.e., evidence-based programs that target at-risk populations), the savings—in lives and dollars—is great. A recent Health Affairs article shows that increasing the use of 20 proven clinical preventive services (including tobacco cessation screening, alcohol abuse screening, and daily aspirin use) from current levels to 90 percent in 2006 could avert the loss of more than two million life-years annually and result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending.

Prevention and wellness initiatives in PPACA, while requiring an initial investment, pay for themselves over a 10-year window, and many in as few as 2-3 years. Workplace and community wellness programs supported in the bill are extremely e

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

The cost-saving potential in Medicare is great. While we’ve already begun to realize some of the cost-savings in Medicare via the implementation of several PPACA provisions—The Obama Administration released a report in August of this year showing a savings of $8 billion by the end of next year, and as much as $575 billion over the rest of the decade—we have only scratched the surface of cost savings in Medicare. There are three additional areas with significant cost-saving potential that would help to improve health outcomes and reduce federal spending:

1. Reduce Preventable Hospital Readmissions. 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.

2. Implement Care Coordination in Medicare. Increased care coordination in Medicare has the pote

OMB Director Peter Orszag is right, there are health care savings to be found in our current health care system. Several delivery system reforms included in PPACA have the potential to transform our health care system and save billions of dollars. Below are three crucial, cost-saving elements of health reform that must be fully appropriated:

1. Prevention: Seventy-five percent of health care spending is linked to treating chronic conditions, such as diabetes, hypertension and cancer. These chronic conditions are largely preventable and if caught early, the costly complications can be effectively managed and minimized. Preventive education and early intervention programs are critical to managing and preventing chronic disease and many effective, evidence-based programs are already in place across the country. Community based programs like the use of the Diabetes Prevention Program Protocols by YMCA and other organizations can reduce the incidence of diabetes by 58 percent and reduce health care spending within two years. If the federal government paid even a third of

The first thing we need to clear up is what is meant by prevention. Too many, including John Goodman and much of the press, defiine prevention simply as disease detection (secondary prevention). These preventive efforts include cancer and other screenings and are intended to detect disease earlier to allow more effective clinical interventions that could improve the quality and/or longevity of life. They are not fundamentally intended, and never have been, to save money.

Two other forms of prevention do save money and its here we need to invest. The first, primary prevention efforts to reduce smoking and weight when appropriately designed can save money, and improve clinical outcomes. A national randomized controlled trial showed that the diabetes prevention program--a specific diet, exercise, nutrition and educational intervention targeting overweight prediabetic adults reduced the incidence of diabetes by 58%. This is compared to a 24% reduction (relative to placebo) for metformin, a proven medication designed to regulate blood sugar levels. The DPP has been adopted in c

Real Health Care Reform

Health reform had a tough day. But we are not giving up yet. As we go forward we must focus on two facts that shape the expectations about health care reform. First 85% of Americans have health insurance and second 96% of voters in the last election had health insurance—their expectation is that reform would make insurance less expensive. By refocusing the attention on insurance reforms, and affordability those with insurance would have a major stake in the bill. And yes the proposal moves us along the path toward universal insurance.

Below are three ideas that are bipartisan, common sense and substantive. Making progress relies on moving forward clear, commonsense reforms likely to attract bipartisan interest. These include reforming the health insurance market to protect children and adults, making health care more affordable for the 180 million Americans with private insurance, improving the quality of care for all Americans, and moving forward alo

As in most debates, especially those that aim to make significant changes in policy, balance is a key to success, and that could not be more true than in answering the question of how best to change individual behavior from unhealthy to healthy through wellness programs.

There is a long line of corporate programs that are making a difference in the lives of their employees including Johnson & Johnson, Pitney Bowes, Caterpillar and yes Safeway. Using incentives and rewards, these companies and many more are improving the health of their employees by helping them quit smoking, lose weight, exercise more and better managing disease. The key to success is the employer providing incentives and rewards to their employees to participate in these wellness programs.

However, allowing variation in premiums based on behavior is another idea to try and get people to change their behavior. Current proposals before Congress limit the variation in premiums to 7.5 to 1. This variation includes basing it on smoking status, a proven harm to health. In fact, participation in a w