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Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
Prevention: Medicine for the Health Economy
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Prevention: Medicine for the Health Economy

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  • Chronic conditions linked to obesity, including type 2 diabetes, high blood pressure, heart disease, arthritis and some cancers, require extended care (CDC, 2009)
  • http://www.youtube.com/watch?v=7QwX_soZ1GI
  • Transcript

    • 1. Prevention:Medicine for the Health Economy Peter Wolff March 27, 2013 IHL 6049 – Integrative Wellness Management
    • 2. State of the Nation Lifestyle choices, including poor nutrition, lack of exercise, tobacco use, and excessive alcohol consumption, are the primary causes of chronic health conditions, leading to 70% of all deaths nationally. 75% of health care dollars are spent on preventable, chronic conditions. More than two-thirds of surveyed Americans believe more attention needs to be placed on preventing chronic disease. (CDC, 2009)
    • 3. Research Question How do we bend the cost curve on health? I intentionally limited the scope of the research herein by applying a health economics lens, with the intention of discovering promising models of health care that fit into existing financial structures.
    • 4. Motivations Understand how integrative health and health promotion fit into the landscape of our health economy. Be prepared for business and policy negotiations in corporate, government and non-profit organizations. Construct a vision for a sustainable future of integrative health and wellness.
    • 5. The Data
    • 6. We’re #1! In 2009, the United States spent more on health as a percentage of GDP than any other nation  USA – 17.4%  Japan – 8.5%, while providing comprehensive health coverage to all if its citizens (Squires, 2012) The United States ranks  22nd among industrialized nations in life expectancy  27th internationally in infant mortality (CDC, 2012)
    • 7. More on Spending Concentration of Health Care Spending in United States spent more than $2.6 trillion on medical care in 2010, the U.S. Population, 2009 or $8,458 per person. Percent of Total Health Care Spending (≥$51,951) (≥$17,402) (≥$9,570) (≥$6,343) (≥$4,586) (≥$851) (<$851) Note: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian noninstitutionalized population, including those without any health care spending. Health care spending is total payments from all sources (including direct payments from individuals and families, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care),
    • 8. Why the Inflated Costs? Pharma accounts for 10% of spending, with a 114% surge in spending between 2000 and 2010 (Kaiser, 2012) Medical technology accounts for about 50% of the growth in health care spending. (Smith, Newhouse, & Freeland, 2009) Employee / patient ratio increased from 2.8 to 8.4 between 1970 and 2010 (Getzen, 2010, p.10)
    • 9. Three Big ReasonsHigher pricesMedical technologyObesity(Commonwealth Fund: Squires, 2012)
    • 10. Poll How many of you have health insurance? IHL survey 2012  28% had no health insurance  38% are managing a chronic health condition
    • 11. Insurance – Who Has It?
    • 12. Who Doesn’t
    • 13. Bright Spots Children’s Health Insurance Program (CHIP)  Access to care for children has improved, with the rate of uninsured children declining to an all time low of 8% in 2010 (CDC, 2012) Patient Protection and Affordable Care Act (ACA)  Provisions of the law will extend health insurance coverage to uninsured citizens at the beginning of 2014
    • 14. How Did This Happen?
    • 15. Health in the Free Market In all other industrialized countries, access to affordable care is centrally governed and financed through universal insurance-based or single-payer systems (Squires, 2012). In the United States, market efficiency is purported to provide an “optimal” balance of health services for all who need them (Reinhardt, 2001). Since the 1970s, we have seen greater degrees of social inequity and unprecedented price inflation for health services.
    • 16. Insurance
    • 17. Players
    • 18. US Health Care System Mix of private insurance and single-payer systems Who pays?  48% - US government  34% - Private insurance companies  11% - Personal wages or savings  7% - Charities (Getzen, 2010)
    • 19. Characteristics of Insurance Uncertainty of an expected medical loss motivates people to purchase insurance. Moral hazard is the observed change in human behavior, to engage in more high-risk activities, due to the presence of insurance. Adverse selection is a behavioral condition in which people with the highest need for health care are also the most likely to seek out insurance. (Getzen, 2010)
    • 20. Health Care Reform? Bill Moyers interview http://www.youtube.com/watch?v=7QwX_soZ1GI
    • 21. Affordable Care Act Extend coverage to the uninsured Control costs Improve quality of care
    • 22. More Coverage Approximately 32 million uninsured Americans will gain health benefits About 50/50 split between increased Medicaid enrollment and mandatory insurance obtained from private plans via state-run insurance exchanges (Washington Post, 2010)
    • 23. Prevention
    • 24. Chronic Disease The rising tide of health care costs are running parallel to the rise in obesity.  Obesity was responsible for 27 percent of the rise in inflation-adjusted health spending between 1987 and 2001 (Thorpe, Florence, Howard & Joski, 2004).  Across all payers, obese people had per capita medical spending that was 42 percent greater than spending for normal-weight people in 2006 (Finkelstein, Trogdon, Cohen & Dietz, 2009)
    • 25. Obesity Trends* Among U.S. Adults, BRFSS 1990 (1) (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%
    • 26. Obesity Trends* Among U.S. Adults, BRFSS 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    • 27. Obesity Trends* Among U.S. Adults, BRFSS 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    • 28. Obesity Trends* Among U.S. Adults, BRFSS 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    • 29. Obesity Trends* Among U.S. Adults, BRFSS 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    • 30. Obesity Trends* Among U.S. Adults, BRFSS 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    • 31. Obesity Trends* Among U.S. Adults, BRFSS 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
    • 32. Obesity Trends* Among U.S. Adults, BRFSS 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
    • 33. Obesity Trends* Among U.S. Adults, BRFSS 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
    • 34. Obesity Trends* Among U.S. Adults, BRFSS 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
    • 35. Obesity Trends* Among U.S. Adults, BRFSS 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
    • 36. Obesity Trends* Among U.S. Adults, BRFSS 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 37. Obesity Trends* Among U.S. Adults, BRFSS 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 38. Obesity Trends* Among U.S. Adults, BRFSS 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 39. Obesity Trends* Among U.S. Adults, BRFSS 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 40. Obesity Trends* Among U.S. Adults, BRFSS 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 41. Obesity Trends* Among U.S. Adults, BRFSS 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 42. Obesity Trends* Among U.S. Adults, BRFSS 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 43. Obesity Trends* Among U.S. Adults, BRFSS 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 44. Obesity Trends* Among U.S. Adults, BRFSS 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 45. Quality of Preventive Care“When lawmakers discuss providing access to andfunding for prevention, they usually mean reimbursingclinical screenings performed in a doctors office”(Goetzel, 2009).“Statistically, nationwide, anywhere from 50%, and insome places 80%, of patients have chronic conditions andpreventive health needs that are not being met”(Brown, 2012).
    • 46. Prevention in the ACA Although the ACA catalyzed the National Prevention Strategy effort with a call to shift the focus from sickness and disease to prevention and wellness, no explicit funding for health promotion initiatives like behavior change, lifestyle choices, and self-care practices is included, only recommendations. Sequestration is impacting the relatively small budget allocated for preventive screenings.
    • 47. Prevention in the ACA Employers have the ability to encourage participation in wellness programs by using discounts or incentives valued at up to 30 percent of insurance premiums costs.
    • 48. Possible Solutions Accountable Care Organization (ACO) Employer-based Prevention Clinics
    • 49. Integrative Primary Care Patient Centered Medical Home (PCMH) More time with patients is shared between doctors, advanced-practice nurses, physician assistants, health educators, social workers and pharmacists
    • 50. Cost and Quality In the Colorado pilot, acute inpatient admissions declined 18 percent and emergency department visits dropped by a 15 percent. The control groups in the study saw increased utilization. High satisfaction - 97 percent of participants in the Colorado study said they would recommend the medical home to family and friends. The New York medical home pilot demonstrated per patient per month cost reductions of 14.5 percent for adults and 8.6 percent for children compared to the control group
    • 51. Integrative Primary Care Employer-based Prevention Clinic The short-term objective is reducing utilization of expensive emergency room visits and hospital care, but the long-term justification is creating a healthier workforce by preventing and managing chronic disease.
    • 52. Cost and Quality Given their business orientation, most employers are seeking a financial return on the cost of implementing a program. Worker focused programming is not encumbered with institutional limitations. Employers free to adopt complementary and alternative modalities of healing, such as meditation, yoga, or Traditional Chinese medicine.
    • 53. Trends Pa ent- Centered WorksiteMedical Home Preven on Clinic Primary Care Health Insurance Preven on with CAM Biomedicine Employment Preven on with Primary Care

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