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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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