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Health Reform Calls for Preventive Care, But Questions Persist About Savings

Les Masterson, for HealthLeaders Media, June 29, 2009

Supporters say prevention will save the nation billions in averted long-term healthcare costs, and recent studies show that Americans support investing in prevention. But questions persist—most notably from the Congressional Budget Office.

Prevention has been mentioned as an important piece of healthcare reform. In its health reform draft proposal, The House Committees on Ways and Means, Energy and Commerce, and Education and Labor shed some light on where the prevention dollars would flow:

  • Expand community health centers
  • Waive cost-sharing for preventive services in benefit packages
  • Create community-based programs to deliver prevention and wellness services
  • Target community-based programs and new data collection efforts to better identify and address racial, ethnic, and other health disparities
  • Strengthen state, local, tribal, and territorial public health department programs

This proposed package of prevention programs in the healthcare reform debate would go beyond provider-based healthcare with supporters hoping to create a better wellness culture in the country. But will the government be more successful than doctors, employers, health plans, and population health companies who have struggled to get people more active and eat right? Then, there's the question whether prevention programs actually save money.

Employers and the population health industry have been discussing the issue of prevention and ROI for years. Groups, such as the Trust for America's Health, suggest the U.S. could save $16 billion annually within five years and experience a 5.6:1 ROI by simply investing $10 per person annually in community-based programs to increase physical activity.

Another study, funded by Pittsburgh-based health insurer Highmark Inc., found a modest 1:64:1 ROI in a four-year review of the insurer's employee wellness program, which includes employer health risk assessments, online programs in nutrition, weight, and stress management, tobacco-cessation programs, on-site nutrition and stress classes, biometric screening, and health coaching.

Anna Silberman, vice president of preventive health services for Highmark, says the company's prevention program stops non-healthcare users from becoming "huge users of the system." Prevention not only reduces direct medical costs, but also saves companies and the nation on work-related costs in the areas of absenteeism, work production, and presenteeism, she says.

Silberman says the healthcare system should reward physicians for educating their patients about prevention and reminding patients of recommended tests, such as mammograms and diabetes screenings. "There are so many things that we can do that often get put on the backburner because we're dealing with the acute thing that's happened as a result of not addressing them earlier in our lives," she says.

However, there are others who say prevention doesn't save much—if anything. The issue is that preventive programs are open to a wide population rather than those who could be at risk of chronic diseases, such as diabetes, heart failure, or kidney disease. So, in fact, the companies are using a wide net to help people who may never have a chronic disease or are destined for a chronic disease regardless of activation level or food choices.

One group to question the cost-effectiveness is the CBO, which suggested in December that more prevention would bring modest cost reductions over 10 years, and could actually increase costs.

Mary Jane Osmick, MD, vice president and medical director at LifeMasters, a health management company in Irvine, CA, supports wellness programs, but acknowledges there are still questions about whether wellness programs can save money.

"My guess is that there is a [positive] ROI, but I don't know that we have the methodology to say this is what it is and this is when you'll see it. I think the jury's still out on that. But I sure believe it from a physician stand point, that prevention is the absolute way to go," says Osmick.

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