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

Judith H. Hibbard, PhD, professor of health policy in the University of Oregon's Department of Planning, Public Policy and Management in Eugene, OR, who created the Patient Activation Measure, which is a questionnaire that gauges an individual's activation level in health, says whether prevention is cost-effective depends on the program. "If you mean by clinical prevention, I don't think it's going to get us that far. If you mean to really help people to avert illness or avert future declines in health, then yes, I think it could [save money]."

Hibbard says prevention programs can't merely happen in physicians' offices. Ninety percent of what determines an individual's health state is outside of the healthcare system. For prevention to be successful, the country will have to need a more encompassing wellness program.

"I think we have to take a more holistic view and get outside the system too. People live inside the community and not just look for the medical system to make that happen. They need to be part of the solution too—not divorced from it," says Hibbard about empowering the individual.

With that thought in mind, Sen. Tom Harkin, D-IA, filed legislation that would provide tax credits for employers that spark employers to participate in programs, such as health education and behavior change.

Health management company Alere also recently presented its National Health Improvement Strategy that it claims could save American businesses and health insurers "tens of billions of dollars" by focusing on preventing health risks and chronic illness. Alere CEO Ron Geraty, MD, promotes more collaboration between providers, employers, and health plans in the areas of health information technology, home monitoring services, rapid diagnostic tools, clinical outreach, and health coaching. He says these program could avoid episodic visits, procedures, and treatments. In addition to national nutrition programs, Geraty says the government needs to kick off a national healthy pregnancy campaign because healthy babies lead to healthy adults.

"We think a concerted strategy for the country is needed to say ‘we care about health, we promote health, and then when there is disease, we are actively managing the longitudinal impacts of those illnesses.' That will really change the way healthcare is delivered in the country," says Geraty.

What would need to happen?
In order to change the healthcare system to focus on prevention, industry experts pointed to a number of needed changes:

• Paying healthcare providers for keeping patients well, such as reimbursing for patient education, prevention, and early detection. "I think it's important for physicians and other healthcare professionals that there be a mechanism introduced where immunizations are adequately reimbursed for," says Silberman.
• Physicians need to be trained on nutrition and exercise so they can provide guidance to patients.
• Incentive programs for people who are active in physical or nutrition programs, which employers have found can improve the wellness culture
• Technology to make health a more compelling choice, such as portable interactive Web sites that integrate a person's personal health record and patient history. "Most people when they think of personal health records think of a place to store medical information, which I think is critically a part of it, but we think the PHR ought to be a personal healthcare planner," says Geraty.

Silberman says the good news is that much of healthcare costs is preventable. But to benefit from prevention, the nation will need to make major investments inside and outside of healthcare.

"There's so much potential when you think about the fact that 75% of what we cope with as a country is preventable," says Silberman.

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