His concerns are echoed by the Partnership to Fight Chronic Disease (PFCD), a coalition of advocates, providers, business groups, and health policy experts, which has identified three areas in which it says additional information is needed for policymakers to fully assess the effect of prevention programs:
- Baseline assumptions. Healthcare expenditure estimates depend on baseline assumptions, including the current health status of a population and the impact of those trends. The CBO needs to be more transparent in indentifying its baseline for analysis.
For example, the PFCD contends that it is not clear how the rise in obesity is factored into the baseline for current or projected spending, although research has shown that Medicare spending is directly affected by the obesity status of people entering the program.
- Broader perspective on impact. CBO scoring does not currently include analysis of the broader impact a policy change will have on healthcare and the economy. PFCD notes that because Medicare is the largest payer for healthcare services, changes to Medicare policy will likely impact the entire healthcare system. But for CBO purposes, only the impact on federal Medicare spending is captured. Wellness and prevention programs that impact population health affect healthcare spending in the private sector and have overall effects on the economy. Providing analysis of the overall impact of Medicare changes would provide lawmakers with important information.
- Long-term analysis. The CBO scoring windows cannot sufficiently capture the long-term value of population health improvement programs. Without an understanding of the long-term value legislation may provide, lawmakers are not able to distinguish between federal spending without expectation of a return and federal spending as an investment.