The numbers are staggering. Medicare spending is expected to double by 2016 to $862.7 billion. U.S. health care spending is approaching $2 trillion a year, and is also expected to double in the next 10 years.
Driving the increases is the treatment of chronic diseases such as cancer, diabetes and heart and lung diseases. They are the leading causes of death in the U.S., and they are largely preventable — 80 percent of the risk factors are behavior-related. People smoke, eat too much, don’t exercise. Their lifestyles increase the chances of developing deadly, costly diseases.
If our health care system could shift a small percentage of total spending into programs that help prevent people from getting sick in the first place, it would dramatically reduce the overall cost of care.
And when people are sick, if we could target more resources to helping them manage their illness — rather than waiting for the next episode that requires hospitalization and treatment — we could help reduce health care costs and have healthier people.
One of the problems is that doctors, nurses and other care providers don’t have adequate financial incentives to focus on prevention. There are some 15,000 reimbursement codes under our Medicare system, and only a handful are for preventive care. Rather, the system today is designed around treating patients once they become sick.
There are few, if any, patient education billing codes, for example, allowing providers to be reimbursed for helping educate patients about the importance of exercise, proper diet or other activities that promote health. When tests reveal patients are at risk of a chronic disease, physicians have no incentive to help them make necessary changes to stay healthy.
Of course, convincing people to change behaviors and live healthier lifestyles is easier said than done. But it can be done, and is being done by hundreds of thousands of people.
One of the best examples of systematic behavior change can be seen in the way diabetes is now treated. When someone is diagnosed with diabetes, it is not a death sentence. People with diabetes can live long and healthy lives if they manage their blood glucose levels carefully, get exercise and maintain a healthy diet. The problem is that many need a support system, a coach, an advocate to help them stay on track.
Our company, Healthways, believes that every individual is capable of achieving his or her own level of personal health and well-being, even if they have a chronic disease. We provide the support system, not only for people with diabetes, but for people who are in the best of health and others who are in the final stages of life. We offer that support to more than 2 million people, and can demonstrate savings of more than $1 billion for our customers.
We see that prevention works. It is not a simple fix; but if we continue to work carefully to support individuals in making the necessary changes to live healthier lives, we will be making an investment in people that will have a very positive impact, on their health, and on the bottom line.
Dexter Shurney, M.D., is chief medical officer of Nashville-based Healthways.
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