There is no doubt that preventing people from becoming sick will improve the quality of life for millions of Americans dramatically. More than one-half of Americans are currently living with one or more serious chronic disease.
Certainly, some preventive care will only provide the benefits of improved health. However, if the country can be strategic with the investments in prevention, we can improve the bottom line and curb spiraling health care costs.
A 2008 report, "Prevention for a Healthier America," developed by TFAH with the New York Academy of Medicine (NYAM), The Robert Wood Johnson Foundation (RWJF), The California Endowment (TCE), and Prevention Institute, found that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years. This is a return of $5.60 for every $1.
More recently, TFAH released "A Healthier America: Strategies to Move From Sick Care to Health Care in Four Years," which provides high-impact recommendations to prioritize prevention and improve the health of Americans. In the report, the recommendations are paired with examples happening across the country and include preventive initiatives that target health concerns, including asthma, diabetes, prescription drug abuse, childhood obesity, physical (in)activity and workplace wellness.
In addition to the two reports, communities across the country are showing that fighting against spiraling health care costs and for improved health by focusing on prevention benefits everyone. By centering on asthma, diabetes, physical activity and other issues, hospital systems, nonprofits, state and local governments, accountable care communities and insurers are getting a real return on their investment when they focus on prevention.
The ROI of Asthma Prevention
The Community Asthma Initiative (CAI), implemented by Boston Children's Hospital, has provided support to improve the health of children with moderate to severe asthma in at-risk Boston neighborhoods. The CAI has led to a return of $1.46 to insurers/society for every $1 invested, an 80 percent reduction in percentage of patients with one or more asthma-related hospital admission, and a 60 percent reduction in the percentage of patients with asthma-related emergency department visits.
The Green & Healthy Homes Initiative (GHHI) was founded in 2009 to break the link between unhealthy housing and unhealthy children. In 16 cities nationwide, GHHI has achieved a 67 percent reduction in hospitalizations and emergency department visits for children with asthma episodes, saving taxpayer funds supporting Medicaid; accounted for fewer missed school days, improving education attainment and parents' presenteeism; and improved the use of federal dollars.
The ROI of Diabetes Preventive Services
The first-of-its-kind Accountable Care Community (ACC), launched by the Austen BioInnovation Institute in Akron, Ohio, brings together more than 70 partners to coordinate health care inside and outside the doctor's office for patients with Type 2 diabetes. By improving care and making healthier choices easier in people's daily lives, the ACC reduced the average cost per month of care for individuals with Type 2 diabetes by more than 10 percent per month within 18 months of starting the program -- an estimated savings of $3,185 per person per year.
The Diabetes Prevention Program (DPP) is based on the Diabetes Prevention Program Research Study that was led by the National Institute of Health (NIH) and supported by the Centers for Disease Control and Prevention (CDC). The study demonstrated that modest weight loss of 5 percent to 7 percent and increased physical activity to 150 minutes a week through a lifestyle change program reduced the risk of developing Type 2 diabetes by approximately 58 percent. The YMCA of the USA and UnitedHealth Group (UHG) are inaugural partners in the National DPP. In the past two years, the YMCA's DPP (partially funded by CDC and UHG) has trained more than 800 lifestyle coaches, started more than 300 classes in 30 states around the country, and served nearly 6,000 participants, one-third of whom have finished the program. Participants in the Y's program lost an average of 4.8 percent of their body weight, while hundreds of individuals lost an average of 7 percent of body weight.
State and Local Governments and Prevention
In response to increasing premiums due to over-utilization of health care services, poor preventive adherence, and lack of attention towards early detection, in 2009, Nebraska created an Integrated Health Plan. State employees who qualify for the new health plan have lower premium costs and access to comprehensive preventive coverage and year-round wellness programs. In order to qualify, any employee or spouse needs to complete three steps on an annual basis: Participants choose and enroll in their choice of a wellness program (some of which are provided by the state), participants complete a biometric screening option, and participants complete an online health assessment.
Since the integration of Nebraska's new health plan, there have been significant improvements in some high-risk areas. Along with health improvements, the state also saw a reduction of health care costs during the first two years of the program. When comparing wellness program participants' health costs to non-wellness participants, the state saw a reduction of $4.2 million in medical and pharmacy claims. The return on investment for the program in the first two years was $2.70 for every $1 invested in wellness programs.
Insurers and Prevention
Much like many hospitals and hospital systems across the country, insurers are increasingly turning to prevention as a way to improve the quality of life of their patients. In addition, they see prevention as a way to cut their health care costs and improve their employees' health, well-being and productivity.
Blue Cross and Blue Shield (BCBS) companies are using their resources, including hundreds of employee volunteers, to promote wellness and the prevention of disease through programs tailored to meet the needs of rural, urban and targeted ethnic and cultural communities. They have partnered with the first lady's Partnership for a Healthier America to sponsor 40 new Play Streets -- roads closed to traffic and open to the community to encourage physical activity. They also partnered with community organizations to launch Healthy Kids, Healthy Families, focusing on nutrition education, physical activity, managing and preventing disease, and supporting safe environments with the goal of improving the health and wellness of at least 1 million children over three years across its health plans in Illinois, New Mexico, Oklahoma and Texas. In Nebraska, they partnered with community organizations to launch Omaha B-cycle, the first large-scale municipal bike sharing system in Omaha. And, they are working to address health care disparities in low-income and ethnically diverse communities by funding 12 safety net health care center programs in Maryland, Virginia and D.C. that provide health care services for low-income, medically-underserved communities.
Kaiser Permanente funds community health initiatives (CHI) that take a preventive approach to health care through targeted grantmaking and convening and partnering with community organizations. Their CHIs focus on policies and programs that promote healthy eating and active living -- HEAL -- where people live, work and play. Their approach is to assess a community's health, make investments in their needs, and track outcomes, with a minimum of a seven-year to 10-year investment to ensure behavior and health changes.
Strategically and Smartly Investing in Prevention
In "A Healthier America," TFAH argued that moving the nation from a sick care system (wherein we treat people only after they become ill) to a true health care system (that keeps people healthy in the first place) has the potential to keep people healthy and cut costs. The report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective. Some recommendations include:
- Advance the nation's public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities.
- Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor's office.
- Integrate community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities.
- Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs.
- Maintain the Prevention and Public Health Fund and expand the Community Transformation Grant program so all Americans can benefit.
- Implement all of the recommendations for each of the 17 federal agency partners in the National Prevention Strategy.
- Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.
Prevention delivers real value as a cost-effective way to keep Americans healthy and improve their quality of life. Everyone wins when we prevent disease rather than treating people after they get sick. Health care costs go down, our local neighborhoods are healthier and provide more economic opportunity, and people live longer, healthier, happier lives.
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