Federal Prevention Fund: Two Steps Forward, One Step Back

When President Obama signs payroll tax cut legislation today at a White House ceremony, with him will be working Americans who represent the 160 million taxpayers the bill will benefit. Based on best estimates, a third of the men and women expected to be at Obama’s side are at risk for diabetes and have two or more risk factors for heart disease. Two-thirds will be overweight or obese and a third will have high blood pressure. In that light, the payroll tax cut extension loses much of its luster, as the bill also will cut $5 billion from the Prevention and Public Health Fund to help avert a scheduled 27 percent drop in Medicare physician reimbursements.

It’s a penny wise pound foolish approach to Medicare’s dysfunctional sustainable growth rate (SGR) that kicks the can down the road at the expense of programs to fight the very conditions that drive most health care spending. We fully support fair payment to physicians and understand the magnitude of the threat they face with the scheduled SGR adjustment. But gutting badly needed federal support for wellness and prevention isn’t a solution. It’s an exclamation point on the short-sightedness of this legislation and a disheartening step back just as the federal government appeared to be moving firmly forward toward supporting workplace and community health promotion initiatives.

We wrote recently about the “glaring disconnect” that remains between the strong evidence base for programs targeting diabetes and other chronic conditions and the broader application of those care strategies. Throttling back federal spending on wellness and prevention robs us of a promising opportunity to close that gap. Yes, we must find payment strategies that satisfy providers and promote greater quality, value and accountability in care—and there are lawmakers working toward this sensible goal, such as Rep. Allyson Schwartz, D-Pa. But until we’re there, let us not dig the spending hole deeper with stop-gap solutions that diminish our best chance to climb out: wellness, prevention and care management.

IOM Report Reflects Expanding Role of Population Health Management

Over the past couple weeks, there’s certainly been no shortage of commentary on our industry and its evolution from the early days of siloed, call center-based disease management to today’s integrated, sophisticated population health management (PHM).

Certainly, the recent CBO report was a catalyst for some of these conversations—especially as the Care Continuum Alliance (CCA) and others highlighted the outdated design of the programs detailed in that report. But another catalyst is the increasing interest in PHM strategies from public and community health organizations, as well as primary care groups.

This was reinforced in my mind this week as I read the Institute of Medicine (IOM) report, Living Well with Chronic Illness: A Call for Public Health Action. At the request of the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation, the IOM developed the report to identify public health strategies that reduce disability and improve the function of and quality of life for people with chronic conditions.

As you’d expect, the report focuses on public health and its authors almost exclusively are public health leaders. The important point here, however, is that the report gives great attention to and identifies significant opportunities for the current and likely future iterations of population health management strategies and services. Specifically, the report includes several recommendations significantly relevant to our industry, including that:

  • the CDC increase demonstration programs for chronic disease control that cut across specific diseases or multiple chronic conditions and emphasize mitigating the secondary consequences of various chronic conditions;
  • the Department of Health and Human Services and state and local government public health agencies evaluate existing, emerging and new models of chronic disease care that promote cooperation among community-based organizations, the health care delivery system, employers and other stakeholders to support living well with chronic illness; and
  • HHS supports states in developing comprehensive, collaborative, population-based strategic plans with resources that focus on the management of chronic illness, including community-based efforts.

A key takeaway from the IOM report: Ultimately, successful health care is local. Current federal and state policy priorities seek to advance this concept through community-based, primary-care led models to improve health and health care quality and to constrain costs. Yet, all stakeholders recognize that this evolution in health care delivery will require the integration and coordination of numerous care providers and services in new ways. We’re seeing this happen throughout the industry in multiple collaborative projects. The IOM cites other challenges, including a lack of incentives for care coordination and the prevalence of fee-for-service payments.

This week’s IOM report asserts the potential for community-based care and collaborative models to improve the lives of people managing chronic conditions and to mitigate the impact of chronic disease. These models will benefit from the very strategies and tools in the wheelhouse of population health management as practiced today. It’s a particularly salient point in a week when so many were overly fixated on old approaches to chronic condition care.

—Tracey Moorhead, President & CEO

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