The current debate around how to best control burgeoning health costs has pushed the issue of prevention to the forefront. That’s right where it should be. By shifting our health care to be more pro-active and prevention-oriented, we can make a major impact on common and costly chronic diseases such as diabetes. In turn, this will help to secure the financial stability of our health care system and continued economic growth and prosperity.
Over the past century, the burden of disease among Americans has shifted from acute and infectious illness to chronic disease. With more than 75 cents of every dollar in this nation spent on patients with chronic disease, prevention offers the opportunity not to spend more money — but spend smarter. By embracing prevention, we can help more Americans lead healthier, active lives free from disease, so that they can avoid costly complications and hospitalizations, and remain productive in their communities and workplaces.
Prevention today involves a lot more than flu shots, cancer screening, and annual checkups. It is a pro-active strategy of disease avoidance and mitigation that should be embraced throughout and beyond the health system. In the context of chronic illnesses such as asthma, cancer, depression, heart disease and diabetes, prevention runs the gamut from lifestyle changes to screening for risk factors and symptoms, to early intervention to slow or reverse disease, to active management of already present cases.
The case of diabetes — one of the fastest growing and most-threatening chronic conditions in the U.S. — provides perhaps the most compelling example of our opportunity. For most individuals who progress to type 2 diabetes, the disease can be prevented or delayed significantly by following a well-established routine of diet and exercise. The potential impact of such an approach is enormous, both in terms of lives saved, and dollars saved.
Consider the economic impact alone. On average, diabetes patients have medical expenditures 2.3 times higher than those of other patients of the same age. With the incidence of diabetes expected to double worldwide by 2030, it is not only a medical necessity but an imperative to identify those at highest risk and implement disease prevention strategies.
Fortunately, we now have the tools to do just that. Recent advances in understanding the biological complexity of human disease have transformed our ability to predict and prevent the onset of chronic diseases such as diabetes. Where previously we had one somewhat inadequate tool for measuring diabetes progression — the fasting glucose test — today we have sensitive diagnostic tests capable of measuring a wide range of biological processes implicated in the advance toward diabetes. As a result, physicians can identify those patients at highest “near-term” risk for diabetes — and target intervention efforts to them.
Stratifying those truly at highest near-term risk among the 57 million Americans now considered to be “pre-diabetic” would streamline diabetes prevention, and allow physicians to focus their efforts on those most in need — thus transforming preventive medicine from a means to protect the general population to a truly personalized effort to fight disease in at-risk populations.
This fundamental shift would pay substantial long-term dividends in reduced medical expenditures, improved patient quality of life and improved workplace productivity. Economic research unveiled at the most recent American Diabetes Association meeting shows that such a prevention strategy would be cost-effective in the near-term, and actually save the health care system money over the long-term. Likewise, the Diabetes Prevention Program administered in community based settings — a well-recognized “gold standard” — illustrates that cost-savings can be achieved in two to three years.
Effectively adopting such a strategy requires a new approach throughout the health care system, from physicians whose familiarity or comfort with new technologies can be slow to develop; to professional organizations who can be slow to adopt changes that deviate from the status quo; to private insurance companies and government health plans, whose reimbursement support for physicians and patients who adopt such tests and prevention strategies into clinical practice is critical.
Health reform opens the door to making true progress on prevention. On the other side of the door lies better health for our entire population — and a healthier, more vibrant economy. To get there, we must embrace policies that make it easier for patients to actively prevent and manage disease — as well as those that encourage health care providers to collaborate on care of chronically ill patients and take steps towards paying for outcomes and not just volume of services.
These types of “game changers” are required to set us on the right path for our health and our economy by providing better results for all our health care spending.
Emory university’s Dr. Kenneth Thorpe is the Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management. Dr. Thorpe is currently executive chairperson of the Partnership to Fight Chronic Disease. In the early 1990s he served as a health care advisor to President William Jefferson Clinton.