Our health care system and the federal budget are drowning under the burden of chronic diseases, like obesity and diabetes, and their associated costs. Health care spending is a primary driver of our annual federal deficit and care for patients with chronic diseases account for three-quarters of our nearly $3 trillion in total health care costs. Yet many of the most common chronic diseases can be prevented or delayed through changes to diet, physical activity, and other lifestyle choices. Galvanizing a national effort to prevent disease is both a necessary and an urgent component of any strategy to improve our nation’s physical and fiscal health, yet efforts to systematize prevention have not reached scale for a number of reasons.
In a new report from Trust for America’s Health, the Bipartisan Policy Center’s (BPC) Nutrition and Physical Activity Initiative was invited to reflect on obesity and cost containment. In this expert commentary, we outlined a few strategies that could help accelerate prevention’s role in improving health and containing costs:
- Increasing investment in prevention — combined with continued learning from existing efforts about what is working best to improve health and cut costs
- Increasing investment in robust data collection with longer follow-up, including analyzing and disseminating information about what is learned
- Identifying areas of common ground and building partnerships among the full range of stakeholders
We drew these lessons from our experience contributing to a report released in April by BPC’s Health Care Cost Containment Initiative, A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment. This report proposes reforms to health care delivery and financing systems, highlighting the critical intersection between two often-siloed spheres of federal policy—health and budget. Though much of the report focuses on ways to improve quality and lower costs in Medicare, the authors recognize that—in addition to improved care coordination for chronically ill patients—reducing chronic disease prevalence is critical to controlling costs. And while the doctor’s office is an important venue to deliver advice and screening, we should complement those efforts with cost-effective prevention in our communities, our workplaces, our schools, and our homes.
Because the economic evidence base for prevention is in the early stages of development, experts disagree over the precise relationship between prevention and cost containment. More rigorous research is needed to identify and quantify what type of programs are most effective at improving health and saving money in large populations over time. Moreover, our current system often lacks the incentives to deliver and finance preventive services—especially in the non-clinical settings. To date, the amount of money spent on community-based prevention has been limited, the scope of the programs relatively narrow, and the timeframe relatively short
That is not to say there are not success stories. For example, some employers are seeing healthier, more productive employees and lower health care claims as a result of comprehensive workplace wellness programs. Groups of prediabetics are reducing their risk of developing diabetes by learning about and implementing strategies for healthy eating and active living with health coaches at their local YMCAs.
Both government and the private sector should further invest to improve our understanding of which prevention strategies work, develop innovative approaches based on the evidence collected, and better align incentives to support effective interventions. Consequently, the BPC report calls for increased investment in demonstration programs with rigorous evaluation to determine effectiveness, build the evidence base, and position all stakeholders to make more informed investments in programs that improve health and control costs.
For example, the report recommends investing some of the Prevention and Public Health Fund in demonstration programs to build the evidence base around prevention strategies. The National Diabetes Prevention Programs and Community Transformation Grants are just two examples of current programs being tested, but there is room to expand our inquiries, synthesize the findings, and share them widely with key decision makers across sectors.
We also recommend limited financial incentives to help spur private-sector investment and innovation in comprehensive workplace wellness programs—particularly for small businesses that face higher hurdles to designing, implementing and evaluating these programs. The Affordable Care Act authorized $200 million to be appropriated over five years for comprehensive workplace wellness, yet only a fraction of these funds have been allocated thus far.
While a successful national prevention strategy requires engagement from all sectors, the federal government has an important opportunity to catalyze research and development through the Prevention and Public Health Fund and accelerate our understanding of what works. We cannot yet say with precision what an ounce of prevention might be worth. But we do know that to stem the rising tide of chronic disease—and its associated costs—we must invest significant effort in changing the environment and behaviors that bring about such diseases.