StrataGist 2010

One Analyst's Observations…

Working From Within: Proactive Health Care (April 2010)

While many citizens and politicians consider the current U.S. health care system to be broken, progress is being made on some fronts. Several health care organizations are gathering and disseminating information that can embolden and enlighten patients, payers, and providers.

Health Care Research Sources:

Peruse the web sites of the following groups and you'll encounter interesting and useful findings that range from clinical and medical outcomes to consumer surveys:

Proactive Health Care:

Programs and tools that enable Americans to take better care of themselves have been widely developed and implemented over several decades: Disease management, health savings accounts, home health care, nurse advice phone lines, telephone triage systems, etc. In April 2010, the Robert Wood Johnson Foundation highlighted the Chronic Care Model, noting that nearly half of all Americans live with at least one chronic condition, a figure which is expected to increase nearly 30% by 2030. Chronic disease management is recognized as an effective way to prevent complications and costly medical interventions, but many health care systems and practitioners are not coordinating or providing the training and follow-up patients need to practice proactive self-care. The Chronic Care Model offers a graphic outline that health care system administrators can use to implement quality improvements at organizational, practice, and patient levels through clinical and patient teamwork, community resources, disease management techniques, guidelines, etc.[1]

One health care system is responding to the challenge. According to a recent Herald and News article (Klamath Falls OR), the Board of Sky Lakes Medical Center is implementing a proactive health care program to improve Klamath County's health care ranking within Oregon (from its second-to-last position). RWJF report findings indicate that approximately 25% of adults in Klamath County smoke, while 25% are obese, and 5% of females age 15 to 19 have a child (compared with less than 4% statewide). Sky Lakes will concentrate on funding, policy making, and strategic planning to promote benefit programs and community outreach.[2]

Preventive Measures:

The Agency for Quality Health Research (AHRQ) and Centers for Disease Control and Prevention sponsored the U.S. Preventive Service Task Force to gather and publish recommendations to improve Americans' lifestyle choices. Maintaining the status quo has tragic consequences: More than 33% of premature deaths in the United States are linked to physical inactivity, poor diet, and tobacco use. Intervention with evidence-based preventive strategies in clinical and community settings could reduce a portion of those deaths.[3]

In March 2010, the Kaiser Family Foundation posted a panel discussion video that discussed how engaging consumers in health care self-management can control costs and improve outcomes.[4] Engagement may be possible, but getting consumers to pay for preventive or proactive care may be an uphill battle. According to a 2009 survey conducted by IBM, cost is the primary barrier to seeking health care for many Americans, regardless of employment or insurance status. The findings indicate that 55% of the entire survey pool, 76% of unemployed Americans, and 81% of uninsured Americans "can't afford" out-of-pocket wellness visit costs. One-quarter of respondents did not see their physicians for wellness visits during the prior year. Wellness is also a driving force in the emergent wireless health care services. The article suggested that such a lack of interest may adversely affect the growth of that market, since consumers seem unwilling to pay out-of-pocket for their own wellness care.[5]

Americans already spend quite a bit in out-of-pocket health care costs. According to national statistics published in the Statistical Abstract of the United States (2007), "private consumer" out-of-pocket and health benefit expenditures (excluding net cost of insurance) rose from $340.7 billion in 1990 to $948.9 billion in 2007. Americans also support a $1.0 billion supplement market ("The U.S. Supplements Market" report from Kalorama Information). Weight loss products ranging from diet sodas to diet food, meal replacements, and pills generated an estimated $24.5 billion in 2006 ("The U.S. Weight Loss & Diet Control Market" from Marketdata Enterprises, Inc.). For consumers who are independently pursing their own "self care" solutions, wellness visits may seem redundant or unnecessary.

For past issues of StrataGist, visit the 2008-2009 and 2010 Archives.

[1] "Proactive Health Care Approach Lauded," Herald and News, April 22, 2010.
[2] "Making Health Systems Work For People With Chronic Conditions," Robert Wood Johnson Foundation, April 1, 2010.
[3] "Integrating Evidence-Based Clinical And Community Strategies To Improve Health Methods," U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality (AHRQ).
[4] "Better Care--Lower Costs: Exploring The Promise Of Patient Engagement," Kaiser Family Foundation, March 5, 2010.
[5] "IBM: Cost Prohibits Proactive Healthcare," Mobi Health News, August 17, 2009.