Valerie Bassett Massachusetts Public Health Association August 3, 2011

community-based

prevention

the need for

in payment reform

spending on “health care” vs. “sick care”

Each year, we spend

97% of our health care dollars caring for individuals once they’re already ill . . .

. . . and only 3% of those dollars on preventing diseases from developing in the first place.Source: Woolf S. The big answer: Rediscovering prevention at a time of crisis in health care. Harvard Health

Policy Review. 2006;7(2):5-20.

The New England Health Care Institute cites research showing that 88% of our health is determined by our environment and our behavior –

not by the health care we receive.

our health spending mismatch

Community-based prevention works to prevent illness and injury before they happen Settings include schools,

workplaces, neighborhoods

Clinical prevention involves screening and disease management Conducted in health settings

prevention must be part of payment reform

Community-based prevention efforts include: Serving healthier foods in schools to prevent

obesity Banning smoking in certain areas to prevent

exposure to secondhand smoke Building sidewalks and bicycle lanes to encourage physical activity

community-based prevention

Prevention can save Massachusetts nearly half a billion dollars each year.

A 2011 study showed that reducing the prevalence of diabetes and hypertension by 5% would lead to large decreases in medical costs within only a few years.

cost savings from prevention

Source: Ormond B, Spillman C, Waidmann T, Caswell K, Tereshchenko B. Potential national and state medical care savings from primary disease prevention. American Journal of Public Health. 2011;101(1):157-164.

Annual medical savings in Massachusetts after a 5% reduction in preventable medical conditions

$450.4

$55.0 $55.0

$192.6$147.7

$0$50

$100$150$200$250$300$350$400$450$500

TotalSavings

StatePortion -MedicaidSavings

FederalPortion -MedicaidSavings

MedicareSavings

OtherPayer

Savings

Mill

ion

s o

f d

olla

rs s

av

ed

Source: Ormond B, Spillman C, Waidmann T, Caswell K, Tereshchenko B. Potential national and state medical care savings from primary disease prevention. American Journal of Public Health. 2011;101(1):157-164.

projected savings from prevention

Treatment Expenditures in Massachusetts, Heart Disease

$3.35b

$1.37b $1.99b

1

1.5

2

2.5

3

3.5

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

Year

Bil

lio

ns

of

$

Projected, ifcurrent ratescontinue

Withmoderatechangestowardsprevention

Source: Milken Institute. An Unhealthy American: The Economic Burden of Chronic Disease. Available at: http://www.chronicdiseaseimpact.com/ebcd.taf?cat=state&state=MA

disinvestment from prevention

The Governor’s FY12 budget proposal slashes $25M in public health funding

The proposed cuts to the Department of Public Health follow more than $90M in cuts over the last three years, a loss of more than a quarter of state funding for DPH community-based programs since FY09.

Include a strong role and sufficient resources for the Department of Public Health in payment reform

Call for a DPH statewide plan for prevention, rather than relying only a plan for providing health care to those who are already ill

Support measures that will link funding for primary prevention to health care payers, such as the Prevention and Cost Control Trust

what can we do?

Stable source of funding for evidenced-based community health programs

Competitive grants awarded to communities and groups of communities

Oversight Board will document the most prevalent and costly health conditions  each year and identify evidence-based interventions

Requires a surcharge of less than 1% on Health Safety Net Surcharge Payers

Prevention and Cost Control Trust – HB1498

The bill to create a Prevention Trust, HB 1498, sponsored by Rep. Jason Lewis was reported favorably out of the Public Health Committee. It needs your help to stay alive. You can:

Sign on to MPHA’s letter at http://www.mphaweb.org/Prevention_in_Payment_Reform.htm

Call/meet with MA Health Care Finance Committee chairs and members to urge that the Prevention Trust be included in payment reform legislation. They are listed here http://www.malegislature.gov/Committees/Joint/J24

If you want to take more action on this or would like support, call MPHA and ask for Maddie 617-524-6696x111.( and sign up for our emails online at www.mphaweb.org !)

Questions?