Community leaders in public health and prevention, including EOHHS Secretary JudyAnn Bigby, doctors at the frontlines of providing care, and public health experts, met at the State House this morning to celebrate the launch of the Prevention for Health Caucus, chaired by Senator Harriette Chandler and Representative Jason Lewis, and to stress the vital need for health promotion and prevention efforts here in Massachusetts.
The takeaway message of the event was: Prevention efforts must be included in upcoming health care payment reform.
Reiterated by all the speakers this morning was the critical need to transform our current health care system, which focuses on treating illness, into a system that focuses on keeping people healthy and preventing disease. Massachusetts spends 97% of its health care dollars to treat illness, leaving only 3% of those dollars to prevent diseases and promote wellness. However, 88% of individuals’ health is determined by one’s environment and behaviors, not the health care received. In Massachusetts, diseases related to smoking, obesity and physical inactivity are the leading causes of preventable death, and result in billions of state dollars lost to preventable medical costs and productivity losses.
However, as a physician working at one of Lawrence’s community health centers emphasized this morning, our health care system’s current fee-for-service payment method doesn’t encourage him to help his patients change behaviors to improve their health. While it pays providers to diagnose and treat asthma or diabetes, it does not offer equal financial rewards for providing nutrition counseling or smoking cessation programs. Further, for community health centers, whose financial health is intrinsically linked to partner hospitals, prevention efforts can result in even greater loss of revenue due to reduced emergency department admissions at their partner hospital.
Not only does the current system fail to reward providers for keeping their patients healthy, it does not address the environmental factors that drive health-influencing behaviors, such as nutrition and physical activity. Many patients in Lawrence have no local access to fresh, nutritious produce, with the closest supermarkets being in neighboring suburbs. Without a car, the cost of transportation creates a significant barrier for this community to access nutritious food.
Valerie Basset from Massachusetts Public Health Association emphasized that addressing the environmental factors that influence people’s health behaviors is just as important as promoting clinical preventions. These primary preventions, including improving the walkability and safety of neighborhoods and providing more nutritious school lunch programs, can enable and encourage health behaviors that prevent illnesses before they even happen. Including primary prevention in payment reform, by strengthen DPH funding and linking funding to health care payers, Basset emphasized, is an opportunity to maximize prevention efforts.
Further, she stressed, prevention makes good financial sense, with the potential to save Massachusetts nearly half a billion dollars each year with just a 5% reduction in diabetes and hypertension prevalence.
Reorienting our health care system to promote prevention and wellness, rewarding physicians for keeping their patients healthy and enabling individuals to promote their own health in their own environment, are important steps towards improving the health of the Commonwealth and priorities of HCFA’s own Campaign for Better Care. The Prevention for Health Caucus is an exciting new leader and partner in efforts to ensure these prevention priorities are a key consideration as the legislature moves forward on the next phase of health care reform.