Monday, January 26, 2009

Health Affairs Broadcast: Prevention Doesn't Save Money. Is Anyone Listening?

Now that the Obama Health Reform Dirigible is about to be launched, recall much of its ballast is predicated on the twin notions that electronic health records (EHRs) and prevention will ‘save money.’ Both fictions have been past topics of the Disease Management Care Blog, which is confident that both initiatives will add to health care costs. The DMCB doesn’t think additional cost is not necessarily a problem, so long as the end-user patients get reasonable value for their dollar. It’s just that the DMCB distrusts the ability of a huge sprawling ‘mainframe’ Federal bureaucracy to get anything right.

You don't have to take the DMCB's word for it. To learn more about the important topic of prevention, the DMCB recommends Rutgers University’s Louise Russell’s Health Affairs perspective piece. Freshly published, short, to the point, highly readable (few references to ‘QALYs’) and packed with references pointing to the original research, it points out what many health services researchers have been saying for decades: most interventions designed to prevent heart attack via blood pressure or blood lipid control or aspirin cost. Well run programs that promote lifestyle changes to prevent diabetes cost. In fact, of the hundreds of published studies on the topic of prevention, about 80% have been shown that they cost.

Too bad disease management’s legacy is so entangled in the cost ‘savings’ business proposition, especially because many vendors also offer prevention programs. In its travels, the DMCB is still running into this simplistic black and white either-there-is-or-there-isn’t-an-ROI archetype. The truth is, depending on the population, the condition and the insurance benefit, some later generation disease management programs may reduce costs and, if not, are still a great deal for the healthcare dollar. If healthcare consumers want tailored programs to achieve blood sugar control, weight reduction, lower blood pressure or better fitness, it may well cost them via higher premiums from their health insurer. Is that necessarily bad?

The DMCB has read that the HHS Secretary Designate likes to relax by thumbing through issues of Health Affairs. Hopefully he’s read Dr. Russell’s manuscript. Hopefully the new class of Health Czars is aware of the budgetary implications of promoting healthcare prevention programs. Hopefully they’ll get around to telling the American public the truth. By the way, Governor Ed Rendell (D) of Pennsylvania has amply demonstrated that taxpayers are willing to take on new costs if it’s in their interest. I’m sure he’d be willing to share some pages out of his playbook.

For more peer-reviewed truth than you’ll ever want to know about the topic, check out this link at the Tufts CEA registry. It was used by Dr. Russell in her paper. The registry reminds the DMCB of the commercial in which the hapless traveler checks into a dusty motel and is told he can access every movie ever made in every language anytime day or night. When it comes to a huge organized data base of intervention studies that reconcile the benefit versus the cost of care, the same is true here: every paper ever published in every journal anytime day or night.

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