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Unlocking preventive care's potential

Ken Thorpe, PhD and Kavita Patel, MD

In the United States, nearly 1 in 4 Americans die from a preventable cardiovascular disease [1], costing the nation an annual $444 million [2].  U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell recently announced that the Centers for Medicare and Medicaid Services (CMS) is rolling out a new accountable care model designed to reduce patients’ risk of cardiovascular disease by focusing on prevention [3].  The announcement coincided with a Bipartisan Policy Center (BPC) briefing on preventive care, featuring key health policy experts in Washington, D.C.  Both events indicate that the shifting health care landscape requires new ways to control costs and improve patient outcomes.
Part of the change we are seeing today in health care is tied to demographics.  Every day 10,000 baby boomers turn 65 and become eligible for Medicare, increasing the program’s cost.  A staggering 80 percent of the program’s spending covers more than 50 percent of the Medicare population that is treated for five or more chronic conditions like cardiovascular disease each year [4].  That is why Dr. Darshak Sanghavi, Director of the Preventive and Population Health Models Group at CMS’ Center for Medicare and Medicaid Innovation (CMMI), mentioned Secretary Burwell’s announcement at the BPC briefing.  Prevention can help reduce Medicare spending on the chronically ill and improve beneficiaries’ current and future health status.
In fact, CMS’ new cardiovascular disease program aims to reduce the overall costs incurred by Medicare from cardiovascular disease and increase the quality of life for its beneficiaries.  The program will work with 300,000 beneficiaries across the country and score their risk of having a heart attack or stroke within the next ten years.  If their primary care physicians are able to reduce the risks of heart attack and stroke and save CMS money in the long run, the physicians will receive bonuses [5].  If the new program succeeds in reducing costs and improving quality of life, it could usher in new, exciting ways of compensating doctors for promoting prevention and saving dollars.  Attendees at the BPC briefing applauded this effort to promote effective preventive measures that both utilizes primary care physicians, who stand on the frontlines of fighting for healthy seniors, and incentivizes physicians to think about the long-term costs and quality of life for Medicare beneficiaries.
While CMS’ new programs offer a lot of promise, Medicare Advantage (MA) has been successfully integrating preventive services into health care delivery for years.  MA has a long history of providing beneficiaries with high quality, coordinated care with a strong emphasis on prevention.  Over 17 million MA beneficiaries currently benefit from services like preventive screenings, home health visits and educational mailings with prevention calendars and recommended testing.  In fact, over the past decade, beneficiaries using MA have used fewer services – including those needed to treat cardiovascular disease – through lower rates of hospitalization and admissions, than beneficiaries using traditional Medicare [6].  Evidence continues to show MA plans effectively use preventive services to reduce overall utilization and cost, improving health outcomes and increasing patient satisfaction.
As health care delivery and physician payment reform continues, prevention will become an even larger part of discussions around controlling costs and improving quality.  Secretary Burwell’s announcement and the BPC briefing underscore a growing need to find new ways to better deliver care and keep patients healthy.  And Medicare, specifically Medicare Advantage, will be a key driver of that innovation.








Monday, June 15, 2015