Medical research and innovative service ideas are already helping to alleviate health care problems caused by the aging of the American population and rising prices, according to a panel of experts who gathered in Washington just before the November election.
Given the opportunity, scientists and health care providers can meet these and other new challenges, according to speakers at the conference, which set aside immediate political controversies and focused instead on the long-term challenges and opportunities facing the nation’s health care system.
Co-hosted by the Alliance for Aging Research and the American Pharmacists Association Foundation, the conference, “Beyond the Election: America’s Health Care Issues,” focused on the cost of disease in the United States, the costs and utilization of drugs, and programs that have demonstrated cost savings, including prevention efforts and lowering or elimination of copays.
The symposium’s featured speakers laid out the realities of health care costs in the coming years and paired the sobering numbers with real-life innovations on the business and community levels that have achieved a measure of success.
Moderator Grace-Marie Turner, president of the Galen Institute, invited participants at the National Press Club to study the major problems of the country’s health care system–such as rising insurance costs, the numbers of uninsured, and regulations and penalties that govern the system–and then to look at opportunities to improve the system through information technologies, care management, and prevention.
Costly Tsunami Approaching
Dan Perry, executive director of the Alliance for Aging Research, described the looming challenge of an aging population as a “tsunami of health care costs.”
He noted that although the debate over health care typically narrows during an election season, Americans must look to the decades ahead. “Seventy-seven million baby boomers are aging, with the first wave eligible for Medicare in six years. Promoting health and independence for older Americans must be a priority.”
Mortality rates continue to drop, said Perry, in response to new health care technology and better awareness of personal actions that can sustain good health. The actual number of disabled elderly was significantly lower than projected over the past 20 years, he noted, which resulted in lower costs than expected.
But Perry warned that $26 billion in hidden health care costs can be expected to arise from a coming decrease in the ability of older Americans to care for themselves–an ability that declines quickly after age 80. By 2030, he said, nursing home costs could reach $190,600 per bed per year.
Meanwhile, care for people with chronic conditions already consumes 78 percent of U.S. health care spending, and conditions such as heart disease, neurological disease, cancer, and diabetes are costing $814 billion a year. Diabetes alone accounts for more than one-third of all Medicare spending. Currently, 4.5 million Americans suffer from Alzheimer’s disease, at a cost of $100 million a year, and as many as 16 million people in the United States could be affected by this disease by 2030.
Those numbers point to one imperative: “We have to control these diseases,” Perry stressed. “Shifting costs won’t solve this problem.”
Research Expenditures Rising
The good news, Perry said, is that Americans have high expectations for medical research. “They value it and are willing to pay for it. Medical schools and research universities are often the pride of their communities. We must energize our best minds, reduce the impact of disease, and make the U.S. the engine of innovation for the world.”
Money spent on technology and research is considered well spent by the American public because it works to avert the impact of numerous diseases. Whether the innovation is as simple as the benefit of taking a daily aspirin, or an advanced product breakthrough such as cholesterol-lowering drugs, ACE inhibitors, and cancer medications, the success of such research is tangible.
In 2000, the United States invested $634 billion in breakthrough treatments. Without that investment, Perry contended, the U.S. would have seen:
- 470,000 more deaths;
- 2.3 million more disabled individuals; and
- 206 million more days in the hospital.
Using newer drugs and therapies could lower overall health expenses by as much as $111 per person, per year, per condition, for the general population and $155 for Medicare beneficiaries, Perry said.
Perry believes the rest of this century will bring a series of medical breakthroughs. For example, he expects researchers to find ways to control and possibly reverse Alzheimer’s and Parkinson’s diseases, with 20 drugs currently in development for each of those ailments. Cures for many cancers will become available, he said, and risks for cardiovascular disease will be identified and targeted for specific preventative interventions.
Business Helps Employees Manage Health
The speakers who followed Perry discussed breakthroughs in new health care models that are succeeding in business and within entire communities.
In 2002, for example, the mail document business Pitney Bowes undertook a health plan redesign to increase compliance with prescribed medication and disease management among employees with chronic conditions. David Hom, who as Pitney Bowes’ vice president of employment brand total rewards is responsible for the benefits and compensation package the company offers to its employees, discussed how his firm helped employees manage their health.
The company created a model for a healthy corporation, encompassing culture and values, benefit plans, management practices, and employee resources. That foundation was combined with a healthy work environment consisting of onsite medical facilities, fitness centers, ergonomic workspaces, stretch breaks, non-smoking worksites, healthy food options in cafeterias, and even lactation rooms. The third component was to require personal responsibility for wellness, disease prevention, and condition management.
According to Hom, employees with chronic conditions such as diabetes became more compliant in their own treatments, increased the appropriate use of prescription drugs, and visited the emergency room less frequently.
City Encourages Citizens to Stay Healthy
John Miall, risk manager for the city of Asheville, North Carolina, talked about applying such a model to an entire community. He observed that the incentives in the heath care industry all have to do with someone being sick. He suggested aligning the incentives with the well, encouraging people to stay healthy.
The citizens of Asheville, he said, know something about this idea. In an undertaking called the Asheville Project, the community collaborated to improve the conditions of people with chronic diseases.
Using diabetes as a chronic condition that needed attention, pharmacists in Asheville were offered a curriculum and certificate to learn hands-on care–foot exams, eye exams, and blood pressure tests–for their customers with diabetes. The state waived copays for drugs and glucose testing materials. This established a relationship between the patients, the pharmacists, and the physicians, a constant feedback loop that improved the level of care, Miall said.
In the eight years since the Asheville Project began, costs for diabetic care decreased greatly, from $6,127 to $4,651 per patient per year.
The project has grown to include many more participants and other chronic diseases. “Sometimes,” Miall concluded, “you have to build systems that don’t exist.”
Local, Personal Care Essential
Dan Garrett, senior director of the medication adherence program for the American Pharmacists Association Foundation, helped implement the Asheville Project. To manage chronic care effectively, he said, health care must be local, and there must be self-management. The person with the condition has to manage the disease.
Fifty percent of all prescriptions written are not filled or not taken, according to Garrett. People with a “silent disease” such as diabetes or heart disease need to understand the importance of taking care of the condition. Local networks of pharmacists need the motivation, training, and time to help patients manage their care.
“Align the incentives,” he urged, “improve the outcomes, and control the costs.”
Public-Private Partnership to Help 31 Million
Dr. Martin J. Murphy, Jr., told the conference that cancer will overtake cardiovascular disease as a cause of death in the United States because of the availability of improved medications to mitigate heart disease.
The good news, he said, is that two-thirds of all cancer is preventable, and preventative measures and early treatment will change the outcome for patients with those diseases.
Murphy, founding chairman and CEO of AlphaMed Consulting, Inc., a corporation that provides strategic support for academic cancer centers and cancer drug development programs of global pharmaceutical and top-tier biotechnology companies, worked to develop, at the request of President George H.W. Bush, the CEO Roundtable, which in turn spawned the Cancer Gold Standard project.
Partnering with the American Cancer Society, the Centers for Disease Control and Prevention, and others, the Cancer Gold Standard project engaged companies and states in a public-private partnership to aid employees and their family members who are not receiving recommended medical care. The participants target tobacco use, diet and nutrition, physical activity, screening and early detection, access to quality treatment, and clinical trials.
The 41 corporations, states, and organizations involved–including Wachovia, Eli Lilly, Johnson & Johnson, Pfizer, Aventis, the Mayo Clinic, and the states of Arkansas, North Carolina, and West Virginia–will roll out the program by the end of 2005, directly affecting 31 million Americans.
“It is this kind of entrepreneurship, innovation, and thinking outside the box” that will solve the problems of health care in the United States and let us move into the future,” concluded Turner.
Susan Konig ([email protected]) is managing editor of Health Care News.