By Jeanne M. Lambrew and John D. Podesta
Special to washingtonpost.com's Think Tank Town
Tuesday, October 17, 2006 12:00 AM
Fears for our health typically focus on dramatic threats like avian flu, E. coli or denial of needed care due to high cost or lack of insurance. Yet, the real killer in this new century is chronic illness. About 70 percent of deaths and costs in the U.S. are attributable to chronic diseases like cardiovascular disease, diabetes and cancer -- diseases that can be prevented or controlled. Fewer than half of adults receive recommended preventive services, costing us millions of lives and billions of dollars.
Barriers to prevention exist at all levels. Most people neither know what they need nor value prevention. Most providers put urgent care ahead of preventive care -- trained to cure rather than prevent disease. Most health insurers invest little in wellness, knowing that other insurers will reap the benefits later. And, the U.S. spends nearly seven times more on care for the dying than on maintaining health in the first place.
Clearly, change is needed. This change should put wellness ahead of sickness in allocating U.S. resources and priorities. It should make prevention like homeland security, where success is measured by the absence of tragedy. And it should recognize that our current, fragmented insurance system has failed to give us the value in health outcomes that we pay for.
As part of its overall effort to reform the health system, the Center for American Progress proposes a Wellness Trust. The Wellness Trust would carve prevention out of health insurance and take responsibility for a new, outcomes-oriented system. It would do so through five activities:
Setting National Prevention Priorities. The Trust would produce an annual list of prevention priorities for the nation. These priorities would be used to design the delivery system, set financial incentives for providers and individuals, and communicate the importance and value of wellness.
Employing Effective Delivery Systems. The Trust would let form follow function, designing a delivery system with its boundaries outside of the health system. At the national level, the Trust would create an information nexus, connecting providers and patients with the latest information. State and regional grants would foster community-based interventions such as workplace and school-based wellness programs. And, the Trust would pay directly for preventive services, independent and irrespective of an individual's health coverage, wherever they are delivered -- in pharmacies or supermarkets, workplaces or senior centers.
Driving Success Through Payment Policy. The Trust would align financial incentives with effective practices for prevention. It would use: competitive contracting at the national level, performance bonuses in state and regional grants, pay-for-performance systems, and incentives for individuals to use priority services.
Creating an Electronic Health Record. To ensure that this system is integrated within the spectrum of health care, an electronic prevention record would be developed and run by the Trust. It would ideally be part of a full-blown electronic health record. But, in the interim, a stand-alone program would allow for life-long tracking of services and payment in multiple settings.
Pooling Resources and Authorities. The Trust would be a quasi-independent agency, with its own Trustees. It would be funded through a consolidation of existing insurance and public health spending on prevention and would potentially add new sources of funding (e.g., alcohol or junk food taxes).
Creating such a system will require change. Health insurers' roles would be reduced. Health providers would no longer be the sole source of prevention. And, individuals would assume greater responsibility for maintaining their own health. But, this change would yield longer and better lives, improved productivity, and less avoidable health care spending.
The Wellness Trust is a necessary part of health reform, but is not sufficient. Since people with insurance are paying more for less, and fewer people have insurance at all, the priority is to ensure that all Americans have affordable health coverage. We must also tackle health care costs while ensuring choices that matter. But we can begin now with sensible steps toward a prevention system that will improve coverage as we expand it.
Jeanne M. Lambrew is a Senior Fellow and John D. Podesta is President and CEO of the Center for American Progress.