I’ve written in the past about the need for specialist health care organizations (such as behavioral health organizations) to reposition themselves in an era of changing technology, science, and financing. There are many possible directions for repositioning – from primary care for individuals with chronic conditions; focused disease management programs for consumers with multiple chronic diseases and complex social support needs; and program to address unnecessary use of high-cost acute care interventions.

Now comes yet another study on the cost savings opportunities of prevention efforts in two areas – high blood pressure and diabetes. The study authors concluded that reducing the prevalence of diabetes and high blood pressure by five percent would save the nation about $9 billion a year in the short term. In addition, conditions related to those health problems would also be reduced, which would increase the savings to about $24.7 billion a year in the medium term.

The study was conducted using 2003-2005 data from the Medical Expenditure Panel Survey.   Study results were released on-line on November 18, and are scheduled to be published in the January print issue of the American Journal of Public Health.

This is data that can be the foundation for designing (and marketing) prevention programs.   For more on the evolving wellness and prevention market, check out these recent articles by our team:

• Market Opportunity in Prevention Programs: Reform Creates New Market Niche for Prevention (available to premium OPEN MINDS Circle members)
• New Science Changing The 'Perceived Value' of Prevention & Early Intervention  (available to all OPEN MINDS Circle members)
• Mental Illness & Addiction Prevention & Treatment Critical to U.S. Health Reform (available to premium OPEN MINDS Circle members)
• UnitedHealth Group Launches Diabetes Prevention & Control Alliance With Partners Walgreens & YMCA of the USA (available to premium OPEN MINDS Circle members)
• J&J to Grow New Wellness & Prevention Business as Part of Consumer Division (available to premium OPEN MINDS Circle members)

The December 17 issue of Business Week had a provocative headline—The Coming U.S. Doctor Shortage: Health-care reform will mean 30 million more patients—and bigger crowds in waiting rooms. I thought the positioning of this piece played into the 'fear of health care reform' camp that looks at the nation's health as a zero sum game. If you give minimal coverage to all, the rest of us with insurance will suffer. But the piece did raise some interesting points:

• In 1997, lawmakers placed a cap on the number of medical residencies in order to contain costs under Medicare, which pays for most of these training slots.Medicare pays $100,000 a year per residency, at a total cost to the program of about $9 billion. The funding began in 1965 when the U.S. was preparing to extend government health coverage to 19 million elderly Americans. As the Medicare rolls grew—to 45 million by the end of 2008—a cap was placed on the number of medical residencies to control spending.
• According to the U.S. Department of Health and Human Services, last year there were nearly 17,000 fewer primary-care doctors than needed in inner-city and rural areas. The Association of American Medical Colleges predicts that by 2025 there will be a shortage of as many as 159,300 doctors.
• An amendment to the health-care reform bill—proposed by Senate Majority Leader Harry Reid (D-NV), Charles Schumer (D-NY), Bill Nelson (D-FL.)—would add 15,000 residencies at a cost to Medicare of about $1.5 billion to anticipate and prepare for this shortage

What caught my attention in the article was this handy chart—showing the growing demand for services and the almost-flat supply line. I believe we can flatten the demand line for physicians and increase the supply line with just a few policy changes.

On the demand side, if we encourage individuals to take more control of their own health care, demand for physician time will decline. There are also a variety of technological substitutions for physician office visits and an array of non-physician health professionals that can fit the bill.


On the supply side, there are two major ways to enhance supply. First, use technology to increase physician productivity—less paperwork, e-health to extend reach, and more. The other way is to pay primary care physicians more. Payment policies have favored procedure-oriented specialists—and the physician’s choice of specialties reflects this.

The headline in the February 20, 2010, edition of The Los Angeles Times tells a story, "Consumers who buy individual health policies feel trapped. They have few options other than dropping coverage as insurers raise rates and slash benefits. Insurers blame the soaring cost of medical care and the churn of customers in the individual market."

No argument from me; for individual and small group health insurance policies, the rates—and rate increases—are crazy. But, the insurers' complaint about churn is spot on. Until we have universal health care coverage for 95% or more of the population, this ‘shift the risk’ game will continue. There is nothing that consumers or insurers can do about it. Solutions? Only two.


1. The government provides catastrophic health insurance for everyone, and/or


2. Employers are required to provide—and individuals are required to buy—health insurance.


Hopefully, our representatives in Washington will eventually understand these basic health care financing principles.

So what gives? A new study by the American Journal of Preventive Medicine, “Patient Costs As a Barrier to Intensive Health Behavior Counseling” found that if there is a fee for participating in weight loss or smoking cessation programs, neither consumers or health care professionals are interested. When there are fees (of any type) for participating in the programs, health care professionals referred 97% fewer consumers; of those referred, 81% fewer consumers actually followed through and participated.

To me, this speaks to two issues. First, health care professionals don't believe in the value of prevention programs—or they’d refer more of their patients. This is bad news for programs in the disease management space. Second, consumers are not connecting their health status with their behaviors—and the long-term consequences (in quality of life, cost, mortality, etc.) of their behaviors. This is bad news for behavioral health provider organizations and professionals.

I'm not sure what the solution is to this dilemma. And, I'm not so sure that making all of these programs 'free' is the best policy choice. The research is pretty clear that without some financial participation (no matter how minimal), consumers have a lack of engagement in health services. But, helping to change perceptions of the value of prevention programs is the bigger issue.