All posts by Christian Holm

HC Policy Power Players Series: United States Preventive Services Task Force

USPSTF-300x100
The Members

The United States Preventive Services Task Force, or USPSTF, is made up of 16 members from a number of organizations and institutions outside of the federal government. They are doctors, nurses and epidemiologists with vast expertise in numerous medical fields including pediatrics internal medicine, geriatrics, women’s health, behavioral medicine, and family care.

The task force is responsible for making preventive care recommendations, and deeming which services are unnecessary. The task force is funded, staffed, and appointed by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality. The USPSTF meets in Washington several times a year to produce the best preventive care recommendations.

What USPSTF Does

The USPSTF ranks its recommendations using a three letter grading scale. An “A” recommendation indicates that there is a “high certainty” that the net benefit of the preventive service is substantial. A “B” recommendation means either the net benefit, or the certainty of the benefit is moderate. A “C” recommendation means the service is selectively recommended, and that only a small group of patients is likely to achieve any benefit. “D” ratings indicate that the service is not recommended, and that the harms of the service likely outweigh any benefit. “I” ratings indicate there is insufficient evidence to make any judgment on the service.

Making the Recommendations

The USPSTF has influence in a couple of major areas. The recommendations of the USPSTF are often the standards by which insurance providers make their coverage policies.  When the Affordable Care Act (ACA) was passed, it included language that formalized their influence over the new marketplace plans by mandating the USPSTF recommendations be “essential benefits.” Under ACA, close to 90 million Americans with employer and individual health policies will no longer have to pay a co-payment or deductible for recommended preventive screenings with an A or B grade.

The Impact
Why Preventive Care Matters

Chronic illness is one of the biggest drivers of increased health care costs in the United States.  Nearly three trillion dollars is spent on health care annually, and treating chronic illness accounts for 75 percent of this spending. This phenomenon will only get worse as America continues to age. While Americans are typically living longer, many of them live with chronic illness that affects their quality of life and productivity.

There are sorted opinions on how preventive care will affect overall health care costs. Consider this: A 2008 study in Circulation estimated the total cost of preventive care for heart disease and diabetes over 30 years to be $8.5 trillion, but would only save $900 billion in treatment costs over 30 years. The net effect of this is an additional $7.6 trillion in spending over this 30 year period. In other words, attempting to prevent the disease is far more costly than incurring the already high cost of treating heart disease and diabetes. Additionally, the Congressional Budget Office concluded in 2009 that preventive care would likely improve people’s health but wouldn’t generally reduce health care spending, largely because people would be living longer. While many preventative services do improve health and wellbeing for millions of people, many of these recommendations may increase health care costs. However, the USPSTF does not factor in cost whatsoever when making recommendations.

What to Watch for in 2014

Health care reform will continue to be a hot topic as the ACA continues its rollout. Some interesting recommendations in the process of being evaluated include aspirin use to prevent cancer and cardiovascular events, as well as screenings for dementia, and for suicide risk. The USPSTF will remain in the background influencing how the ACA and other public health initiatives, both public and private, will determine what preventive care services should be a part of American health care.

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HCPolicy Power Players

At TogoRun, we pride ourselves in finding and telling the untold stories—stories about important people and organizations who have not received the recognition they deserve.

When it comes to health care policy in the U.S., the Department of Health and Human Services, the Food and Drug Administration and the White House are household names; however, there are many other groups frequently overlooked despite their influence in building the future of health care.

In a new series, HCPolicy Power Players, we will focus on profiling the key players in the public and private sectors who shape health care policymaking.

Our series will shine light on five groups who illustrate current health care policy priorities, and where policy is heading. They play a part in answering critical questions in improving mental health resources, make decisions on care for one of the nation’s largest health systems and have their fingers on the pulse of health care innovation and preventive care.

As we evolve our HCPolicy Power Players series, we would like your input. We want to know your thoughts on how these groups will have an impact on health care policy? What you think these organizations can do to move health care policy in the right direction? And, what other groups you think we should add to our HCPolicy Power Players series?

Be on the lookout soon for our coverage of the U.S Preventative Services Task Force.

We look forward to your feedback and sharing with you the importance of these up-and-coming heath care policy power players.

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At Institute of Medicine obesity panel, a coordinated public effort is the doctor’s orders

The obesity epidemic is one of the most pressing problems the health care sector faces. Accounting for $190 billion in health care spending annually, obesity is one of the leading causes of preventable death in the United States.

While the numbers are staggering and the implications of obesity are grave, we are at a potential turning point in the fight.

The Institute of Medicine recently hosted a roundtable panel entitled “The Current State of Obesity Solutions in the United States.” During the discussion, leaders from the private sector, governments and non-profit groups reported on the progress of solutions and the actions being taken to rally against this disease.

Many panel members were optimistic about the state of potential solutions. A heavy emphasis was placed on strengthening patient engagement, expanding a “systems approach” in which obesity registries, data metrics and expanded health teams are used, and bolstering efforts to combat childhood obesity with increased exercise and nutrition standards.

Obesity as a disease needs a joint clinical-community response

The resonating theme from the panel was the need for a strengthened clinical-community relationship in which a larger part of the community participates in promoting a healthy lifestyle. Dr. Howard Koh, assistant secretary for health, spoke about the role society plays as health providers. “Health care goes beyond the doctor’s office; health starts where people live, learn, labor, play and pray.”

Dr. Howard Koh

Instead of stigmatizing obesity as an individual problem, Dr. Koh advocated for the treatment of obesity as a disease, requiring more than a simple diet plan and exercise routine.

The panel concurred that obesity is not just a health problem; it is a social problem that requires a comprehensive social response. Dr. Bill Dietz, chief consultant for the Institute of Medicine, compared the obesity epidemic and potential plateau in obesity rates in children to the rise and fall of tobacco use during the mid-20th century.

Lessons society can learn from anti-smoking campaigns

Smoking was first considered a critical public health issue when the link between smoking and cancer was originally reported in the 1950s. The rate of tobacco use leveled off during that period, but remained high well into the 1990s until rates gradually decreased.

Dr. Dietz explained that this drop off was the result of a very coordinated social campaign to inform the public about the severely negative impacts of smoking, while also providing resources to help users quit. With support from inside and outside the health care community, the campaign brought together doctors, celebrity spokespeople and educators to fundamentally alter perceptions and attitudes about smoking.

While anti-smoking campaigns tend to focus on scare tactics and graphic content to stigmatize smoking, I believe obesity campaigns should focus on providing support structures and promoting the tremendous rewards of living a healthy lifestyle.

Employers role in fighting obesity

One piece of good news is that public policy has recognized the necessity of broadening health care engagement outside of the doctor-patient relationship. A provision within the Affordable Care Act allows employers to charge obese employees an additional thirty to fifty percent in health care contributions to cover the increased cost of being obese, which on average is $1,152 more a year for men and $3,613 more for women.

The goal here is not to punish people for being obese, but rather to encourage individuals and employers alike to recognize the real costs of being obese.

One of those employers is Hy-Vee Inc., a grocery store chain in the Midwest. Speaking at the panel on behalf of Hy-Vee was assistant vice president of health and wellness Helen Eddy. Eddy explained how Hy-Vee uses a comprehensive method to promote the health of its employees; from healthy food choices in the work place, to an exercise-friendly work environment and behavior modification designed to address unhealthy choices.

The results are impressive. The cost of employer health care contributions is $6,400 per employee, nearly half the national average of $10,000 to $12,000 per employee. Hy-Vee has been able to give its employees a one month premium holiday five of the last six years.

There are some exciting things happening in the fight against this disease, but one big obstacle remains. Obesity needs to be recognized as a widespread social crisis, not just an individual problem. Increased social awareness and engagement can change that.

With obesity rates in children decreasing in many states, there is a glimmer of hope. Something is working. The question is will obesity rates plateau for decades to come just as tobacco use has in the past? Is stagnation good enough? What is your opinion?

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