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Opportunities
Medicare will spend about $500 billion over the next decade on potentially preventable hospital readmissions Medicaid faces the same set of issues, particularly with dual eligibles Build effective care coordination into the essential benefits in the exchanges Medicaid medical homes section 2703
California
Rising rates of chronic diseaseex diabetes. In 2000 7% of adults were diabetics compared to over 9 percent today Obesity adds nearly $16 billion a year to the cost of health care in California alone. At current trends this could rise to about $40 billion within the next ten years
Sources: Cigarette consumption data per adult per year are extracted from Tobacco Situation and Outlook Report Yearbook. U.S. Department of Agriculture, October 2007. Obesity data based on measured body mass index in NHANES from 1960 to 2010.
Trends in Treated Prevalence, Adults, 1987 - 2009 Conditions Mental Disorders Cancer Heart Disease Arthritis 1987 4.9% 3.6% 2009 14.3% 6.2% Change 9.4% 2.6%
7.4%
7.2% 1.3% 3.9% 13.1%
9.6%
14.7% 19.3% 8.7% 24.3%
2.2%
7.5% 18.0% 4.8% 11.2%
Hyperlipidemia
Diabetes Hypertension
Trends in the Prevalence and Incidence of Diagnosed Diabetes and in Prevalence of Obesity
9 8 7 6 5 15 20 25
Obesity* (Percent )
4 3 2
10
Prevalence * (Percent)
1 0 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05 0
Year
* Prevalence for all ages; incidence for 1879 years; and obesity for 20 years * Data modeled by joinpoint regression (Source: Narayan)
Percent
4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Normal Overweight Obese Total 2.4% 2.6% 3.8% 3.0%
Percent of Change in Total Health Care Spending Associated with Obesity, Increased Treatment Intensity and Both Obesity and Treatment Intensity, 1987-2007
Costs of Obesity
Higher job absenteeism: $4.3 billion annually in U.S. Recent estimates show much higher than previously estimated: $2,741 higher annual health care costs per obese adult Aggregate national costs per year: $190 billion (20.6% of US national health expenditures)
The Challenge
To develop a comprehensive approach that: Averts rising incidence of chronic illness Better detect existing chronic disease More effectively manage chronically ill patients to keep healthy
The Challenge
Not all chronic conditions are potentially preventable! Many cardiovascular related conditions potentially are (T2 diabetes, hypertension) others likely are not (Parkinsons, Alzheimers, others )
Averting Disease
Identify evidence-based lifestyle interventions and develop cultural adaptations within the US
Diabetes prevention program Medicare coverage (none today) Essential benefits Medicaid
Bariatric surgery
For BMI 35 with one weight-related comorbidity
Pharmacotherapy is excluded from Medicare Part D coverage, resulting in a significant treatment gap
Despite recent FDA approval of pharmacotherapy that can produce 10% to 15% weight loss