| About Us |
A Vision For Better Health |
||||||||||||||||||||||||||||||||||||||||||
IMPROVING PREVENTIVE AND PRIMARY CARE IN Task Force on Improving Preventive and Primary Care in March 2010
Achieving this vision in five years is realistic. But to do so, we must have in place a well-funded, comprehensive preventive and primary care system in both counties. We must have insurance coverage for preventive/primary care services, and everyone must have access to a primary care practitioner. The Columbia County Community Healthcare Consortium has received a 2-year grant from the New York State Department of Health to develop recommendations that will improve preventive and primary care in The main purpose of this document is to present a vision of better health and a more effective, well-funded preventive/primary care system. A secondary purpose of this document is to describe the current consequences of inadequately funding and developing preventive and primary care services in our two counties. Our health status for many medical conditions falls
Our health status could be significantly improved. We expended about $380 million on health care in 2008 in our two counties. Some of these funds should be shifted to build a comprehensive preventive and primary care system. See How Close, How Far
significantly short of goals outlined by the Federal Government and the New York State Department of Health. Nonetheless, significant dollars are expended on health care. In our two counties, an estimated $380 million was spent in 2008 on personal health care services covering about 111,000 people, or about $3,420 per person.[1] This amount has been increasing by about 6.2% per year.[2] The shortcomings of our preventive and primary care system is not a criticism of the providers in our counties. They reflect standards of high quality and a deep sense of public commitment. Indeed, the Task Force does not advocate replacement of the current system of preventive/ primary care, but rather to build upon it. Our current preventive/primary care services suffer from a lack of sufficient resources and are hindered by certain State policies. With the proper amount of resources and the adoption of useful State policies, the Task Force believes that the preventive/primary care system in our two counties could achieve the vision for better health as outlined in this document. BENEFITS OF PREVENTIVE AND PRIMARY CARE The main rationale for focusing on primary/preventive care is simple: extensive research demonstrates that primary and preventive health care is the most effective means for improving health status while constraining costs.[3] Moreover, many health conditions are preventable; half of all deaths, according to the U.S. Centers for Disease Control and Prevention, are linked to unhealthy behavior and unsafe environments.[4] Research also recommends that significant funds be invested in expanding primary care.[5] Such investments will prevent illness, identify them early and trigger timely treatment, and reduce the amount of medications, the use of specialists, and the number of surgeries, hospitalizations, and trips to the emergency department. [6] [7] [8] [9] Although primary care has proven it can decrease health care expenditures, cost containment policies in CONSEQUENCES OF INADEQUATE PREVENTIVE AND PRIMARY CARE This section describes some of the consequences of a preventive/primary care system that suffers from inadequate resources and misdirected or outdated State policies. Chronic Disease The most expensive and most damaging part of our health system is the large presence of chronic disease, yet a large percentage of chronic diseases can be prevented or their impact mitigated and better managed through preventive/primary care services. Thousands of people in our counties suffer from conditions such as cardiovascular disease, diabetes, arthritis, cancer, and asthma, among others. In New York State, as many as 30% of our population suffers from a chronic disease and about 75% of all deaths are due to a chronic disease. Chronic disease consumes about 75% of our health care dollars. They also reduce productivity at the workplace since ill employees and their caregivers are often forced either to miss work days or to attend work but not perform well. Inappropriate Use of Emergency Departments Inappropriately using emergency departments (ED) for primary care is costly, and many ED settings are not designed to provide continuity of care or follow-up care. Furthermore, people using the ED for primary care creates overcrowding, depriving timely access to patients who truly require emergency care. In Many uninsured and under-insured people and those without geographic access to a doctor have no other place to go except to the local ED for illnesses and conditions that could have been treated in a primary care setting. Many times these people delay obtaining needed care for a relatively minor condition; thus, they wait until their condition becomes very serious, which then requires far more expensive care such as hospitalization, medications, and the use of specialists. Many people with chronic disease use the ED for legitimate emergency situations due to a complication arising from their disease. However, if adequate resources were devoted to primary care to prevent and better manage their disease, then many of these trips could be avoided. Cost Of Medications The amount expended on medications Statewide has increased by two-and-a-half times over the past decade.[15] Extrapolating from State data, approximately 1,333,000 prescriptions are filled at pharmacies for our county residents every year.[16] The driving force in escalating cost is the quantity of medications that are being consumed. The number of times that a prescription drug was written, renewed, or provided increased 26% in physician offices and hospital outpatient departments during the period 1995-2005 in 70% of all physician and hospital outpatient department visits result in a prescription drug being written, renewed, or provided. Although nearly everyone in the age 65+ group uses one or more medications (92%), a significant percentage of people in other age groups also use medications: 74% of adults age 45-64 and 54% of adults age 18-44.[19] A big reason for the medication use is chronic disease. People with one chronic condition fill up to 10 prescriptions per year and people with 4 chronic conditions fill up to 37 prescriptions per year. [20] Misuse and overuse of prescription drugs also leads to avoidable, potentially serious adverse drug events. Physician and Clinic Services New Yorkers average of about 5 physician visits per person per year,[21] which total about 555,000 visits for our two counties. These visits are provided by physicians in private offices, clinics, and hospital outpatient departments, covering primary care and all other specialty services. As with medications, the increase in spending per enrollee in private insurance plans is driven primarily by an increase in the quantity of outpatient services per enrollee (99%) rather than an increase in prices (1%). One of the reasons for the growth in the number of visits is the growing extent of chronic disease. 50% of all office visits are made by patients with one or more chronic conditions.[22] Impact of Preventive/Primary Care The extent of the consequences described above can be mitigated by creating and financially supporting a comprehensive primary care system. Such a system will reduce and manage the prevalence of chronic disease, provide an alternative to the emergency department for primary care needs, reduce the consumption of costly prescription drugs, lower the number of expensive visits to medical care specialists and clinics, and reduce the number of surgeries. A VISION FOR IMPROVING OUR HEALTH STATUS, HEALTHY LIFESTYLES AND HEALTH CARE SYSTEM The Task Force chose to articulate its vision for improved health status and healthier lifestyles by describing below a series of goals that would be fulfilled by the end of 2015. The vision for how these goals can be fulfilled – by creating a comprehensive, fully-funded preventive/primary care system – is also described. I. HEALTH STATUS GOALS The goals below are based on the Surgeon General’s Healthy People 2010 and the State DOH Prevention Agenda. See Table below. For each goal, we also provide data for both CURRENT AND FUTURE HEALTH STATUS IN This table displays the current number of deaths and number of people with a given medical condition. With a comprehensive, well-funded preventive/primary care system, we could achieve much better health status in the future.
See the statistics at How Close, How Far
Cancer Goal: By 2015, lower the cancer death rate to 159/100,000 people from its current level of 191/100,000 people in Although the cancer death rate in both counties is higher than the 2015 goal, it is especially high in Research has demonstrated that many cancers could be prevented. According to the NYS Comprehensive Cancer Control Plan, developed jointly by the State DoH and the American Cancer Society, perhaps as many as one-third of cancer deaths could be prevented; some sources quote a level as high as 50%. Cancer can be prevented by eliminating the use of tobacco, improving nutrition, increasing physical activity, reducing alcohol consumption, and adopting sun-safe behaviors. A comprehensive preventive/primary care system can reduce the incidence of new cancers by helping patients adopt healthier lifestyles, and it can reduce mortality by identifying cancers earlier through patient screening tests and by coordinating the many services cancer patients need. Cardiovascular Disease Goal: By 2015, lower the coronary heart disease (CHD) death rate to 162/100,000 people from its current level of 319/100,000 people in Goal: By 2015, lower the stroke death rate to 24/100,000 people from its current level of 35/100,000 people in both counties. About 60 people die each year in both counties from stroke. Achieving our goal would lower the number of deaths to about 40. Cardiovascular disease (CVD) is any disease of the circulatory system. Most of the deaths from CVD relate to coronary heart disease (heart attack), stroke (cerebrovascular disease), congestive heart failure and other diseases of the circulatory system. About 7% of adults (about 6,200) suffer from some form of CVD. [24] Cardiovascular disease, specifically heart disease and stroke, kills more Columbia/Greene residents than any other condition. The health burden of CVD is matched only by its economic burden. The estimated medical care cost of CVD is nearly $33 million. A person with heart disease has substantial medical expenses for diagnostic tests, surgeries, hospital and doctor visits, physical therapy and drugs. A conservative estimate of the cost of treating one person with heart disease for a 20-year period is $121,000 (NYS average cost). For those needing special procedures and on-going care, the costs can be more than $4.8 million per person over the course of a lifetime.[25] The current death rate for coronary heart disease is nearly double the 2015 goal; it is 319/100,000 people in Stroke is the leading cause of adult disability in Many CVD conditions are largely preventable – 80% of stokes, for example – by making healthy lifestyle choices that help reduce risk and severity. A fully-funded preventive/primary care system will help patients manage their risk factors such as controlling blood pressure, avoiding tobacco use, maintaining a proper weight, lowering cholesterol levels, striving for optimum sugar control if diabetic, and getting checked for heart rhythm disturbances, among others. Primary care will also emphasize early identification and treatment of heart attacks and strokes, and help patients avoid recurrent cardiovascular events. Diabetes Goal: By 2015, lower the percentage of people who have diabetes to 3% of the population from its current level of 9% in Treating diabetes is extremely expensive. Estimated diabetes medical costs in our two counties are $17.5 million.[26] The national annual cost of diabetes in medical expenses and lost productivity rose about 75%, during the period 1997 to 2007. The factor driving this rapid growth in cost is the rapid growth in caseload. Since 1994, An alarming recent trend is the increased number of children and adolescents, especially from minority populations, who have been diagnosed with diabetes. The Federal Centers for Disease Control and Prevention has recently predicted that one out of every three children born in the There are two main types of diabetes. Type 1, which is not preventable, most often appears during childhood and adolescence. People with type 1 diabetes must take insulin every day to survive. Type 2 diabetes, which is linked to obesity and physical inactivity, accounts for 90%-95% of diabetes cases and most often appears in people older than 40 years of age. Type 2 diabetes can be controlled with medications and lifestyle changes, including eating healthy foods and being physically active. Conditions that exacerbate Type 2 diabetes, such as high blood sugar levels, high blood pressure, and low-density lipoprotein levels, can be controlled with medications and lifestyle changes, including eating healthy foods and being physically active. Primary care can help diabetics control these conditions by working with them to alter their lifestyle and obtain the care and medications they need, and teaching them to self-manage and monitor their conditions. Asthma Goal: By 2015, lower the percentage of people who have asthma to 5% of the population from its current level of 8% in both counties. An estimated 7,100 adults and 1,750 children suffer from asthma. Reaching the 2015 goal would lower this number to 4,440 adults and 1,110 children. Asthma affects more than 8,800 adults and children in the two counties. It is a chronic disease of the lungs and occurs at any age, but is more common in youth. Asthma is the leading chronic illness among children today; nationally, nearly 1 in 13 school-age children has asthma, and the rate in NYS is slightly higher. It has emerged as a significant chronic disease over the past 25 years and continues to be a major public health problem in the The estimated annual health care costs of asthma are about $2.25 million. Asthma causes lost school days for children and lost work days for adults. Although there is no cure for this health condition, asthma attacks can be prevented or controlled with proper primary and preventive care. Chronic Joint Pain, Arthritis, and Osteoporosis Goal: By 2015, lower to 33% the proportion of adults with chronic joint pain from 53% in Goal: By 2015, lower to 28% the proportion of adults with arthritis and other rheumatic conditions from 32% in One of the biggest causes of chronic joint pain is arthritis, which is the leading cause of disability, affecting sufferers both at the worksite and at home. One-third of adults have a doctor-diagnosed case of arthritis. Nearly 60% of persons with arthritis are of working age, and they have a low rate of labor-force participation; arthritis trails only heart disease as a cause of work disability. Arthritis has a sizable economic impact, costing us more than $16 million per year in health care. It is the source of many visits to health care providers and causes a high number of hospitalizations per year. Many people with arthritis do not think anything can be done to help them. They do not seek medical attention because they believe arthritis is simply part of the aging process. However, there are many strategies that can be pursued to prevent arthritis such as good nutrition and moderate physical activity to maintain a healthy body weight. For those living with arthritis, proper diagnosis by a primary care provider is a key component of effective treatment. Fundamental interventions also include good nutrition and moderate physical activity as well as medications that reduce pain and inflammation, heat or cold therapies, and the use of splints and braces. Approximately 4,000 women and men age 50 and over have osteoporosis and many more are at significant risk of developing the condition.[28] Osteoporosis causes bones to become thin and weak; thus, the major health consequence of osteoporosis is an increased risk of fractures. One in three women and one in eight men aged 50 years and older will experience an osteoporotic-related fracture in their lifetime. Primary care can help prevent osteoporosis, and help patients who do have the disease to manage it. Chronic back conditions are both common and debilitating: 70%-to-85% of people have back pain at some point in their lives.[29] In the Mental Health Goal: By 2015, lower the proportion of adults reporting 14 or more poor mental health days in the past month to 8% from the level of 10% in both counties. About 8,800 people report this condition, and reaching the goal of 8% would lower the number to 7,100. Goal: By 2015, lower the rate of suicide to 5 per 100,000 people from 11/100,000 in Greene County and 7/100,000 in Columbia; reaching this goal would lower the number of suicides from about 10 to about 6. Mental disorders are common – about one-fourth of American adults suffer from a diagnosable mental disorder in a given year.[31] Mental disorders are a leading cause of disability for people ages 15-44. Nearly half of all people with any mental disorder have two or more disorders. An estimated 7% of adults (about 6,000) have a Major Depressive Episode in his/her lifetime (an MDE is defined as having 5 or more of 9 symptoms relating to depression).[32] An estimated 11% of adults (about 10,000) have had an episode of Serious Psychological Distress in the past year (an SPD is defined as anxiety or mood disorders).[33] There is substantial overlap in the populations who have an MDE or an SPD. Even though mental disorders are widespread, the main burden of illness is concentrated in a much smaller proportion – about 6% -- who suffer from a serious mental illness. [34] Nearly everyone sees a primary care practitioner within a 12-24 month period for routine visits and physical ailments. Many people, however, do not seek mental health services due to a fear of stigmatization or an unawareness of the condition. Routine primary care visits can be used to screen patients for their mental health status, and if necessary, the primary care practitioner can coordinate services with a local mental health provider. Thus, nearly everyone can ultimately be screened for a possible mental illness. Also, the primary care provider can treat any physical ailments that may exacerbate the person’s mental health condition. The primary care system can meld the physical health system with the mental health system to meet a need that is often difficult to address. Dental Health Goal: By 2015, lower the percentage of children ages 6-17 who have dental caries to 42% from its current level of 61% in Goal: By 2015, lower the percentage of children ages 6-8 who have untreated dental caries to 21% from its current level of 44% in Tooth decay, gum infections, and orthodontic problems affect a large proportion of people. More than half of children experience tooth decay by third grade. Applying this percentage to children ages 6-17 could mean that as many as 8,400 have had tooth decay. More than a third of children ages 6-8 have untreated dental caries, which could mean over 6,000 children ages 6-17 have untreated tooth decay. About 70% of adults – about 61,000 people – have lost one or more teeth due to tooth decay or gum diseases.[35] Dental caries is one of the most prevalent chronic illnesses among children. In the Tooth decay and advanced gum disease lead to loss of teeth if not treated in a timely manner. Loss of one’s’ teeth reduces daily functioning in terms of chewing and speaking and also reduces self-esteem and one’s quality of life. Low-grade chronic infections in the mouth have been linked to illnesses such as cardiovascular disease, respiratory ailments, and adverse pregnancy outcomes. Persons with diabetes are also at increased risk for periodontal infections. About 5% of overall health care expenditures are for dental services. Maternal And Infant Health Goal: By 2015, lower the infant death rate to 5% from 10% in About 1,300 women give birth every year in the two counties. About 25% of pregnant women (about 335) do not receive early prenatal care, which includes three major components: risk assessment, treatment for medical conditions or risk reduction, and education. Each component can contribute to reductions in perinatal illness, disability, and death by identifying and mitigating potential risks and helping women to address behavioral factors such as smoking and alcohol use that contribute to poor outcomes. Prenatal care should begin early and continue throughout pregnancy; the II. HEALTHY LIFESTYLES Healthy lifestyle patterns will, if adopted, greatly improve health status in many of the areas mentioned in the “Health Status” section above. Achieving healthy lifestyle goals will be facilitated by a comprehensive, well-funded preventive and primary care system. Such a system will be an integral part in helping patients quit their use of tobacco, lose weight, comply with health screening guidelines, receive their immunizations and vaccinations, obtain mental health counseling, overcome their abuse of alcohol and substance abuse, and obtain family planning services. Obesity Goal: By 2015, lower the percentage of adults who are obese to 15% from about 24% in both counties. The number of obese adults is 21,000. Reaching the 2015 goal would lower this number by over one-third, reducing the number of obese adults to about 13,000. Nearly 60% of Tobacco Use Goal: by 2015, lower the percentage of tobacco use to 12% among adults from 24% in “Tobacco use and dependence is the leading preventable cause of morbidity and mortality in The annual health cost caused by tobacco is over $19 million.[40] Alcohol and Drug Abuse Goal: By 2015, lower the young adult DWI arrest rate to 44/10,000 from 87/10,000 in Goal: By 2015, lower the percentage of adults binge drinking in the past month to 13% from 19% in Goal: by 2015, lower the alcohol-related motor vehicle crash death rate to 5/100,000 from 7/100,000 in Goal: By 2015, lower the drug-related hospitalization rate below the current level of 16/10,000 in The number of adults who have a dependence on alcohol is about 2,700 in both counties and those who have a dependence on illicit drugs is an estimated 1,800 adults. The number of youth is unknown. Alcohol abuse causes serious health conditions. Long-term heavy drinking increases risk for high blood pressure, heart rhythm irregularities, heart muscle disorders, and stroke. Long-term heavy drinking also increases the risk of developing certain forms of cancer and for cirrhosis and other liver disorders. Alcohol use has been linked with a substantial proportion of injuries and deaths from motor vehicle crashes, falls, fires, and drownings. It also is a factor in homicide, suicide, marital violence, and child abuse and has been associated with high-risk sexual behavior. Illegal use of drugs, such as heroin, marijuana, cocaine, and methamphetamine, is associated with various health conditions and other serious consequences, including injury, vehicular crashes, disability, and death as well as crime, domestic violence, and lost workplace productivity. Drug dependence is a chronic, relapsing disorder. Addicted persons frequently engage in self-destructive and criminal behavior. The four goals listed above are the only ones for which data are available for Greene and Family Planning Goal: By 2015, lower the percentage of teen pregnancies to 28%. Fortunately, the rate in One of the keys to a healthy pregnancy is planning it. When pregnancies are planned, the mother is very conscientious about her health status and is more prepared for all the challenges of having a healthy baby and raising a family. Adolescent pregnancy is a significant public health problem. Teen mothers in NYS are more than three times as likely as older moms to receive late or no prenatal care (11.6% vs. 3% for women over age 19), compromising the health of mothers and newborns. Infants born to teen mothers are at higher risk for low birth weight, infant morbidity and mortality. Teen mothers are more likely to suffer from lost social, educational and vocational opportunities, perpetual poverty and dependence on public income maintenance and health programs. The children are at greater risk for child abuse and child safety issues as well as for behavioral and educational problems. Teenaged mothers are less likely to become or stay married. Young fathers are less likely to marry the mothers of their children and more likely to have lower educational attainment and earnings, which limits their children's chances of success. III. HEALTH SYSTEM DELIVERY COMPONENTS If we are to achieve better health status and adopt healthier lifestyles, several key components in our health care delivery system must be in place. Goal: by 2015, 100% of the population should have coverage or all 111,000 people living in both counties. Currently, 92% of the people in both counties have coverage. A fundamental component of improving access to preventive/primary care is health insurance. If people cannot afford care, they most likely will not seek it. Therefore, preventable or easily treatable conditions become more serious until they must be treated extensively, causing unnecessary pain and costing unnecessary dollars. At the time the Vision Statement was released, President Obama had just enacted legislation to expand health care coverage. Thus, we are uncertain of the exact details of coverage for preventive/primary care. As a result, our Vision Statement still advocates comprehensive health care coverage for these services. Adequate Supply of Primary Care Providers Goal: by 2015, 100% of the population should have access to a primary care provider. Currently, 87% of the people in both counties have such access. An insufficient supply of doctors means that people cannot obtain appointments or obtain them within a useful timeframe. An insufficient supply of doctors also means some people have to travel excessive distances to seek care, which also hinders timely access, especially if transportation is not available. Our counties need an adequate supply of primary care doctors, and they should be appropriately distributed. Certainly, both counties have made significant progress in meeting the need for primary care providers. Primary Care Medical Home Goal: By 2015, 100% of the population should have a Primary Care Medical Home. Although the percentage of people who have a PCMH is unknown at this time, the proportion is presumably low since the concept is relatively new and few insurance companies provide reimbursement for it. This goal is actually a subset of the previous one. All of us should have a primary care provider, as stated previously, and that provider should offer a Primary Care Medical Home (PCMH) to his/her patients. The PCMH delivers the full range of primary/preventive care services. It coordinates and manages all care for the patient, including diagnostic, specialty, inpatient, behavioral, and disease management services. The PCMH also identifies patients who potentially are in need of mental health and drug and alcohol abuse services, and helps arrange for and coordinates the appropriate treatment. Research shows that the PCMH improves quality, reduces errors, constrains costs and increases patient satisfaction.[41] [Note: this paper uses the term "Primary Care Medical Home" given the enormous impact that primary care has on reducing costs and improving health status. Different organizations use different terms, but they refer to the same or similar concept]. Through the Primary Care Medical Home, primary care doctors and their staff: · send reminders to all patients about preventive care and to those patients who require routine and follow-up services; · ensure that patients obtain needed immunizations and vaccinations; · ensure that patients comply with health screening guidelines to identify and treat health care problems early, including the various chronic diseases; · coordinate diagnostic findings from specialists and coordinate care among them and other providers; · manage patient care, by using care plans, assessing progress, addressing barriers, coordinating care and follow-up for patients who receive care in other care settings, including inpatient and outpatient facilities and mental health and substance abuse services; · teach patients how to manage their illnesses, diseases, and risk factors; · respond to changing patient conditions; · provide 24 hour communication access (telephone, email) to clinical support; · Ensure the availability of timely and appropriate appointments; · use electronic health information technology; · survey patients’ care experience and use the information for service improvement; and, · make referrals for patients who need assistance maintaining or obtaining public or private health insurance. Affordable Health Care Goal: By 2015, ensure that the annual rise in the cost of health care decreases. The costs of health care in Health care dollars consume an increasing portion of our Gross State Product, from 12% to 16% during the period 1992-2008. If current trends continue, health care will consume as much as 20% of the GSP by the 2020.[42] As more and more dollars are consumed by health care, we will have fewer dollars to expend on other important public priorities such as energy, transportation, housing, and education. Reimbursement for Services Goal: By 2015, ensure adequate reimbursement for primary care providers, including reimbursement for the primary care medical home. The New York State Primary Care Coalition succinctly summarizes the reimbursement flaws in our health care delivery system, “Historically, reimbursement has been inadequate and often inequitable for primary care services, regardless of the payer. Moreover, in many cases, payment is for episodic visits rather than prevention and care management. Prevention and care management are essential to improving outcomes and decreasing costs over the long-term, especially for complex, chronically ill patients, yet primary care providers are neither reimbursed nor rewarded for prevention or care coordination. And while primary care providers bear the costs of prevention and care management, the financial benefits of fewer emergency department visits and hospitalizations accrue to the payers.”[43] Our health care delivery system must reimburse primary care providers to help their patients quit their use of tobacco, lose weight, comply with health screening guidelines, receive immunizations and vaccinations, obtain mental health counseling, and overcome their abuse of alcohol and substance abuse. Reimbursement must promote early identification and treatment, coordination with other providers, and long-term management of chronic conditions. Our system should reward, rather than penalize, healthcare providers who successfully reduce excessive care. Tracking Progress and Identifying Problems Goal: By 2015, ensure that a comprehensive preventive/primary care health surveillance system is available to track relevant health concerns. Although some data collection systems are operational, many data gaps exist. A comprehensive surveillance system will identify, evaluate, and monitor health care problems. It will collect data to help us better understand the extent to which the public is pursuing and meeting health status and lifestyle goals and complying with health screening guidelines. A data system can explain the reasons for success and failure, and determine the effectiveness of various interventions. In particular, a surveillance system will focus on the key preventable diseases that are responsible for more than half of all deaths and 75% of expenditures, and help us to better understand how to reduce the impact of these diseases. Quality Health Care Services Goal: By 2015, ensure that health care services are of the highest quality. The NEXT STEPS During the period March 2010 – January 2011, the Task Force on Preventive and Primary Care will develop recommendations for improving preventive and primary care services in Two Sets of Recommendations The Task Force is developing two related sets of recommendations. One set will impact the entire preventive/primary care system and will affect multiple medical conditions and harmful lifestyles. For example, the Task Force is focusing on ways for increasing access to primary care practitioners, ensuring that everyone has a primary care medical home, increasing reimbursement for physicians who emphasize prevention, and improving the means for tracking and monitoring health care problems. In addition to developing recommendations that will have wide applicability, the Task Force also is developing a second set of recommendations specifically to address five top priorities that the Task Force selected. These recommendations will advocate a set of enriched and enhanced activities for the five priorities, which reflect some of the most costly medical conditions and unhealthy lifestyles, ones that inflict great human suffering and require significant sums of money to treat. The priorities are: (1) cardiovascular disease; (2) obesity; (3) tobacco use; (4) substance and alcohol abuse; and (5) poor mental health. The Task Force selected the five top priorities after reviewing data from federal, State, and local sources on multiple medical conditions and lifestyles. To see a user-friendly summary of which medical conditions and lifestyles are the worst in each county, see “How Close...How Far, an Assessment of Health Status in Public input The general recommendations as well as the ones for the five priorities will be developed during the time period March 2010 – January 2011. They will focus on the appropriate allocation of resources, the configuration of the health care delivery system, and changes in State law and policies. We will be developing the recommendations within the context of an extensive public process to ensure that the recommendations we ultimately submit to the State Department of Health reflect local concerns, creativity, and support. Our public process will include multiple points of input – involvement of two advisory groups; surveys of households, businesses, local officials and health care providers; focus groups; web site submissions and commentary; and, public meetings. These points of input will be publicized in public media and on our web site to further ensure wide public participation. The Columbia County Community Healthcare Consortium encourages you to participate in our process of developing recommendations. Our joint efforts will serve to ensure that the vision for better health and a higher quality of life is indeed achieved. ENDNOTES [1] Expenditure data are trended to 2008 from information published in “New York Personal Health Care Expenditures, All Payers, State of Residence, 1991-2004,” Office of the Actuary, [2] Ibid. Annual trend factor is 6.2%, which is based on the CMS tables 1991-2004. [3] [4]New York State Department of Health. Press Release. State Health Commissioner Daines Kicks Off Public Health Week. March 30, 2007. [5] Rosenbaum S, Hin P. “Laying the Foundation: Health System Reform in [6] Brownlee S. “Overtreated. Why Too Much Medicine is Making Us Sicker and Poorer.” 2007. 7 Franks P, Fiscella K. “Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience.” Journal of Family Practice 1998;47:105–9. [8] Mahar M. “Money-driven medicine: the real reason health care costs so much.” 2006. [9] Mark DH, Gottlieb MS, Zellner BB, Chetty VK, Midtling JE. “Medicare costs in urban areas and the supply of primary care physicians.” Journal of Family Practice 1996;43:33–9 [10] New York State Department of Health. “Statewide Planning and Research Cooperative System, Table 8. 2006 Annual Report.” [11] [12] Cunningham P, May J. “Insured [13] National Health Statistics, Reports. “Table 5. Percent distribution of emergency department visits, by immediacy with which patient should be seen.” Number 7. August 2008. [Author’s note: this table shows that about 32% of ED visits are either non-urgent (should be seen within 2-24 hours) or semiurgent(1-2 hours)]. [14] Weinick, R, [15] “ [16] Kaiser State Health Facts. “ [17] Federal Centers for Disease Control and Prevention. [18] Bundorf M, Royalty A, Baker L. “Health Care Cost Growth Among the Privately Insured.” Health Affairs, 28, No.5 (2009). pp.1294-1304. [19] Federal Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. Table 2. “Prescription Medicines-Median and Mean Expenses per Person: [20] Partnership for Solutions, [21] Federal Centers for Disease Control and Prevention. [22] National Health Statistics Report. “Percent distribution of office visits by selected co-morbid conditions, [23] The figure of $14.2 million was extrapolated from different sources. The National Cancer Institute estimates that national cancer treatment costs were $72 billion in 2002 or $4.6 billion in NYS using our population percentage of 6.4%. The figure of $4.6 billion was trended to 2008. County-specific costs then were extrapolated by applying the two counties’ percentage of NYS population (.00572 of the State’s population) to NYS total costs and adjusting for cost-of-living differences. [24] New York State Department of Health. “The Burden of Cardiovascular Disease in NYS.” BRFSS, (2007). P: 4. [25] New York State Department of Health. “Cardiovascular Health in NYS.” [26] National direct medical costs were $116 billion in 2007 according to the Federal CDC, National Diabetes Fact Sheet, 2007. Extrapolating this figure to NYS, the cost would be conservatively about $7.4 billion since NYS has 6.4% of national population. County-specific costs then were extrapolated by applying the two counties’ percentage of NYS population (.00572 of the State’s population) to NYS total costs and adjusting for cost-of-living differences [27] Ibid. [28]New York State Department of Health. “Osteoporosis Education a Priority in
[29] US Department of Health and Human Services. “Healthy People 2010. Chronic Back Pain.” 2000. [30] Ibid. [31] National Institute of Mental Health. “The Numbers Count: Mental Disorders in [32] Federal Substance Abuse and Mental Health Services Administration. “Prevalence of Major Depressive Episode Among Adults.” 2007. [33] Federal Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. 2004 and 2005.” Figure 6.1. [35] Healthy People 2010. Section on Oral Health [36] The Commonwealth Fund. “Aiming Higher: Results from a State Scorecard on Health System Performance/” 2007. [37] Finkelstein EA,Trogdon JG, Cohen JW, Dietz W. “Annual Medical Spending Attributable To Obesity: Payer-And-Service-Specific Estimates.” Health Affairs, 28, no. 5 (2009). [Author’s Note: the article cited a national expense of $147 billion for 2008; since NYS accounts for about 6.4% of [38] New York State Department of Health. “Priority Area: Tobacco Use. The Burden of Tobacco and Secondhand Smoke.” 2008. [40] New York State Department of Health. Press Release. “State Health Commissioner Speaks Out After Oscars to End Smoking In Youth-Related Movies.” February 23, 2009. [Author’s Note: this press release stated that the cost was $8.2 billion statewide. County-specific costs then were extrapolated by applying the two counties’ percentage of NYS population (.00572 of the State’s population) to NYS total costs and adjusting for cost-of-living differences]. [41] Rosenthal TC, MD. “The Medical Home: Growing Evidence to Support a New Approach to Primary Care,” The Journal of the American Board of Family Medicine, 21 (5). 2008. PP 427-440 [42] Expenditure data are trended to 2008 from information published in “New York Personal Health Care Expenditures, All Payers, State of Residence, 1991-2004,” Office of the Actuary, [43] Primary Care Coalition. “5-Point Agenda.” http://www.nyprimarycarehome.org/five_points.html [44] The
|
||||||||||||||||||||||||||||||||||||||||||
