As Congress debates the future of health care for our nation, it is important to review the legislative efforts of Sen. Tom Carper to promote wellness and reduce the probabilities of an individual developing a chronic disease The Ensign-Carper amendment allows employee-sponsored health plan costs to be cut by as much as 50 percent for those who engage in healthy behaviors. If it is part of the final bill, the amendment will provide incentives to Americans to lead healthy lifestyles in order to lower their overall health care costs.
These programs have been found to be successful in smoking cessation, weight loss and preventive care programs.
One of the most serious problems that confront medical practitioners and patients alike is failure of the patient to follow treatment regimens. Patients who do not follow the treatment plan are more likely to be ill, have a reduction in quality of life, miss work or school, require medical care and become disabled.
A study examining the relationship of total costs of diabetes care to treatment adherence found that individuals with adherence greater than 80 percent had half the annual costs of those with adherence of less than 20 percent. It is estimated that 50 percent of chronically ill individuals do not consistently follow treatment recommendations. The cost of care each year attributable to non-adherence has been estimated to be $100 billion.
I would like Delaware’s congressional delegation to consider extending the model of incentives to individuals with chronic disease, an area of potentially greater cost savings. The Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion reported that the medical care costs of people with chronic diseases in 2005 accounted for more than 75 percent of the nation’s $2 trillion in medical care costs.
Until these chronic diseases can be prevented, physicians will continue to prescribe the most effective treatments and medications to control disease progression.Surprisingly, there are only a few adherence programs that have been demonstrated to be cost-effective. Sen. Carper is familiar with my outcome research reducing hospital and emergency care for children with severe asthma, conducted at the Alfred I. duPont Hospital for Children.Fifty-nine children with frequent hospital care (median of seven hospital days and four emergency visits the year prior to admission) received medical treatment, education and counseling in an inpatient setting for 10 days. They were followed for four years as outpatients, and the median number of hospital days and emergency care visits for each year of follow-up was 0. This was associated with a 76 percent reduction in charges for asthma care.
These results were achieved by helping the families adhere to a complex asthma treatment plan.
In 2002, the Medical Society of Delaware convened a state-wide stakeholder’s conference to discuss a report from the Medication Adherence Task Force on asthma care.
Stakeholders recommended that asthma patients have incentives to follow a treatment plan and stay healthy. These included reduced or no co-pays for medications, scheduled well-office visits and necessary equipment to measure lung function and treat asthma symptoms at home. While there are many reasons other than cost that are responsible for poor adherence to therapy (e.g. side effects, depression, etc.) cost has been relatively easy to study.
Researchers found that the addition of a fixed $20 co-payment or 25 percent co-insurance reduces adherence to cholesterol-lowering drugs by 5 percent, with larger reductions in adherence observed in low-income patients.
Adult asthmatics in Asheville, N.C., who received both counseling and free medication from pharmacists had significantly reduced overall asthma-related costs despite increased medication costs that resulted from increased use. These studies confirm the validity of the recommendations of the Medication Adherence Task Force Stakeholders’ Conference and support legislative action for incentives, such as reduced or no co-pays, for responsible, chronically ill, medication-dependent citizens.
I believe Sen. Carper’s philosophical approach to promoting individual responsibility and maintaining health could easily be extended to those with chronic diseases.