Preventative health, health disparities and the ACA

Inside Edge Consulting, Princeton

November 13, 2014

At the recent National Forum for Heart Disease and Stroke Prevention (NF) Annual Meeting, preventative care was an important topic of conversation for the attendees. Specifically, the focus was on preventing cardiovascular deaths, the number one killer in the United States.

As we have seen over the last few years, especially related to the Affordable Care Act (ACA), many organizations have a focus on preventive health. The challenge, however, is that prevention is not always part of the healthcare context for patients that need it most — patients with lower levels of education, non-English speakers and those in many urban and rural settings.

Numerous elements of the ACA have been designed to place a larger emphasis on preventive health, including the development of Patient Centered Medical Homes (PCMH) and the CMS Triple Aim. PCMH is intended to integrate the different elements of primary care to provide higher quality care at a lower cost. The CMS Triple Aim, as the name denotes, has three components:

  • Providing better care for individuals, based on the following points: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity
  • Providing better health through increased physical activity, decrease in substance abuse, and improvement in nutrition
  • Reduction in per-capita healthcare costs
  • The challenge discussed at the NF Annual Meeting is the fact that many of the programs targeted at prevention do not reach the populations indicated above. Whether they are programs implemented by payers, employers, pharmaceutical manufacturers, or other organizations, they are often not targeted at these high risk populations or are not enduring in nature.

    These populations are most at risk and truly cost the most in the system, since they often use the emergency department as their primary source of care, and their lack of prevention can mean a higher burden of illness. Moving forward, we need to work together to really understand how we can impact these populations to increase care and decrease cost.

    Affordable Care Act