Health care policy expert says now is the time to focus on prevention

Mark McClellan

December 14, 2011 — With national health care reform underway, there should be plenty of opportunities for individuals, health care providers, insurers, and policymakers to emphasize preventive care. Focusing national attention on taming the rise of behavior-related ailments—diabetes, obesity, lung cancer—would save money as well as improve the overall health of Americans.

The problem, says Mark McClellan, “is actually making these kinds of steps happen.”

A doctor and economist by training, McClellan is senior fellow, director of the Engelberg Center for Health Care Reform, and Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution. He delivered the 154th Cutter Lecture on Preventive Medicine at Harvard School of Public Health’s Snyder Auditorium on December 5, 2011 with a talk titled “Prevention and Health Care Reform.”

Prior to working at Brookings, McClellan was administrator of the Centers for Medicare & Medicaid Services under former president George W. Bush. Before that he served as commissioner of the Food and Drug Administration; a member of the President’s Council of Economics Advisers; and senior director for health care policy at the White House.

Ever-increasing health care costs—and troubling increases in the percentage of Americans afflicted with preventable diseases—make it clear that “population health should be a central focus of health care reform,” said McClellan.

A number of health care organizations around the country are working hard to make that goal a reality, he said. New York Presbyterian Hospital and Denver Health & Hospital Authority are both examples of institutions that provide hospital care as well as community- and school-based programs focused on lifestyle and behavior change.

But these examples are rare, McClellan said. It’s not easy to shift the focus to prevention because current public policies don’t provide enough support for it. There are limited resources for public health initiatives; health care reimbursements are mostly tied to the “fee-for-service” model, not prevention; there’s skepticism about whether or not preventive measures actually work, because many risk factors, like eating habits or smoking, are hard to modify; and it’s difficult to replicate successful programs in different regions of the country.

Nevertheless, McClellan said, it’s important for policymakers to identify and support workable reforms.

He suggested several ways to aim the focus more squarely on population health:

• Effectively measuring and tracking preventive efforts to show that they work

• Working to insure that health care providers receive Medicare, Medicaid, and private insurance reimbursements for preventive efforts as well as fee-for-service work

• Designing health benefits programs that offer more options, like rebates for healthy living or incentives for choosing generic medicines

• Giving people more low-cost health insurance options

McClellan acknowledged that there are “philosophical differences” in Washington about the national health care reform effort, and that it can be challenging to pursue outside-the-box thinking on health care. “But we can still make progress,” he said. “Staying with fee-for-service is not working. We need to think of something better.”

–Karen Feldscher

photo: Colleen Keller