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If you could propose one idea to help improve health care delivery in the United States, what would it be?

Contributors Respond

Larry Hausner, MBA

Larry Hausner, MBA

CEO, American Diabetes Association

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Read Larry Hausner's bio

Despite the rapid development of innovative technologies in the health care field, we have yet to discover a panacea that will easily transform our health care system into one that provides high-quality and cost-effective care.  What we have discovered and come to agree on over the last decade is that our sick care system must be reconfigured to a health care system that emphasizes wellness and prevention.  For that reason, I offer that it benefits us to consider targeted interventions and programs that address some of our most pressing health care crises. 

Consider the diabetes epidemic. Nearly 26 million Americans have diabetes and another 79 million have prediabetes placing them at high risk of developing the disease. Last year, we spent $245 billion on diabetes; a 41 percent increase in spending in just five years. Every day, 238 Americans with diabetes undergo an amputation; 120 enter end-stage kidney disease programs; and 48 become blind – all due to the devastating effects of the disease. By 2050, the Centers for Disease Control and Prevention estimates one in three adults in our country – one in two among minority populations – will have diabetes if present trends continue.

Diabetes is devastating our country, both in terms of its human and economic toll. We cannot allow it to further overwhelm our health care system and our fellow Americans especially when we know how to help prevent it.  One specific evidence-based intervention that will move us away from our history as a sick care system to one that promotes disease prevention is the National Diabetes Prevention Program (National DPP).  The National DPP is a community-based lifestyle intervention based on a successful clinical trial at the National Institutes of Health which found individuals with prediabetes can reduce their risk for type 2 diabetes by 58 percent with lifestyle changes including improved nutrition, increased physical activity and weight loss of 5-7 percent.  The results were even stronger for seniors; participants over the age of 60 reduced their risk for type 2 diabetes by 71 percent.  Further research translating the clinical trial to a community setting showed these results can be replicated in a group for a cost of about $400 per participant.  The National DPP is based on this effective low-cost community model.

However, access to this evidence-based intervention is lacking and must be improved.  For example, in Medicare, where we currently spend one out of every three dollars on diabetes and half of all Americans age 65 or older have prediabetes, we pay for care to treat the complications of diabetes, things like kidney dialysis and amputations, but not for evidence-based diabetes prevention services.  It is unconscionable that Medicare currently does not cover the National DPP for high risk seniors even though we know it is effective at preventing or significantly delaying the onset of type 2 diabetes.  Doctors, including my good friend and the Association’s President of Medicine and Science, Dr. John Anderson, feel like they are doing a disservice to their patients because they have no tools available to assist their Medicare patients newly diagnosed with prediabetes because Medicare does not cover this proven intervention to prevent and delay type 2 diabetes. Members of Congress have heard the pleas by doctors like John and introduced the Medicare Diabetes Prevention Act (HR 962/S. 452) which would add the National DPP as a covered benefit under Medicare for high risk seniors.  We cannot stop simply because a bill has been introduced; now is the time for policymakers to take action and work to transition our health care system from a sick care system to one that promotes health.

Transforming our health care delivery system will take a deliberate shift in our way of thinking about health care and it begins with prioritizing disease prevention and promoting tools like the National DPP. We cannot begin to rein in our healthcare spending if we do not begin to tackle chronic disease prevention rather than focusing on the acute care of patients who present with complications.

Myrl Weinberg, FASAE, CAE

Myrl Weinberg, FASAE, CAE

CEO, National Health Council

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Read Myrl Weinberg's bio

The ultimate end user of our country’s health care system is the patient. Therefore it makes sense that patients and their family caregivers should be active partners from the very beginning of the creative and decision-making processes to advance the delivery of quality care, enhance research, and encourage the development of new treatments. “Patient engagement” has become the buzzword of the year, and for good reasons.

The emerging field of patient-centered outcomes research, for example, is premised on the view that by integrating patients in every aspect of the research continuum, the resulting research will be more relevant to patients’ decision making. Similarly, the FDA is adopting a new paradigm of patient-focused drug development, recognizing that patients have a direct stake in the outcome of the review process and are in a unique position to contribute to weighing benefit-risk considerations that can occur throughout the medical product development process.

However, from a researcher perspective, little guidance exists to determine who should be involved, how and what role the patient community should have, and at what points in the process the patient community should be engaged. From a patient community perspective, expectations are unclear about how their input will be used to inform the process. There is little understanding of how to build sustained capacity and comfort throughout the patient community for effective engagement. In addition, there is little consensus-based guidance on how to conduct or assess whether an approach to patient engagement will yield meaningful results for all parties involved.

The National Health Council believes that it is only through new platforms for collaboration that bring together people living with chronic diseases and disabilities, researchers, and experts from the provider, payer, corporate, and policymaker arenas will the ideal state of patient engagement and, ultimately, patient-centered care be achieved.

Nancy Brown

Nancy Brown

CEO, American Heart Association

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Read Nancy Brown's bio

The most impactful improvements in healthcare delivery in the United States will be the result of a more innovative system that truly puts the patient at the center of their own care. At the American Heart Association, we believe patients must be given the opportunity to actively engage in their own care if we are to truly impact health and health outcomes.

There is convergence of factors that are enabling this engagement to happen: The implementation of the Affordable Care Act, the momentum around mobile health and new digital health technologies, and growing consumer awareness of – and interest in - health and well-being. Each of these factors plays a critical role in improving healthcare delivery.

Now that  an estimated 30 million Americans who previously did not have access to healthcare will now be in the system because of the Affordable Care Act, we will see a drive toward consumer engagement and accountability, especially as many begin to seek insurance through the public and private insurance exchanges. And with 50% of those over age 50 having at least one chronic illness, there is an impetus for new delivery models and patient-centered care. Traditional models will no longer be sufficient for more widespread care delivery.

Digital health technologies are enabling exciting new healthcare delivery models, and many consumers are starting to take notice. A Harris Interactive/HealthDay survey released last week found that more than one-third of respondents who are online said they were “very” or “extremely” interested in using smartphones or tablets to ask their doctors questions, make appointments or get medical test results. An equal number of respondents were interested in using smartphones and tablets for healthcare services such as monitoring blood sugar, monitoring high blood pressure, or diagnosing ailments.

In past decades, the American Heart Association has seen incredible advances in treatments for cardiovascular diseases and stroke, yet we’re also seeing more people than ever before requiring those treatments, because risk factors like obesity and diabetes are becoming much more prevalent. Digital health technologies, tools and sensing devices allow consumers to automatically have a record of what they eat, what they weigh, their blood pressure, how active they are, and many other health factors.  Wearable trackers by Nike, FitBit and others are helping consumers automatically track daily fitness and even sleep quality. By giving consumers the health information they’re looking for in real-time, these technologies encourage greater accountability in pursuing healthy habits and demonstrate, with real data, how our daily choices impact our health.

All of these changes are already beginning to catalyze new innovations in the healthcare delivery landscape. While we still have a long way to go to reverse the negative health impact of obesity and diabetes, these incredible technologies present an unprecedented opportunity to put patients at the center of their care and chart a new course toward health.

Christopher W. Hansen

Christopher W. Hansen

President, ACS-CAN

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Read Chris Hansen's bio

The most important improvement we can make in health care delivery in this country is emphasizing patients’ quality of life during and after treatment. Many people who face life-threatening diseases such as cancer now live long, full lives thanks to scientific advancements. But our nation’s health care system too often focuses solely on curing the patient and not on also providing the patient comfort, resulting in preventable suffering during life-saving treatment. Patient comfort should not take a back seat during treatment, and it does not need to.

The good news is there is a fast-growing movement in our health care system to focus on patients’ quality of life by providing palliative care services. Palliative care is specialized medical care that can provide patients with serious illnesses such as cancer and their caregivers better quality of life by focusing on relief from pain, stress and other symptoms of treatment. It is appropriate at any age and any stage of diagnosis, and can be provided alongside curative treatment for the disease. It is an extra layer of support delivered by trained specialists who work together with other doctors and nurses in a team-based approach that focuses on the patients’ needs, coordinates their care and gives patients and their families a voice in determining the care they receive.

Studies have shown that patients who received palliative care consultations spent fewer days in the ICU and were readmitted to the hospital less frequently. Palliative care consultations have also proven to save hospitals money. Unfortunately, many patients and families are unfamiliar with it or do not have access to it. Yet, according to a 2011 poll by ACS CAN and the Center to Advance Palliative Care, once people learn about palliative care, 92 percent would consider it for a loved one.

Two bi-partisan bills recently introduced in Congress can play a role in reversing this trend. The Patient Centered Quality of Life Act (H.R. 1666) co-sponsored by Rep. Emanuel Cleaver (D-Mo.) and Rep. Spencer Bachus (R-Ala.) would facilitate and expand federal research into palliative care, support training for health professionals to effectively practice palliative care and convene a national summit to develop tools and model best practices for providing palliative care. The Palliative Care and Hospice Education and Training Act (S.641 and H.R. 1339) co-sponsored by Sen. Ron Wyden (D-Ore.), Rep. Eliot Engel (D-N.Y.) and Rep. Tom Reed (R-N.Y.) addresses the deficit in palliative care training offered in the nation’s medical schools by creating new incentives for the training and development of interdisciplinary health professionals in the field.

The costs of these bills are negligible, yet they would make meaningful changes to the way many patients receive care and participate in decisions about their treatment. No wonder numerous public health groups back the bills, which are quickly gaining support in Congress.

Robert J. Hugin

Robert J. Hugin

Chairman and CEO

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Read Bob Hugin's bio

Supporting the ecosystem of medical innovation is the most important thing we can do to improve health care for patients with unmet medical needs in the United States.

Medical innovation is a crown jewel of America and its economy.  It has been the greatest source of longer life and economic prosperity in our country and around the world.  In the course of just one decade, from 1999 to 2008, medical innovation brought about a 45 percent reduction in deaths from cardiovascular disease.  Biopharmaceutical therapy for a devastating disease like Alzheimer’s can reduce nursing home admissions by 50 percent.  HIV has gone from an untreatable, fatal disease to a serious but manageable condition.  And in cancer, nearly 50 million life-years have been saved for patients since 1990 because of innovative approaches to cancer prevention and treatment. 

How did we accomplish this?  By working together – large and small companies, academic researchers, government agencies, and patient organizations alike.  By taking risks and investing in innovation.  And those investments have paid off in scientific advancement and economic growth. For example, the US government spent $3.8 billion over thirteen years investing in the Human Genome Project, generating enormous private sector activity.  Every $1 invested in the Human Genome Project created $140 in economic value, repaying the government for its investment via tax revenue many times over, and producing transformative scientific and medical advances for patients. 

We cannot take this ecosystem for granted.  In fact, it is very much at risk.  Short-sighted policies that limit scientific and medical innovation today could negatively affect patients for decades in the future.  Consider Alzheimer’s Disease.  The Alzheimer’s Association reports that without new disease-modifying treatments, by 2050, at least 13.5 million Americans will have developed Alzheimer’s disease, costing this country $1 trillion per year – a crushing expense.  A new therapy that delays the onset of Alzheimer’s by five years would reduce by nearly 45% the number of people with the disease by 2050, and save $447 billion per year.  We cannot afford NOT to invest in the discovery and development of such a potential treatment today. 

So how do we protect the ecosystem of medical innovation?  Fortunately, while the challenges are greater than ever, so too are the opportunities.  We are only at the early stages of being able to capitalize on the revolution in molecular biology and information technology.  With more than 5,000 new treatments in development, the promise and potential of recent scientific and technological advances is enormous.  We must be bold and courageous and stay focused on developing innovations that meet patients’ most pressing unmet needs.  And to do this, we must have a policy environment that supports  innovation, values the entire ecosystem of medical progress – academic medical centers, voluntary health associations, government agencies like the FDA, CMS and NIH, and, crucially, the biopharmaceutical company scientists, entrepreneurs and investors responsible for discovering, developing and bringing to patients the vast majority of new treatments.

Part of a supportive environment for innovation is ensuring that patients have access to the most innovative treatments. New therapies that reduce hospitalizations, promote productivity and improve quality of life have the potential to make real reductions in the overall cost of health care, but access to these treatments is critical.  Medicare Part D is an example of how the public and private sectors can work together to maximize benefit to patients and value to society.  This government supported, privately delivered program based on competition and choice has expanded access for good prescription coverage to 30 million seniors, with 90 percent satisfaction among participants, at a cost more than 40 percent lower than projections, and substantial demonstrated savings in other parts of the medical system.  We must work to protect this model and also ensure patient access to therapeutics in Medicare Part B, other government-funded health programs, and in plans offered through health exchanges.

We can improve health care in the United States by fostering a policy environment  that strengthens the ecosystem of innovation, so that working together, we can pursue bold innovations that create longer life and better health for patients.

Moncef Slaoui

Moncef Slaoui

Chairman, R&D, GlaxoSmithKline

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Read Moncef Slaoui's bio

When extraordinary advances are made in science, why does it take so long to translate them into treatments for the country's most pressing medical needs?

It's tempting to blame the pharmaceutical industry for being unproductive, regulators for being slow and academia for being resistant to change. In some cases, that criticism has been well deserved. But as the FDA opens up new regulatory pathways and drug pipelines are getting stronger, in part because of great advances in science in certain areas and better collaboration between industry and academia, it's time to come up with some new solutions for advancing medical innovation.

We tackled this issue at the Aspen Ideas Festival. The Aspen Institute's Elliot Gerson moderated a group that included two physicians, Kenneth Davis, president and CEO of The Mount Sinai Medical Center and Tony Coles, chairman and CEO of the biopharm company Onyx; FDA Commissioner Margaret Hamburg and me to discuss how we can reduce the time it takes to discover new drugs and get them to patients .

Our panel agreed that science has never been more exciting but we're not seeing new discoveries and insights translate into real world products at the rate we'd like, particularly in certain therapeutic areas. Key to future improvements is a strong, aligned biomedical ecosystem. But how do we get there? I would propose three, practical proposals:

1. Incentivize pre-competitive research
Let's create a national priority around an area of medical need that is difficult for any one entity to tackle alone, such as Alzheimer's, and agree to share all of our early data and work together to find new treatments. The FDA, which already has visibility of what every company is doing, including making the same mistakes, could develop policy to move that information out of its current silos and provide incentives for those who are willing to share their studies. Complicated diseases such as Alzheimer's are going to require treatments that can be given before the disease advances and that could mean years of long-term studies. By pooling pre-competitive research we could do for Alzheimer's' what the Framingham study did for cardiovascular disease.

2. Incentivize antibiotics discovery and development
This is an area of science that has been deserted by most of the players in the pharma industry. New antibiotics, almost by definition, are going to have their use restricted in order to avoid resistance, and that means that even though there is a strong societal need for these drugs, the traditional funding model for them is dead. We need to encourage and develop more public-private partnerships to re-stimulate interest in antibiotics research and create realistic ways of paying for it.

3. Incentivize innovation by extending market exclusivity
Despite advances in some areas of science that allow us to develop medicines more quickly, it can still take 10, 15 or even 20 years, which means by the time new medicines are approved, only a very short period of exclusivity remains; sometimes it's as little as five years. We need to extend the market exclusivity for medicines to reward the time, energy and resources that have gone into those innovations and provide companies with the motivation to do more.

As panelist Ken Davis put it, in order to have a robust biomedical ecosystem we have to align public policy with the public good. If we are going to continue to be at the forefront of research and innovation, we must prioritize the science we want to do that is in the public's best interest and provide reasonable incentives to speed innovation and make these important treatments available for patients.

Thoughts originally posted on Huffington Post.