Healthcare MBA Thesis

Running head: PREVENTIVE CARE & CHRONIC CONDITIONS

PREVENTIVE CARE & CHRONIC CONDITIONS

Using Preventive Care to Curtail Chronic Conditions in the U.S.

Unique D. Bloom

Florida International University

MAN6974: HCMBA Thesis

Abstract Comment by Unique Mccray:

Preventive care has become an important component in providing quality care and also changing the future of costs driven in the health care system. Preventive care is the part of the healthcare that not only reduces the chances of a patient obtaining a chronic disease but also ensures the quality of life. Several levels of preventive care can be implemented to address the issues of chronic disease on the U.S. health care and how trillions are spent in money and resources in these systems. Improving the debt of the country, decreasing the rates of deaths because of chronic diseases, and increasing the life spans of the population are several challenges in the healthcare industry that can be addressed with preventive care. Populations affected by these challenges include patients in low-income status who are not able to afford health insurance that covers preventive care services, these persons lack the motivation to participate in recommended healthcare services by physicians. This paper will address diverse initiatives that can not only address these challenges but also improve the issues of the cost associated with receiving preventive care. And how can we ensure that using preventive care can improve how to continue to provide value-based care.

Problem Statement

How can preventive care be implemented to address and curtail chronic conditions in populations that are considered low-educated, and have several risk behaviors in the U.S.?

Background Comment by Unique Mccray:

Preventive Care is the act in decreasing the effects of chronic disease on the system of healthcare (Quigley & Carpenter, 2008). The care that is considered preventive is categorized into three levels primary, secondary, and tertiary. The level of primary is the attempt to decrease the chances or attract any disease they may become chronic in the future, for example, quit smoking to avoid lung cancer. The secondary level implements the processes of screening any symptoms of someone’s personal health that may indicate any diseases that can also become chronic, for example, mammograms for breast cancer screening. The level of tertiary occurs once a patient has obtained the chronic disease and now has to begin measures that will decrease symptoms and reduce any risks of more complications, for example, chemotherapy or rehabilitation for chronic disease (Quigley & Carpenter, 2008).

Chronic diseases are defined as medical conditions that persist for at least a year or longer and cause limitations of daily living activities and medical attention (National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], 2020). Heart disease, cancer, and diabetes are the chronic diseases that lead to the deaths and disabilities in the population of the U.S. (NCCDPHP, 2020). Chronic disease is the result of an individual having limited performance in their health and survival associated with the poor choices made in that individual’s lifestyle (Raghupathi, 2019). Chronic diseases affect 44% of Americans as of 2004, in which some of these diseases are considered cancer, diabetes, hypertension stroke, heart disease, asthma, and mental disorders (Raghupathi, 2019).

Every year more than 859,000 Americans die from stroke or heart disease, this shows the economic burden and reason why the U.S. health system is spending $199 billion a year while also causing the productivity lost of $131 billion in employment (“Health and Economic Costs of Chronic Disease,” 2020). Cancer has been a diagnosis of more than 1.6 million people each year, which about 600,000 dies from this diagnosis. Appendix C shows all types of cancer deaths across the U.S. and how each year the number continues to grow due to the population growth but all various risk factors, use of screening tests and treatment improvements (U.S. Cancer Statistics Working Group, 2018).

The statistics have proved cancer to be the second leading cause of death in the U.S., this care is going to reach a cost of $174 billion by 2020 (“Health and Economic Costs of Chronic Disease,” 2020). Diabetes is another high diagnosis of many Americans, more than 30 million with diabetes and 84 million adults with prediabetes (“Health and Economic Costs of Chronic Disease,” 2020). Other illnesses like kidney failure, heart disease, and blindness are caused by diabetes and these have cost the U.S. health system great debt and $237 billion every year for employers (“Health and Economic Costs of Chronic Disease,” 2020). Obesity is a premedical condition that can lead to the chronic diseases of diabetes, some cancers, and heart disease among 1 in 3 adults and 1 in 5 children (“Health and Economic Costs of Chronic Disease,” 2020). This condition has created a debt of $147 billion a year for individuals with obesity (“Health and Economic Costs of Chronic Disease,” 2020).

Several risk behaviors cause chronic diseases: exposure and use of tobacco, inadequate diet, this includes low in vegetables and fruits and high saturated fats and sodium, need for physical activity, extreme alcohol use (NCCDPHP, 2020). The leading behavior in the United States that causes many preventable deaths is cigarette smoking, this causes at least one disease in more than 16 million Americans. Resulting in $170 billion in direct medical cost (“Health and Economic Costs of Chronic Disease,” 2020). Billions could be saved by preventive programs to quit smoking. Another leading cause of chronic diseases is the lack of physical activity, causing the U.S. health system $117 billion every year (“Health and Economic Costs of Chronic Disease,” 2020). Each year in the U.S. 88,000 deaths are caused by extreme use of alcohol, this includes 1 in 10 deaths of the working-age adults, totaling a cost of $249 billion in the U.S. (“Health and Economic Costs of Chronic Disease,” 2020).

Seen in Appendix B, the chart demonstrates the average cost of several leading chronic diseases in the U.S. An increase of 25% will take place in healthcare spending before new technology, due to the population of 65 years or older doubling over the next 30 years (NCCDPHP, 2020). To address the increasing health cost, strategic intervention and innovation need to address the associated reasons and causes of chronic diseases (NCCDPHP, 2020).

By 2030, it is expected that 171 million people will have some type of chronic disease, and many of those individuals that are higher in age will continue to have multiple chronic diseases (Raghupathi, 2019). An estimated total of 58 deaths have been associated with the several chronic diseases stated above and also low-income areas (Epping-Jordan et al., 2005). In the U.S. Healthcare an increase by 3.9 percent in spending, this was an average of $10,739 per person and had a resulting total of $3.5 trillion in the healthcare spending of 2017 (as cited in Health and Economic Costs of Chronic Disease, 2019). Currently, 85% of health care spending has been on chronic diseases, where many Americans have at least one chronic disease and this is seen to increase to 157 million by 2020 (Raghupathi, 2019). The treatments and services of chronic diseases that remain to hurt the nation’s health system and the economy is more than 75% annually and resulting in $2.5 trillion in spending for these conditions (Raghupathi, 2019).

Numerous services such as tobacco cessation screening, daily aspirin use, and alcohol screening with counseling, all have added to the net medical savings by more than $1 billion each (Maciosek et al., 2010). Preventive services have increased the contribution of more than 100,000 years of life to the population (Maciosek et al., 2010). In 2006, a total of 1,233.1 life-years saved per 10,000 people per year showed by the intervention of immunizations for children, which resulted in $267 in net medical cost per person per year (Maciosek et al., 2010).

The utilization of preventive services has shown a reduction in the demand for the use of care services, the motivation to participate and the cost beforehand associated with services needed (Quigley & Carpenter, 2008). Data has shown that several populations that are considered rural, low educated, and low-income are the populations that have shown under-utilization of preventive services. The above communities have and continue to face several barriers in accessing preventive care such as transportation problems, cost, lack of insurance coverage, and lack of promotion for recommended services, providing the importance and needs of engaging in preventive care (Casey, Call, & Klingner, 2001).

In appendix A, the chart explains the relation of individuals with a high school and having diabetes. Not having a high school diploma relates to having little to no education, and many non-educated individuals struggle with medical conditions. Adults 18 years and older of age shown from 1980 to 2017, the correlation of how these individuals being diagnosed with diabetes as the years’ increase. The highest growth in diabetes diagnosis, with the range of 5-13% of individuals with less than high school education. Those individuals with the education of higher than a high school were a diagnosis percentage 3-7, showing that higher education people tend to have fewer chronic diseases.

An example of under-utilization for women in urban communities provided a percentage of 61.5 who participated in mammograms (Casey, Call, & Klingner, 2001). Factors like deductibles and copayments associated with preventive services pf pap tests, mammograms, and counseling affected the utilization (Casey, Call, & Klingner, 2001). Odds ratios have shown that difficulties in individuals affording preventive services, ratios range from 0.67-0.82 and 0.77-0.81 in purchasing of insurance recommended for cancer screening (Casey, Call, & Klingner, 2001).

Primary and secondary levels of preventive care have been able to detect and treat any possible and current disease before reaching chronic stages and this allows overall cost to decrease before reaching tertiary levels of treatment (Güneş, Chick, & Wassenhove, 2009). Several insurance providers include high-deductibles, and also includes low premiums with out-of-pocket expenses for the patient (Agarwal, Mazurenko, & Menachemi, 2017).

Comment by Unique Mccray:

Landscape

Healthcare Providers

The healthcare system relies on the services provided not only by various hospitals but also by private practices and physicians. These are the first hand in providers of preventive care, being able to provide the necessary tools and recommendations for individuals diagnosed with a disease. Proper inventions can improve the quality and use of preventive services, and be able to detect any possible chronic diseases early (“How We Prevent Chronic Diseases and Promote Health,” 2019). Several interventions provided by healthcare providers will reduce risk factors and manage medical conditions with various levels of prevention. Examples include: increasing the access to healthcare for populations with limited to no access; paying providers for the health outcomes instead of services; measuring and communication system developments; increasing use of health IT and cancer screening with minimum health insurance (“How We Prevent Chronic Diseases and Promote Health,” 2019).

Insurance Providers

Medicaid is a provider of health coverage for 63.9 million people as of 2019 (“Medicaid,” n.d.). These Americans are considered eligible by being low-income adults, pregnant women, children, individuals with disabilities and elderly adults. This coverage is managed by states under federal requirements and is jointly funded by both state and federal governments (“Medicaid,” n.d.). Along with the Children’s Health Insurance Program (CHIP) helps millions of their beneficiaries by promoting preventive care and services to live longer and healthier lives. Centers for Medicaid and Medicare Services (CMS) have committed to assist states in increasing access to preventive health care and information about a high quality, impactful and effective practices of care delivery (“Prevention,” n.d.). Initiatives of prevention CMS implements are the following:

· Medicaid Prevention Learning Network: a program that provides Medicaid programs from state-to-state to learn and obtain new technical assistance to better the delivery of preventive care and services.

· Immunizations: facilitating access to vaccines and administration for individuals. Along with CDC, the program Vaccines for Children provides vaccines to the Youth enrolled in Medicaid and CHIP.

· Obesity: Provides access to screenings to reduce obesity while promoting eating healthy and engaging in more physical activity.

· Tobacco Cessation: Reducing disease that smoking causes, and using treatment have been cost-effective in preventive services. Benefits cover quitlines, counseling, and pharmacotherapy to assist with quit smoking.

Medicare is medical insurance, Part B of this program covers health care providers’ and doctor services and outpatient care. This insurance coverage also helps with home health care, medical equipment, and some preventive care services (“What Medicare Covers,” n.d.). The several preventive services Part B covers are the following:

· Alcohol misuse screenings & counseling

· Cardiovascular disease screenings

· Colorectal cancer screenings

· Diabetes screenings

· Lung cancer screening

· Mammograms (screening)

· Nutrition therapy services

· Obesity screenings & counseling

· Prostate cancer screenings

· Tobacco use cessation counseling

These screenings and services provide the primary and secondary level of prevention, to avoid and medical conditions from becoming chronic diseases (“Preventive & screening services,” n.d.).

Policymakers

The National Centers for Disease Control and Prevention (NCCDPHP) is the center that holds the responsibility to help people and communities prevent obtaining chronic diseases and promotes health and overall quality of life in wellness. Each year 7 to 10 deaths are caused by chronic diseases and treatments for those individuals are the cause of the U.S. health care costs (NCCDPHP, 2020). The NCCDPHP advises that several prevention levels can prevent chronic diseases such as physical activity, restricting from the use of tobacco and extreme drinking, and participating in routine health screenings (NCCDPHP, 2020).

The promotion of changing the policy of prevention to produce positive change in the various environments will stimulate large sections of the population. Behaviors that are considered healthy will establish support for the communities and embrace a belief that health policies and settings will support those healthy lifestyles (National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], 2009).

To support health initiatives in the living of communities, and individuals several policies and systems must be promoted such as requiring physical education on schools daily, and increasing low-fat and high-fruit and- vegetable menu selections in these schools along with restaurants and employment cafes (NCCDPHP, 2009).The need for promotion in smoke-free policies in work-places, schools, and public areas to reduce the use of tobacco and promote water drinking through the continuing and extension of fluoridation (NCCDPHP, 2009).

Patients

Options Comment by Sarah J. Hammill: Comment by Unique Mccray:

Option 1. Key stakeholders such as primary care physicians and health care facilities in providing preventive care not only when patients are in desperate need of the services but to continue to promote all levels of preventive care through the routine of providing health care. Policymakers continue to require value-based health care, this would include screening services to prevent or decrease patients from obtaining any chronic diseases. Policies would mandate all physicians and healthcare professional to make evidence-based recommendations to any individuals that show risk behaviors that leads to chronic diseases. This option does cost government agencies and insurance providers to help assist patients and affording preventives services. This option is viable and also legal due to the preventive care already being available and promoted by CDC and CMS. By implementing this option is to reduce the diagnosis and also can be done in a timely matter to help patients screen at initial care visits to avoid chronic conditions in the future. The con to this option would be the motivation to physicians and making the recommendations to patients and providing the levels of preventive care to patients that may need them. Another con would be the promotion to patients to not only listen to their physicians’ recommendations but also follow through with receiving or participating in the necessary preventive care. By providing preventive care recommendations and care in initial care visits and primary care facilities, the increase in the populations of obtaining or receiving a diagnosis of cancer, diabetes, and other chronic diseases will have a great effect on the debt of the nations’ health system.

Option 2. Another option base on the analysis of the problem and background is to implement education and promotion of what is preventive care, the benefits, and examples to the communities. Education has been seen as factor in why individuals may have not taken advantage of preventive available or why they are highest in being diagnosed with diseases that are considered chronic.

Option 3.

Health providers such as insurance providers providing incentives to patients that use preventive

Option 4. Describe the option. What are the pros of this option? What are the cons of this option? Explain your argument briefly and concisely.

No Intervention on the promoting preventive care or services

Recommendation

Choose ONLY ONE option as your recommendation. that your client’s values and his/her ability to make (or not make) decisions (i.e., power) must be kept in mind when making your final recommendation.

Why did your team choose this option over the other ones? Did your team consider the client’s values and power when choosing this option? Did the team consider and identify any possible drawbacks this recommended option may have in its implementation? Did the team provide alternative ways to avert such drawbacks, if any? Make sure NOT to repeat the analysis in this section.

Conclusion

Consider writing at least one concise paragraph wrapping up the entire content of this analysis very briefly. Do not ramble! Get to the point! Do not rewrite previous sections of your paper. The key here is to SUMMARIZE your findings based on the evidence you gathered and understood from the sources you investigated. Make sure to end your concluding paragraph(s) with a persuasive statement.

References

Casey, M. M., Call, K. T., & Klingner, J. M. (2001). Are rural residents less likely to obtain recommended preventive healthcare services? American Journal of Preventive Medicine, 21(3), 182–188. doi: 10.1016/s0749-3797(01)00349-x

Centers for Medicare & Medicaid Services. (n.d.). Medicaid. Retrieved from https://www.medicaid.gov/medicaid/index.html

Centers for Disease Control and Prevention. (n.d.). U.S. Diabetes Surveillance System. Retrieved from https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html#

Centers for Medicare & Medicaid Services. (n.d.). Prevention. Retrieved from https://www.medicaid.gov/medicaid/benefits/prevention/index.html

Epping-Jordan, J. E., Galea, G., Tukuitonga, C., & Beaglehole, R. (2005). Preventing chronic diseases: taking stepwise action. The Lancet, 366(9497), 1667–1671. doi: 10.1016/s0140-6736(05)67342-4

How We Prevent Chronic Diseases and Promote Health. (2019, July 30). Retrieved from https://www.cdc.gov/chronicdisease/center/nccdphp/how.htm

Maciosek, M. V., Coffield, A. B., Flottemesch, T. J., Edwards, N. M., & Solberg, L. I. (2010). Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost. Health Affairs, 29(9), 1656–1660. doi: 10.1377/hlthaff.2008.0701

National Center for Chronic Disease Prevention and Health Promotion. (2009). The Power of Prevention Chronic disease . . . the public health challenge of the 21st century https://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf

National Center for Chronic Disease Prevention and Health Promotion. (2020, January 22). About the Center. Retrieved from https://www.cdc.gov/chronicdisease/center/index.htm

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). (2020, March 10). Health and Economic Costs of Chronic Disease. Retrieved from https://www.cdc.gov/chronicdisease/about/costs/index.htm#ref3

Preventive & screening services. (n.d.). Retrieved from https://www.medicare.gov/coverage/preventive-screening-services

Quigley, A. S., & Carpenter, C. E. (2008). Containing Costs by Preventing Them. Journal of Financial Service Professionals, 62(4), 22–25. Retrieved from http://search.ebscohost.com.ezproxy.fiu.edu/login.aspx?direct=true&db=bth&AN=33195026&site=ehost-live&scope=site

Raghupathi, V. (2019). An empirical investigation of chronic diseases: A visualization approach to Medicare in the United States. International Journal of Healthcare Management, 12(4), 327–339. https://doi-org.ezproxy.fiu.edu/10.1080/20479700.2018.1472849

Sanderson, A., & West Jr., D. J. (2019). A Model for Sustaining Health at the Primary Care Level. Hospital Topics, 97(2), 46–53. https://doi-org.ezproxy.fiu.edu/10.1080/00185868.2019.1605321 Comment by Unique Mccray:

U.S. Centers for Medicare & Medicaid Services. (n.d.). What Medicare Covers. Retrieved from https://www.medicare.gov/what-medicare-covers

U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on November 2018 submission data (1999-2016): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; www.cdc.gov/cancer/dataviz, June 2019.

Appendi ces Comment by Sarah J. Hammill:

Appendix A

CDC - Diagnosed Diabetes

Centers for Disease Control and Prevention. (n.d.). U.S. Diabetes Surveillance System. Retrieved from https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html#

Appendix B

National Center for Chronic Disease Prevention and Health Promotion. (2009). The Power of Prevention Chronic disease . . . the public health challenge of the 21st century https://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf

Appendix C