NHS6008_Banta_Lucresha_Assessment2-1
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Dec 6, 2023
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docx
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1
Needs Analysis for Change
Lucresha Banta, RN, BSN
Economic Decision Making in Health Care
August 2023
2
Between 2008-2018, healthcare expenditures reached over $8 billion, with a vast
majority of spending on chronic disease management such as heart disease, cancer,
and neurological disease. There needs to be a shift of focus from illness to wellness.
Preventing or delaying the onset of chronic disease will help reduce the cost of
healthcare expenditures. As the US population ages, it is crucial to focus on this
population as it will continue to be where the majority of Medicare dollars will be spent.
Value-based payment models will be essential to helping close the gaps from shifting
from a treat model of care to a preventive model of care.
Socioeconomic Disparities
Chronic diseases such as hypertension, diabetes, cancer, and neurological
diseases are the leading causes of death and disability in the US (Stoutenberg, et al.,
2023). In the US, 54.1 million adults are 65 or older, accounting for 16% of the US
population. It is estimated that by 2040, this number will be 80.8 million. The cost of
treating chronic diseases is estimated at $4.1 trillion. Heart disease affects 116 million
adults and results in $216 billion in healthcare costs. Diabetes affects 37 million adults
for $327 million in healthcare spending. Cancer affects 1.7 billion adults with a
healthcare cost of $185 billion. Alzheimer’s disease affects 5.7 million adults, resulting in
$305 billion in healthcare costs (
www.cdc.gov
). To help combat the continuing rise of
healthcare costs, preventative measures must be in place to reduce and prevent the
factors leading to chronic diseases. Insurance companies must continue to drive
towards value-based payment models focusing on wellness instead of treatment.
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Possible Solutions
Solutions to decreasing the costs associated with chronic disease management
include employing community health workers, community education, and educating
medical providers during their medical school careers and current practices. Primary
care offices are often the first introduction into the healthcare system. Education has to
begin with our primary doctors. These solutions will be valuable as payment models
shift to value-based ones.
Community health workers are a much-needed yet underutilized resource for
chronic disease management. These workers help to establish a connection between
the healthcare system and patients. They are responsible for care coordination, health
assessments, education, and psychosocial support (Mistry et al., 2021). Community
health workers are vital because of their ties to the community. They tend to be more
culturally aware of the community's needs and can better provide patient services.
According to Wang et al., chronic disease prevention does not have an immediate,
measurable effect; however, the long-term benefits reduce the incidence of or delay the
onset.
Medical schools play an essential role in preparing future doctors to treat
patients. Education is the key to preventing chronic diseases, and the education of our
providers needs to start at the school level. In findings reported by Stoutenberg et al., it
was found that educating medical students about chronic disease prevention and
interest in public health programs was most significant during the first year of medical
school.
Instilling a foundational level of prevention knowledge in medical students will
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help decrease chronic disease treatment costs. These students will be better suited to
provide education on preventing chronic diseases.
Medicare, insurance companies, and Medicaid must work towards a value-based
payment model. Switching to this payment model allows practitioners to focus on
wellness versus treatment. Insurance companies will provide incentives to providers
that keep their patients healthy. Involving primary care providers to educate patients on
chronic disease prevention will be essential. Developing trust between patients and
primary care providers will help patients seek medical care from primary care providers
instead of non-primary care providers (Wu et al., 2023)
Outcomes and Opportunities for Growth
Heisler et al. report in their study that with community health workers who work in
communities in which they are engaged and familiar, the number of inpatient hospital
visits decreased, and the utilization of ambulatory care centers increased. The use of
ambulatory care centers versus the use of acute hospitals will help reduce costs.
Another study by Mistry et al. showed that 54% of patients scheduled and
followed up with their primary care provider after intervention by a community health
worker. This same study also showed a 38% reduction in emergency room visits and a
53% reduction in hospital admissions. The care coordination that community health
workers provide is essential in decreasing the overutilization of emergency rooms and
underutilization of primary care doctors.
Encouraging the use of community health workers by insurance companies can
be highly cost-effective to reduce chronic disease management costs and still provide
5
patients with essential education. Community health workers are responsible for health
education, addressing barriers to care, care navigation, and patient follow-up. The
workers look at the entire patient to determine needs, including social determinants of
health. Since these workers are community-based, they are familiar with services and
culturally essential issues facing these patients.
Conclusion
According to
www.nichm.org
, community health workers promote health equity
and improve public health. They are trusted advocates and educators within the
communities they reside in. Workers have demonstrated a reduced burden of illness
and reduced hospitalization days. In chronic disease management and prevention,
these are essential goals. With implementation at the level of insurance payors, we can
reduce the costs associated with the long-term management of chronic diseases.
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References
Health and Economic Benefits of High Blood Pressure Interventions | Power of
Prevention (cdc.gov)
Heisler, Michele,M.D., M.P.A., Lapidos, A., PhD., Kieffer, Edith,M.P.H., PhD.,
Henderson, J., PhD., Guzman, R., B.A., Cunmulaj, J., B.A., Wolfe, J., M.P.P.,
Meyer, T., EdM., & Ayanian, John Z,M.D., M.P.P. (2022). Impact on Health Care
Utilization and Costs of a Medicaid Community Health Worker Program in Detroit,
2018–2020: A Randomized Program Evaluation.
American Journal of Public
Health,
112
(5), 766-775. https://doi.org/10.2105/AJPH.2021.306700
Jones, G. B., & Wright, J. M. (2022). The economic imperatives for technology enabled
wellness centered healthcare.
Journal of Public Health Policy,
43
(3), 456-468.
https://doi.org/10.1057/s41271-022-00356-8
Levine S, Malone E, Lekiachvili A, Briss P. Health Care Industry Insights: Why the Use
of Preventive Services Is Still Low. Prev Chronic Dis 2019;16:180625.
DOI:
http://dx.doi.org/10.5888/pcd16.180625
Ma, J., Yabroff, K. R., Siegel, R. L., Cance, W. G., Koh, H. K., & Jemal, A. (2022).
Progress in Reducing Disparities in Premature Mortality in the USA: a Descriptive
Study.
Journal of General Internal Medicine,
37
(12), 2923-2930.
https://doi.org/10.1007/s11606-021-07268-5
Mistry, S. K., Harris, E., & Harris, M. (2021). Community Health Workers as Healthcare
Navigators in Primary Care Chronic Disease Management: a Systematic
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Review.
Journal of General Internal Medicine,
36
(9), 2755-2771.
https://doi.org/10.1007/s11606-021-06667-y
Community Health Workers: Their Important Role in Public Health (nihcm.org)
Promoting Health for Older Adults | CDC
Stoutenberg, M., Lewis, L. K., Jones, R. M., Portacio, F., Vidot, D. C., & Kornfeld, J.
(2023). Assessing the current and desired levels of training and applied
experiences in chronic disease prevention of students during medical
school.
BMC Medical Education,
23
, 1-11.
https://doi.org/10.1186/s12909-023-
04044-3
Wang, Y., Hu, B., Zhao, Y., Kuang, G., Zhaon, Y., LiuN, Q., & Zhu, X. (2021).
Applications of System Dynamics Models in Chronic Disease Prevention: A
Systematic Review.
Preventing Chronic Disease,
18
https://doi.org/10.5888/pcd18.210175
Wu, S., Du, S., Feng, R., Liu, W., & Ye, W. (2023). Behavioral deviations:
healthcare-seeking behavior of chronic disease patients with intention
to visit primary health care institutions.
BMC Health Services
Research,
23
, 1-14. https://doi.org/10.1186/s12913-023-09528-y