What can we do for seniors? Slaying the Medicare Dragons: The Promise of Innovation October 17, 2007 Dr. William Rowley Institute for Alternative Futures
Increasing Prevalence of Diabetes 1995 2005 14 Million 2015 23 Million 2025 2 Diagnosed & undiagnosed <5% 35 Million 47 Million 5-8% 9-11% 12-14% 15-17% 18-20% Sources: CDC Behavioral Risk Factor Surveillance System; Narayan. Impact of Recent Increase in Incidence on Future Diabetes Burden. Diabetes Care 2006;29:2114-2116
Risks of Diabetes Lifetime Risk 52% 49% 31% 45% 40% 27% 20% 15% 10% 5% 0% Prevalence Increases with Age 20 39 40 59 60+ If onset at 50 years old Quality of life shortened 14-18 years Lifespan shortened 9-14 years 65% die of heart disease 3
Burden of Diabetes Americans with Diabetes Annual Cost of Diabetes in 2002 Dollars 582,000 310,000 224,000 120,000 60,000 35,000 112,000 66,000 4 Data from CDC and American Diabetes Association projected to 2025
The Annual Cost of Diabetes $328B $289B $246B $206B $162B $120B Data American Diabetes Association projected to 2025 5
Increasing Prevalence of Obesity No Data 2015 Adults over 20 y/o <10% 10-14% 15-19% 20-24% 25-29% 30-34% 35-39% 40-44% 45-49% 50-54% 6 Source: CDC Behavioral Risk Factor Surveillance System 2015 Projection: Wang & Beydoun. The Obesity Epidemic in the United States Epidemiologic Reviews, 5/17/07
All it takes is personal responsibility 2005 Health Behaviors Survey Percent of Overweight Active Duty 60 50 51.2 55.2 58.3 61.6 Percentage 40 30 20 10 0 1995 1998 2002 2005 13% are obese 3,000 separations per year 7 fitnessbusinesspro.com/military/navy2.jpg
All it takes is personal responsibility Every segment of society shares in this responsibility We can t afford all the disease we are creating! 8 fitnessbusinesspro.com/military/navy2.jpg
Prevention at the Societal Level Start with children 9
Prevention at the Societal Level Change the way we eat 10
Prevention at the Societal Level Universal Design for Active Living 11
Prevention at the Societal Level Bring Activity Back into Life 12
Prevention at the Societal Level Bring Activity Back into Work 13
Prevention at the Health System Level Lifetime diabetes risk in 18 y/o man Normal weight = 20% Overweight = 30% Obese = 57% Very obese = 70% 1. Prevention Early detection of risk Early intervention Education Coaching 14 Narayan, et al. Effect of BMI on Lifetime Risk of Diabetes. American Diabetes Association 66 th Scientific Session, June 2006.
Prevention at the Health System Level 2. Screening Of 35 million seniors in Medicare, 17 million have undiagnosed diabetes or prediabetes Can stop progression of prediabetes to diabetes 71% of time with walking and modest weight loss 3. Behavior Modification 15
Effective Management of Chronic Diseases Medical Problems Diabetes HTN Dyslipidemia Cardiac Risk Targeted Therapies Noninvasive monitoring? 16 Wireless capture to electronic record
Effective Management of Chronic Diseases Medical Home 17 Collaborative team connected by EHR Continuous planned healing relationship Address all health problems & risks - coordinated Effective evidence-based interventions Access to information & coaching Shared decision-making & responsibility
18 How Much Could We Prevent? Effective prevention could eliminate at least half the cases of diabetes Effective management of diabetes could: Avoid or slow peripheral neuropathy by 2/3 Reduce amputations by more than 1/2 Prevent or delay blindness by 2/3 Reduce renal failure by 1/2 Reduce death from stroke/heart attack by ~1/3? Besides saving lives and reducing suffering how many billions would society save?
A Time of Great Challenges! Overall Health System Performance Evaluated on: - Access -Quality -Equity -Healthy Lives - Avoidable Hospital Use & Costs 19 Source: Commonwealth Fund State Scorecard on Health System Performance, 2007
A Time of Great Challenges! Overall Health System Performance Better access is closely associated with better quality Higher quality is not associated with higher costs 20 Source: Commonwealth Fund State Scorecard on Health System Performance, 2007
A Time of Great Challenges! Access Quality Cost To get one you need all three 21
22 The Lesson from the Future Life Conditions World View World View We adapt to major change by changing our minds Life Conditions
Summary Diabetes is one of the biggest challenges of our aging society We will not conquer diabetes until we also address obesity We must keep Americans healthy - prevention We must keep those with diabetes healthy - effective management of chronic diseases If we do these 2 things we will save $ billions To do this we need to change our minds 23
We cannot predict the future But we can create it We need to start with a vision for a future worth creating 24 Institute for Alternative Futures www.altfutures.com