Jane F. Jasek, RDH, MPA
American Dental Association
Elyse A. Perweiler, MPP, RN
National Association of Geriatric Education Centers
Marcel E. Salive, MD
American College of Preventive Medicine
Anne M. Summer, PA, RN
Association of Clinicians for the Underserved
Recommendation: Health promotion and disease prevention services, which are evidence-based and cost-effective, should be included under Medicare.
Background:
Our health care system is in crisis. Older adults are living longer. More than 125 million Americans have chronic diseases and one in ten experiences major limitations in activity, all of which diminish function and quality of life. Chronic diseases account for more than 70% of all deaths in the U.S., two-thirds of which are caused by heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes. Health care spending continues to escalate, with 75% of those costs attributable to chronic disease.
There is a growing body of evidence that prevention is effective in older adults. Many chronic diseases are preventable through risk factor modifications such as smoking cessation, exercise and diet change.
Early identification and treatment of preventable chronic diseases is an investment in America's future as a healthy, productive nation. Medicare modernization must embrace health promotion and disease prevention and develop a comprehensive model of wellness care for older adults. Scientific evidence and cost-effectiveness should guide Medicare coverage decisions for preventive services that can postpone disease and disability, permitting older adults to maintain functional independence and quality of life.
Approaches:
Implementation:
Changes to Medicare should incorporate prevention into the regular coverage process so that evidence-based services are covered systematically. Cost-benefit analyses indicate that tobacco cessation and vision screening services achieve cost savings. Cholesterol screening and subsequent treatment will require budgetary outlays, but the economic analysis indicates that it is a good value, which improves quality of life at a reasonable cost.
Medicare coverage alone is not sufficient to ensure that preventive services are appropriately delivered to all seniors. Allowing a broader range of providers will leverage scarce resources more efficiently and is needed for the behavioral counseling and lifestyle modification components of prevention.
Improved technology employing reminder systems and provider audit and feedback techniques are proven ways that will increase appropriate use of services. Tailoring the current public health education campaigns for tobacco cessation, cholesterol screening and low vision to the senior population can build on previous successes.
For tobacco cessation, guidelines exist for a systems approach in clinical practice. For cholesterol screening, the National Institutes of Health have developed integrated clinical cardiac risk-assessment tools and approaches to screening in public health settings. However, additional research is essential to develop other best practices to effectively deliver and sustain preventive health to seniors, including vulnerable, at-risk and hard to reach populations.
Partnership activities between the Centers for Disease Control and Prevention, the Administration on Aging and state/local government can increase delivery by health departments and state units on aging in public settings. This will ensure achievement of sustainable delivery of preventive services with appropriate treatment and follow-up. Policy choices for the 21st century must acknowledge and reflect the power of prevention and support those efforts.
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