Moderated by Tom Sabulis
Commenting is open below.
By Kenneth Brigham and Michael. M.E. Johns
The current trajectory of Medicare costs cannot be sustained. Politicians propose a variety of solutions, all of which intend to cut the cost of care for people who have a disease. While some of those solutions are creative and might work in the short run, there is a major flaw in the rationale: The cost of disease care will continue to increase. We cannot afford disease care for all who will need it unless we can decrease their numbers. Halving the incidence of chronic disease would save over a trillion disease-care dollars.
To accomplish that, we must change the paradigm. The concept of “predictive health” — health rather than disease and prediction of health status rather than diagnosis as the focus — is a radical shift that can decrease the burden of disease. Much of the knowledge, science and technology that make this possible exists, and more is on the way. The barriers are the professional, social, economic and political stakes in disease care.
The relationship between education and health makes the point that, more than a biologic fact, health is a consequence of the entire human experience. Although we spend more on “health” care than many other countries, we spend about the same as most of them on the combination of health care and social programs. Health is clearly influenced by broader social factors. Education, social infrastructure and safety nets for the less fortunate, as well as access to care, are integral to a people’s health.
Waiting for disease to happen is missing the opportunity. Predictive health defines health in the context of biology, behavior and environment. It evaluates that integrated experience and designs personally tailored changes in behaviors that can forestall or prevent diseases that compromise quality of life, and cost an arm and a leg (often literally) to take care of. In the long run, this could decrease the numbers of people who need disease care.
At the Emory Georgia Tech Predictive Health Institute’s Center for Health Discovery and Well Being®, healthy people have their health profile defined, personal action plans developed and goals facilitated by a “health partner.” The early results indicate improvements in biologic heath (BMI, blood pressure, blood lipids, etc.), well-being (decreased depression and stress), and even some evidence of improved brain function. People They are healthier, and their risks for developing chronic disease are decreased.
Changing paradigms is difficult, but if we are to avert an economic cataclysm, we have to do it. There may be short-term efficiencies, but the iceberg is out there awaiting its encounter with this disease care Titanic. The costs of complex disease care will continue to increase; decreasing the demand for such care is the only long-term solution. Predictive health can do it, if there is enough foresight and fortitude to invest some dollars in keeping people healthy.
We may have the best disease care system in the world, but we do not have the best health care system — yet.
Kenneth Brigham is professor of medicine emeritus at Emory University. Michael M.E. Johns is professor in the Schools of Medicine and Public Health at Emory.