Chapters of a Healthy Life, Healthy Community and Better Outcomes

Focus must shift from disease management to prevention

By Wael Barsoum, MD

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Healthcare in the United States is too focused on disease management, becoming involved only when someone is sick. The time has come for us to focus on being more proactive, rather than reactive when it comes to treating and managing chronic diseases.

A direct result of being disease-focused, healthcare in the United States has become too expensive and problematic for some to access. Patients are not incentivized to live a healthy lifestyle because they don’t see the result of poor habits and choices until it is too late. Moreover, healthcare providers are not encouraged to seek efficient ways to deliver care, improve outcomes and avoid duplication of services.

These are some of the issues that healthcare leaders continue to ponder. We know that a paradigm shift is crucial if we are to chart a new course, and most of us do feel that parts of our healthcare system need a complete overhaul.

Our current situation

In the present environment, we find ourselves reacting to symptoms and illnesses, instead of preventing and managing chronic diseases. If we don’t work more aggressively to make the shift and provide value-based care, costs will continue to skyrocket.

Healthcare costs in the US are rising at an unsustainable rate. As a result of focusing on sick care, per capita healthcare spending in the US is more than twice the average of other developed countries. Total US health spending, both public and private, is projected to rise to one-fifth of the economy by 2025. A recent study by The Commonwealth Fund compared 11 nations on healthcare quality, access, efficiency, as well as indicators of healthy lives such as infant mortality, shows that the U.S. ranks last among wealthy countries.

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The bottom line—the US is in the worst performing group regardless of the measure used. Although we devote at least 17 percent more of our economy to healthcare than other countries, it hasn’t helped deliver results in terms of quality or better outcomes.

How do we change the paradigm?

To control rising costs, we must place emphasis on value and quality over quantity by continuing the shift from fee-for-service to pay-for-performance. By moving to value-based care and focusing on quality, safety, efficiency and outcomes, we will reduce costs, improve health status, achieve better health outcomes and hold patients more accountable for their health. If we empower patients to focus on wellness and healthy living, we will spend less and control costs, and our patients will be happier, healthier and have improved quality of life.

At Cleveland Clinic, we are leading by example by inspiring our caregivers to improve their health and well-being. We offer gym memberships, yoga classes and weight management programs—all free or at greatly reduced cost—along with a weekly farmers’ market where our caregivers and patients can purchase locally grown fresh fruit and vegetables. In 2007, we stopped hiring smokers and provided smoking cessation programs to help our caregivers reduce their risk for heart and lung disease and many types of cancers.

Thankfully, we are now reaping the fruit of our efforts. Our caregivers have lost a combined 500,000 pounds and our employee healthcare costs have plateaued.

Empowering patients to do their part

As healthcare professionals, we can do more to empower our patients to do their part. Forty percent of the risk factors for premature mortality are behavioral, which means there are specific behaviors a person engages in that directly contribute to chronic disease. Those risk factors include but are not limited to obesity, poor diet, a sedentary lifestyle and smoking.

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Part of the problem is that for many years, we were misinformed. We now know that sugar and trans fat consumption are linked to heart disease. The cholesterol that causes heart disease is a combination of low HDL, high triglycerides, and small size LDL particles. Sugar, which is pervasive and hidden in many packaged food products, causes all of that to get worse.

So what should a prescription for better health look like?

  1. Exercise. Exercise reduces insulin resistance and hunger. Experts are now recommending we shift our exercise habits to short bursts of high intensity interval exercise to reduce insulin resistance and control or reduce hunger. Because we live in a society in which we are all pressed for time, this strategy may be more effective than spending an hour on a treadmill.
  2. Change your diet. Eat a plant-based diet, inclusive of healthy fats, lean protein and vegetables to reduce cardiovascular disease, maintain weight control and stabilize blood glucose levels.
  3. Reduce your risk for diabetes. Eliminate sugar and complex carbohydrates.
  4. Choose a primary care provider and develop a relationship with him or her. Discuss your concerns with your doctor and follow their recommendations.

By shifting our focus from managing acute episodes to improving the overall health of patient populations, and shifting from sick care to wellness and prevention, we will provide better care while simultaneously lowering the cost of healthcare and insurance premiums. Together, as physicians, patients and hospitals, we can address and reduce the environmental risk factors that contribute to chronic disease.

We have a long way to go but we can make a remarkable difference if we all do our part!

Dr. Barsoum is President of Cleveland Clinic Florida and staff in the Department of Orthopaedic Surgery.