Valerie Bassett Massachusetts Public Health Association August 3, 2011

1. the need for community-basedprevention in payment reform Valerie Bassett Massachusetts Public Health Association August 3, 2011

2. spending on “health care” vs. “sick care” Each year, we spend97%of our health care dollars caring for individuals once they’re already ill . . . . . . and only 3% of those dollars on preventing diseases from developing in the first place. Source: Woolf S. The big answer: Rediscovering prevention at a time of crisis in health care. Harvard Health Policy Review. 2006;7(2):5-20.

3. our health spending mismatch The New England Health Care Institute cites research showing that 88% of our health is determined by our environment and our behavior – not by the health care we receive.

4. prevention must be part of payment reform • Community-based prevention works to prevent illness and injury before they happen • Settings include schools, workplaces, neighborhoods • Clinical prevention involves screening and disease management • Conducted in health settings

5. community-based prevention • Community-based prevention efforts include: • Serving healthier foods in schools to prevent obesity • Banning smoking in certain areas to prevent exposure to secondhand smoke • Building sidewalks and bicycle lanes to encourage physical activity

6. cost savings from prevention • Prevention can save Massachusetts nearly half a billion dollars each year. • A 2011 study showed that reducing the prevalence of diabetes and hypertension by 5% would lead to large decreases in medical costs within only a few years. Source: Ormond B, Spillman C, Waidmann T, Caswell K, Tereshchenko B. Potential national and state medical care savings from primary disease prevention. American Journal of Public Health. 2011;101(1):157-164.

7. cost savings, cont’d Source: Ormond B, Spillman C, Waidmann T, Caswell K, Tereshchenko B. Potential national and state medical care savings from primary disease prevention. American Journal of Public Health. 2011;101(1):157-164.

8. projected savings from prevention Source: Milken Institute. An Unhealthy American: The Economic Burden of Chronic Disease. Available at: http://www.chronicdiseaseimpact.com/ebcd.taf?cat=state&state=MA

9. disinvestment from prevention • The Governor’s FY12 budget proposal slashes $25M in public health funding • The proposed cuts to the Department of Public Health follow more than $90M in cuts over the last three years, a loss of more than a quarter of state funding for DPH community-based programs since FY09.

10. what can we do? • Include a strong role and sufficient resources for the Department of Public Health in payment reform • Call for a DPH statewide plan for prevention, rather than relying only a plan for providing health care to those who are already ill • Support measures that will link funding for primary prevention to health care payers, such as the Prevention and Cost Control Trust

11. Prevention and Cost Control Trust – HB1498 • Stable source of funding for evidenced-based community health programs • Competitive grants awarded to communities and groups of communities • Oversight Board will document the most prevalent and costly health conditions  each year and identify evidence-based interventions • Requires a surcharge of less than 1% on Health Safety Net Surcharge Payers

12. Action Now The bill to create a Prevention Trust, HB 1498, sponsored by Rep. Jason Lewis was reported favorably out of the Public Health Committee. It needs your help to stay alive. You can: • Sign on to MPHA’s letter at http://www.mphaweb.org/Prevention_in_Payment_Reform.htm • Call/meet with MA Health Care Finance Committee chairs and members to urge that the Prevention Trust be included in payment reform legislation. They are listed here http://www.malegislature.gov/Committees/Joint/J24 • If you want to take more action on this or would like support, call MPHA and ask for Maddie 617-524-6696x111.( and sign up for our emails online at www.mphaweb.org !)

13. Questions?