Diabetes is the sixth leading cause of death. die each year of diabetes-related complications. The estimated economic cost of diabetes in 2002 was $132 …
Health and Government Committee February 6, 2007
Testimony for: Chronic Care Management and Wellness Promotion Study, HB
717
Position: FAVORABLE
Mr Chairman and Members of the Committee,
Representing the Maryland Nurses Association, a voice for Registered Nurses
in Maryland for over a century, I thank you for this opportunity to
testify MNA serves over 50,000 Registered Nurses in Maryland, regardless
of academic preparation, specialty/advanced training, or other professional
organization affiliation Expanding healthcare coverage demands attention
be focused on Chronic Care Management and Wellness Promotion These
programs could save millions of dollars in healthcare costs
Obesity-related disease, such as heart disease, cancer, stroke, and
diabetes, are among the leading causes of death in Maryland Overweight and
obesity are associated with self-reported health complications, including
diabetes, asthma, hypertension, and high cholesterol in Maryland?s adult
population Children and adolescents are also at risk for the health
consequences of increased weight CDC 2004
The Centers for Disease Control and Prevention and the National Center for
Chronic Disease Prevention and
Health Promotion continue to report heart
disease as the leading cause of death in Maryland The mortality rate for
diseases of the heart among African-Americans, is much higher than for any
other racial group The largest proportion of deaths about 70 results
from coronary heart disease CHD CHD is largely preventable through
positive behavioral changes made by generally healthy children and adults
Two major risk factors for heart disease and stroke are high blood pressure
and high blood cholesterol Other important risk factors include diabetes,
tobacco use, physical inactivity, poor nutrition, and being overweight or
obese CDC 2006
Prevention/Wellness
A key strategy addressing these risk factors is to educate the public and
health care practitioners about the importance of prevention Tobacco use,
physical inactivity, poor nutrition, obesity, hypertension, high blood
cholesterol, and diabetes are known and modifiable risk factors for
cardiovascular disease According to CDC?s 2005 Behavioral Risk Factor
Surveillance System BRFSS, the overall rate of adult smokers in Maryland
was 201 In addition, about one fifth of Maryland?s adult population was
estimated to be physically inactive,
711 were consuming fewer than 5
servings of fruits and vegetables a day, 219 were obese, and 70
reported they had been told they have diabetes Twenty five percent of the
state?s adult population had high blood pressure and 339 had high blood
cholesterol African Americans, those in lower-income populations, and
those with lower levels of education tended to have higher rates of
smoking, physical inactivity, high blood pressure, obesity, and diabetes
Chronic Care Management
Chronic diseases are among the most common and most costly health problems
They are also among the most preventable Numerous reports on healthcare
quality estimate nearly 80 percent of the cost of health care is spent
treating complications of chronic diseases LA Times, 7192006; Feld,
2006; Wennberg, 2006 Statistics presented during the Delmarva Foundation
Health Improvement Partnership meeting July 2006 indicated the population
of chronic disease patients in Maryland is 25 percent with 89 percent of
healthcare costs attributed to this same population ?Caring for people
with chronic illness accounts for more than 75 percent of all US health
care expenditures, indicating that overuse and overspending is not just
a
Medicare problem?the health care system as a whole has not developed
efficient, effective ways of caring for people with severe chronic
illnesses? Wennberg, 2006
CDC is adopting a public health model using ?life stages? as the framework
for its programs This model has been described as a holistic approach to
public health, which aims to help people maintain good mental and physical
health throughout their lives rather than focusing on specific diseases or
conditions ?If evidence from these reviews suggests that programs based on
this model are indeed more effective than more narrowly focused programs,
it is likely that policy makers will take notice and embrace this new
paradigm? Steinberg, 2007 The Health Disparities Collaboratives, with
the support of the Health Resources and Services Administration HRSA,
which is part of the US Department of Health and Human Services, along
with strategic state and national partnerships, are transforming systems of
care to improve patient health outcomes and organizational sustainability
HDC, 2006
There are programs with proven records of accomplishment in the areas of
cost saving, high quality chronic disease treatment and
prevention
Indiana?s Family and Social Services Administration and State Department of
Health nationally recognized Indiana Chronic Disease Management Program
provides support and information to people with chronic illnesses so they
can better manage their conditions and improve their quality of life The
University of Washington collaborates with community agencies in the
Seattle area on the Program to Encourage Active, Rewarding Lives for
Seniors PEARLS research project for older adults focused on reducing
minor depression and resulting disability The Dartmouth Atlas Project,
2006 report spoke clearly to the need to overhaul the way chronic illnesses
are managed, investing more resources in an infrastructure that can better
coordinate and integrate care outside of hospitals and in home health and
hospice care venues
Economics
Chronic disease management and wellness promotion programs could save
millions of dollars in Maryland The economic consequences of overweight,
obesity, and associated chronic health complications are considerable
Table 1 Reducing the complication rate by just 50 percent, using
evidence-based medicine, can cut costs by as much as 40 percent Every
dollar
saved is another dollar available to provide healthcare for
residents of Maryland without increasing the overall cost of healthcare
Incentivizing wellness promotion and chronic care management in Maryland
would result in:
decreased numbers of citizens developing chronic diseases,
improved quality of life for citizens ? especially chronic
care patients,
decreased healthcare spending by healthcare providers most
significantly affecting re-admission rates,
decreased costs for healthcare consumers,
decreased demand on the acute care workforce shortage areas
Providing primary care, preventive care, immunizations, wellness care and
education, and assisting patients with maintenance of chronic conditions
represent a major portion of the value nurses bring to the health care
system Nurses are a valuable, but underused resource for providing the
services required in clinics and community care centers, especially in
underserved areas Maryland needs a health care system that rewards, rather
than penalizes, provider organizations that successfully promote wellness,
reduce excessive use of services, and develop broader
strategies for
managing their patients with chronic illnesses
Maryland Nurses Association supports HB0171: Chronic Care Management and
Wellness Promotion Study
Respectfully submitted,
Elizabeth Benson, RN, MEd, FCN
Representing Maryland Nurses Association
3019347543
embenson@csmdedu
References:
1 ANA position paper on Citizens Health Care Working Group Interim
recommendations on health system reform August 2006
http://wwwnursingworldorg
2 Brodeur P Students run LA In: Isaacs SL, Knickman JR, editors
To improve health and health care: The Robert Wood Johnson Foundation
anthology, volume VIII San Francisco CA: Jossey-Bass; 2005
3 CDC The burden of chronic diseases and the future of public
health Atlanta: US Department of Health and Human Services; January
2003 http://wwwcdcgovmill1sjlibraryorg:80/publications/Burden
4 CDC Chronic Disease Prevention Atlanta, GA: US Department of
Health and Human Services, CDC, National Center for Chronic Disease
Prevention and Health Promotion, 2005 http://wwwcdcgov/nccdphp
5 CDC The burden of chronic diseases and their risk factors:
national and state perspectives Atlanta, GA: US
Department of Health and
Human Services, CDC, 2006 http://wwwcdcgov/nccdphp
6 DHMH, Charles County A Community Health Needs Assessment HMC,
LLC February 2006 http://wwwcharlescountyhealthorg
7 DHMH Charles County Community Healthy Living Initiatives ? FY07
HMC, LLC November 2006 http://wwwcharlescountyhealthorg
8 Doty, MM, Holmgren, AL Health Care Disconnect: Gaps in
Coverage and Care for Minority Adults The Commonwealth Fund August
2006 http://wwwcmwforg
9 Feld, Stanley The Texas Academy of Family Physicians, June 2006
As presented at the Delmarva Foundation Partnership Meeting August
2006
10 Health Disparities Collaboratives: home Rockville MD: Health
Disparities Collaboratives; March 2006
http://wwwhealthdisparitiesnet/hd
11 LA Times ?Medicare Looks to Boost Seniors? Use of Preventive Care?
June 19, 2006
12 Maibach EW, Van Duyn MAS, Bloodgood B A marketing perspective on
disseminating evidence-based approaches to disease prevention and health
promotion Prev Chronic Dis 2006 Jul
http://wwwcdcgov/pcd/issues/2006/jul/05_0154htm
13 Schoen, C, How, SKH, Weinbaum, I Public views on shaping the
future of the US
health system Commission on a high performance health
system The Commonwealth Fund August, 2006 http://wwwcmwforg
14 Steinberg, K Wellness in every stage of life: a new paradigm for
public health programs Prev Chronic Dis January 2007
http://wwwcdcgovmill1sjlibraryorg:80/pcd/issues/2007/jan/06_0120htm
15 Wennberg, John E Dartmouth Atlas Project The care of patients with
severe chronic illness: A Report on the Medicare Program May 2006
http://wwwdartmouthatlasorg
TABLE 1
Quick Facts: Economic and Health Burden of Chronic Disease
|Disease/Risk |Morbidity |Mortality Death|Direct |
|Factors |Illness | |Cost/Indirect |
| | | |Cost |
|Heart Disease and|More than 70 |Over 927,000 |The cost of |
|Stroke |million Americans|Americans die of |cardiovascular |
| |over one-fourth |cardiovascular |disease and |
| |of the |disease or stroke|stroke in the |
| |population live |each year, which |United States in |
| |with a |amounts to
one |2005 is projected|
| |cardiovascular |death every 34 |to be 394 |
| |disease |seconds |billion including|
| | | |direct and |
| | | |indirect costs |
|Cancer |About 14 million|Cancer is the |NIH estimates |
| |new cases of |second leading |that the overall |
| |cancer will be |cause of death in|costs for cancer |
| |diagnosed in 2005|the United |in the year 2004 |
| |alone |States |at 189 billion: |
| |This estimate |In 2005, an |of this amount, |
| |does not include |estimated 570,280|69 billion for |
| |in situ |Americans or more|direct medical |
| |pre-invasive |than 1,500 people|costs and more |
| |cancer or the |a day will die of|than 120 billion|
| |more than 1 |cancer |for indirect |
| |million cases of | |costs such as |
|
|non-melanoma skin| |lost |
| |cancer expected | |productivity |
| |to be diagnosed | | |
| |this year | | |
|Diabetes |Over 182 million|Diabetes is the |The estimated |
| |Americans have |sixth leading |economic cost of |
| |diabetes, and |cause of death |diabetes in 2002 |
| |about one third |Over 200,000 |was 132 billion|
| |of them don?t |people die each |Of this amount, |
| |know that they |year of |92 billion was |
| |have the disease|diabetes-related |due to direct |
| | |complications |medical costs and|
| |By 2050, an | |40 billion to |
| |estimated 29 | |indirect costs |
| |million US | |such as lost |
| |residents are | |workdays, |
| |expected to
have | |restricted |
| |diagnosed | |activity, and |
| |diabetes | |disability due to|
| | | |diabetes |
|Tobacco |An estimated 458|Tobacco use is |Smoking-related |
| |million adults in|responsible for |illnesses cost |
| |the United States|approximately 440|the nation more |
| |smoke cigarettes |,000 deaths each |than 150 billion|
| |even though this |year |each year |
| |single behavior |Additionally, if |The economic |
| |will result in |current patterns |burden of tobacco|
| |death or |of smoking |use is enormous: |
| |disability for |continue, 64 |more than 75 |
| |half of all |million people |billion in |
| |regular users |currently younger|medical |
| | |than 18 will die |expenditures and |
| | |prematurely from
|another 80 |
| | |a tobacco related|billion in |
| | |disease |indirect costs |
|Overweight/Obesit|Between 1980 and |The latest study |Direct health |
|y |2000, obesity |from CDC |costs |
| |rates doubled |scientists |attributable to |
| |among adults |estimates that |obesity have been|
| |About 60 million |about 112,000 |estimated at 52 |
| |adults, or 30 of|deaths are |billion in 1995 |
| |the adult |associated with |and 75 billion |
| |population, are |obesity each year|in 2003 |
| |now obese |in the United |Among children |
| |Since 1980, |States |and adolescents, |
| |overweight rates | |annual hospital |
| |have doubled | |costs related to |
| |among children | |overweight and |
| |and tripled among| |obesity more than|
|
|adolescents | |tripled over the |
| |About one in | |past two decades|
| |every six | | |
| |children | | |
| |165?about 9 | | |
| |million young | | |
| |people?are | | |
| |considered | | |
| |overweight | | |
CDC The burden of chronic diseases and their risk factors: national and
state perspectives Atlanta, GA: US Department of Health and Human
Services, CDC, 2006 http://wwwcdcgov/nccdphp
Approved, MNA Board of Directors 2/5/07
Source:bme.unc.edu
