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Effective Approaches for Managing

Obesity and Chronic Disease

Kenneth E. Thorpe, Ph.D

Emory University

kthorpe@emory.edu

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Key Drivers of Rising Health

Care Spending Doubling of obesity since the mid-1980s

accounts for 10% of the rise in spending

Lack of effective care coordination in manyprivate plans and Medicaid. No carecoordination so far in traditional Medicare

Low rates of disease detection for someconditions (diabetes only 72% of totaldiabetes is diagnosed and treated)

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Opportunities

Medicare will spend about $500 billionover the next decade on potentiallypreventable hospital readmissions

Medicaid faces the same set of issues,particularly with dual eligibles

Build effective care coordination into theessential benefits in the exchanges

Medicaid medical homes section 2703

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California

Rising rates of chronic diseaseexdiabetes. In 2000 7% of adults werediabetics compared to over 9 percent

today

Obesity adds nearly $16 billion a year tothe cost of health care in California alone.

At current trends this could rise to about$40 billion within the next ten years

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Trends in Smoking and Obesity in the United States

Sources: Cigarette consumption data per adult per year are extracted from Tobacco Situation andOutlook Report Yearbook. U.S. Department of Agriculture, October 2007. Obesity data based onmeasured body mass index in NHANES from 1960 to 2010.

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Conditions 1987 2009 Change

Mental Disorders 4.9% 14.3% 9.4%

Cancer3.6% 6.2% 2.6%

Heart Disease7.4% 9.6% 2.2%

Arthritis7.2% 14.7% 7.5%

Hyperlipidemia1.3% 19.3% 18.0%

Diabetes 3.9% 8.7% 4.8%

Hypertension13.1% 24.3% 11.2%

Trends in Treated Prevalence, Adults, 1987 - 2009

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0

1

2

3

4

5

6

7

8

9

6 3 6 5 6 7 6 9 7 1 7 3 7 5 7 7 7 9 8 1 8 3 8 5 8 7 8 9 9 1 9 3 9 5 9 7 9 9 0 1 0 3 0 5

0

5

10

15

20

25

Trends in the Prevalence and Incidence of

Diagnosed Diabetes and in Prevalence of

Obesity

Prevalence

* (Percent)

Incidence*(Per 1000)

Obesity*(Percent)

Year* Prevalence for all ages; incidence for 18-79 years; and obesity for20 years

* Data modeled by joinpoint regression(Source: Narayan)

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2.4%2.6%

3.8%

3.0%

0.0%

0.5%

1.0%

1.5%

2.0%2.5%

3.0%

3.5%

4.0%

Normal Overweight Obese Total

Percent

Real Per Capita Growth of Healthcare Spending, 1987-2009.

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Percent of Change in Total Health Care SpendingAssociated with Obesity, Increased Treatment Intensityand Both Obesity and Treatment Intensity, 1987-2007

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Costs of Obesity

Higher job absenteeism: $4.3 billion annually inU.S.

Recent estimates show much higher than

previously estimated: $2,741 higher annual health care costs per

obese adult

Aggregate national costs per year: $190 billion(20.6% of US national health

expenditures)

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Chart 1. Percent Distribution of Medicare Beneficiaries by Number of Chronic ConditionsTreated

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Chart 2. Percent Distribution of Medicare Spending by Number of Chronic Conditions Treated

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The Challenge

To develop a comprehensive approach that:

Averts rising incidence of chronic illness Betterdetect existing chronic disease

More effectively manage chronically ill

patients to keep healthy

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The Challenge

Not all chronic conditions arepotentially preventable!

Many cardiovascular relatedconditions potentially are (T2diabetes, hypertension) others likely

are not (Parkinsons, Alzheimers,others )

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Averting Disease

Identify evidence-based lifestyleinterventions and develop culturaladaptations within the US

Diabetes prevention program

Medicare coverage (none today)

Essential benefits

Medicaid

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Current Medicare Coverage for Obesity

Intensive behavioral therapy (IBT) For one year, provided patients lose 6.6 lb in six months

(~3% body weight, based on clinical trials)

Bariatric surgery For BMI 35 with one weight-related comorbidity

Pharmacotherapy is excluded from Medicare Part Dcoverage, resulting in a significant treatment gap Despite recent FDA approval of pharmacotherapy that can produce

10% to 15% weight loss

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Options for Medicare

Intensive lifestyle programs like the diabetes preventionprogram could be added (much broader than current IBTcoverage)

Pharmacotherapy-induced weight loss of 10% to 15%could produce significant savings for Medicare ifcovered

The combination of lifestyle change and

pharmacotherapy is generally more successful thaneither treatment alone

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Managing Chronic Disease

What works?

Transitional care

Comprehensive medication management

Health coaching

Team based care

Ability to refer at risk patients to evidencebased lifestyle programs

Huge potential in Medicare, Medicaid andinternationally