NPR reported this morning on a health care system in Pennsylvania -- Geisinger -- that is helping its diabetic patients by prescribing fresh foods. They are seeing dramatic improvements in hemoglobin A1c, a marker of blood sugar control, and expect to reap $24,000 in savings for each $1,000 spent on the program.
That loud bang you hear is not a secret airplane landing with a sonic boom but the sound of public health researchers and advocates smacking their foreheads. The public health community has long been pushing for upstream interventions to improve health, like improving access to fresh foods, building safe communities so people can be outside getting exercise, getting tobacco out of public spaces.
This is not to diminish what Geisinger is doing. On the contrary, we need more health systems to innovate in preventive care. But under the traditional payment model -- where every widget (or toe amputation) is reimbursed -- health care organizations stand to make more money treating sick patients than they would keeping populations healthy.
Over the last three decades we have made gradual progress in changing the incentives to encourage more preventive and higher quality care. Hospitals are paid for bundles of service, e.g. heart bypass surgery and rehabilitation, and are on the hook for preventable complications such as post-operative infections. Some health systems provide standard per member per month (or PMPM) payments to health care providers to keep their populations healthy and care for them when they are sick. The Affordable Care Act mandates that health insurance pay for certain 'essential health benefits,' including preventive care such as pediatric well-child visits.
The Geisinger experiment and public health research show that we should be investing a great deal more in keeping Americans healthy and preventing illness in order to reduce suffering and death. And save money.
In its current form, the Republicans' health care reform bill, the AHCA, gives millions of dollars in tax breaks to the wealthy and drops essential health benefit coverage.
This will cost us.