Backers of the health law鈥檚 provision of $15 billion for prevention efforts believe it has the potential to improve health and reduce costs. But some question the administration鈥檚 decision to sprinkle聽money for community programs聽among dozens of groups testing different approaches, rather than聽channeling it to proven programs.
, who chairs the Department of Health Policy and Management at Emory University鈥檚 Rollins School of Public Health, says more of the money should be spent on聽approaches that have a track record of reducing chronic diseases such as heart disease and diabetes, and which聽can be expanded quickly nationwide.
鈥淭hat鈥檚 not what we鈥檙e doing,鈥� says Thorpe, who is also executive director of the , a coalition of patient, provider, business, labor and other groups. 鈥淲e have so many pilot projects in so many jurisdictions 鈥� it will take us a generation to learn from them.鈥�
With Republicans intent on trimming or eliminating the fund, he says, public health advocates may not have a generation to show they can prevent or manage chronic diseases, which聽are and account for 75 percent of the nation鈥檚 health spending.
In fiscal聽2011, the Department of Health and Human Services awarded 35 groups , with grants ranging from $500,000 to $10 million to implement 鈥減roven interventions to help improve health and wellness.鈥� Another 26 will receive between $147,000 and $500,000 鈥渢o build capacity by laying a solid foundation for sustainable community prevention efforts.鈥澛� Over the next five years, the groups receiving funding must meet performance goals, such as reducing tobacco-related death and disability by 5 percent, or reducing obesity rates by 5 percent.
But Thorpe contends more money should be directed to proven and easily scalable projects like the community-based diabetes prevention program administered by the YMCA of the USA in partnership with the Centers for Disease Control and Prevention and聽the聽insurer UnitedHealth Group.
鈥淚t鈥檚 big,鈥� he says of the YMCA program. 鈥淚t鈥檚 scalable, it鈥檚 national. It would have an enormous impact on premiums and certainly Medicare spending.鈥�
In an , Thorpe wrote that the program, which is aimed at overweight adults who do not yet have diabetes, helped participants lose 4.2 to 7 percent of body weight, with even greater weight loss for people aged 60 and older. Over a decade, participants reduced their chances of developing Type 2 diabetes by 34 percent.
For $100 million in prevention fund investment, Thorpe says the program could be expanded nationally. As of last year, nearly 60 million Americans lived within three miles of a YMCA. Not-for-profit groups like local health departments and community health centers also could be certified to deliver the program so even more people could participate, he says.
But others say that testing a side variety of approaches across the country makes sense, because what works in one area may not be as effective in another.
鈥淏ending the cost curve is not going to be done by a singular program,鈥� says Richard S. Hamburg, deputy director of , a nonprofit, nonpartisan group focused on disease prevention.
Sen. Tom Harkin, D-Iowa, who chairs the Senate Health, Education, Labor and Pensions Committee, calls the community-based distribution of grants 鈥渧ery appropriate.鈥� About two-thirds of the money is allocated to three public health activities: reducing obesity, helping people quit smoking and providing childhood immunizations, which Harkin describes as 鈥渢hree of the most cost-effective activities we could do to reduce the burden of illness in America.鈥�
The remainder of the fund, he said in a statement, is dedicated to building the capacity of the public health system, researching new prevention strategies and preventing high-priority health problems such as healthcare acquired infections, suicide, and substance abuse.
But will those investments produce the biggest bang for the buck?
Thorpe, at least, doesn鈥檛 think so.
鈥淲e have a one-time shot of $15 billion dollars,鈥� he says. 鈥淲e can transform the entire prevention system in this country if we have big thinking about it and if we鈥檙e really smart.鈥�