Can Health Care Organizations Improve Health Behavior and Treatment Adherence ?

Many Americans are failing to engage in both the behaviors that prevent and those that effectively manage chronic health conditions, including pulmonary disorders, cardiovascular conditions, diabetes, and cancer. Expectations that health care providers are responsible for changing patients’ health behaviors often do not stand up against the realities of clinical care that include large patient loads, limited time, increasing co-pays, and restricted access. Organizations and systems that might share a stake in changing health behavior include employers, insurance payers, health care delivery systems, and public sector programs. However, although the costs of unhealthy behaviors are evident, financial resources to address the problem are not readily available. For most health care organizations, the return on investment for developing behavior change programs appears highest when addressing treatment adherence and disease self-management, and lowest when promoting healthy lifestyles. Organizational strategies to improve adherence are identified in 4 categories: patient access, provider training and support, incentives, and information technology. Strategies in all 4 categories are currently under investigation in ongoing studies and have the potential to improve self-management of many chronic health conditions. (Population Health Management 2014;17:71–78) More than half of Americans have a chronic illness, and in many cases the illness may be caused by their own behavior. The most commonly occurring chronic illnesses, including pulmonary conditions, cardiovascular conditions, diabetes, and cancer, are greatly influenced by diet, physical activity, tobacco use, and other lifestyle behaviors. The presence of behavior-based chronic health conditions reveals a concerning paradox. Although diagnostic tools and treatments have improved, health behaviors in the population have not, and consequently rates of chronic illness have been increasing steadily. The cost to individuals is clear, while the cost to the nation has been fully recognized only recently. The 5 million admissions to US hospitals in 2000 included treatment for 1 or more potentially preventable conditions at a cost of more than $26.5 billion. A report from the Milken Institute projected that the current path of incidence will see a 42% increase in cases of chronic illness from 2007 to 2023, delivering an increased cost to the health care system of $277 billion. Much of that could be offset if a change in our health behavior can be accomplished. Unhealthy behavior invites disease while it undermines the quality of life of Americans and drives up health care cost. Encouraging healthy behavior may improve the overall health of Americans while helping to curtail the rising cost of health care. The Agency for Healthcare Quality and Research projects that even a 5% decrease in the rate of potentially avoidable hospitalizations could result in a cost savings of more than $1.3 billion. By one projection, modest improvement in unhealthy behavior (eg, reducing the prevalence of overweight to 32.2%, smoking rates to 19%, and excessive alcohol use to 5.8% of the population) has the potential to cut $217 billion in treatment costs by 2023. However, changing attitudes and behaviors, including eating, exercising, smoking, alcohol use, and other lifestyle elements is not easy to accomplish. Unhealthy Behaviors Are Common in the United States Despite much public information about the impact of our behavior on our health, unhealthy behaviors are epidemic. Inactivity and poor eating have fueled a dramatic rise in obesity rates, which have increased multifold in the past 20 years. In 2009–2010, 35.7% of US adults were obese, with rates even higher for adults older than age 60, particularly women. Obesity rates in turn have contributed to hypertension, hyperlipidemia, and—particularly among the 12 million obese children—rising rates of type 2 diabetes. Thirty-three percent of adults have high blood pressure, and Pediatric Behavioral Health, The Center for Health Promotion, National Jewish Health, Denver, Colorado. POPULATION HEALTH MANAGEMENT Volume 17, Number 2, 2014 a Mary Ann Liebert, Inc. DOI: 10.1089/pop.2013. 0045