Diane E. Meier of Mt. Sinai Medical Center builds on the idea of patient-centered care, describing the growing need for more robust palliative care programs. Reviewing the evidence, she relates that palliative care has been demonstrated to relieve physical and emotional distress; improve patient–family–professional communication and informed, patient-centered decision making; and coordinate and sustain care across the many transitions experienced by patients with complex chronic and serious illness. Meier posits that palliative care not only responds to the needs of this growing population of patients, but translates into better quality care and cost savings. Taken to a national scale, she suggests that palliative care could save $6 billion annually.

In his paper, Jeffrey Levi of Trust for America’s Health presents the organization’s collaboration with the Urban Institute, which focuses on developing an economic model that demonstrates the impact of certain community-based prevention programs targeting chronic diseases on healthcare costs. Based on their analysis, he reports that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save the country more than $16 billion annually within 5 years—a return of $5.60 for every $1 invested. Levi acknowledges that these estimates do not reflect the costs of implementation. He additionally notes a paradigm shift in the commitment to prevention efforts, reflected by the American Recovery and Reinvestment Act of 2009 investment of $650 million to introduce community-based prevention programs and study their impacts.


Kenneth E. Thorpe, Ph.D., and Lydia L. Ogden, M.A., M.P.P.

Emory University

The rising rate of diagnosed and treated chronic diseases, many associated with obesity, is a key factor in rising U.S. healthcare spending (Table 12-1) (Thorpe and Howard, 2006). Patients with chronic disease are estimated to account for 75 percent of overall health spending (CDC, 2008) and 99 percent of Medicare spending (Partnership for Solutions National Program Office, 2004). Multiple morbidities are common: more than half of Medicare beneficiaries are treated for five or more chronic conditions yearly (Thorpe and Howard, 2006). Six chronic ailments account for 40 percent of the recent rise in Medicare spending (Thorpe and Howard, 2006). Despite significant healthcare outlays, chronically ill patients receive just 55 percent of clinically recommended services (McGlynn et al., 2003), and that gap in care may explain a nontrivial portion of morbidity and mortality.

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