3. Prevention & Wellness

This page contains additional references for Chapter 3 of Responding to Healthcare Reform: A Strategy Guide for Heatlhcare Leaders.  The most current additions are at the top of the page.  It also includes the annotated references from the book and their associated hyperlinks.

Current References

Musgrove,Philip. “Killing The Greatest Killer–Smallpox.Health Affairs, 2009, 28, 6, 1854-1855
Extract: The eradication of smallpox from the world, achieved in 1977 and certified in 1979 after two anxious years of worrying about undiscovered outbreaks, is a good candidate for Humankind’s Greatest-Ever Achievement. The Apollo space program was much easier, despite its greater technological complexity, because none of it had to be carried out in Bangladesh or Somalia and no government or international organization officials actively tried to sabotage it. The person most responsible for the first and only death of a disease, D.A. Henderson, has now told the inside story of how this was accomplished, starting in 1966, and how on numerous occasions it nearly failed to happen.


Shenson,Douglas. “Putting Prevention In Its Place: The Shift From Clinic To Community.” Health Affairs., 2006, 25, 4, 1012-1015
Abstract: Despite widespread insurance coverage for adult vaccinations, cancer screening, and cardiovascular disease prevention measures, most U.S. adults are not up to date with these routine services. This paper reports the efforts of Sickness Prevention Achieved through Regional Collaboration (SPARC), a New England–based organization working to broaden delivery of preventive measures throughout its communities. SPARC’s model regards the physician practice as only one element of a network of coordinated prevention activities. SPARC began with the conceptualization of a policy challenge, designed and evaluated interventions to address that problem, and is now influencing public health policies to expand the delivery of clinical preventive services.

Karlawish,Jason. “Desktop Medicine.”  JAMA, 2010, 304, 18, 2061-2062
Extract: Concepts of disease are essential for defining medicine. By the 20th century, the dominant concept was pathology in an individual, the foundation for the bedside model of medicine. Bedside medicine organizes the patient-physician relationship around the chief concern, which guides the focus of the history taking and physical examination; medical training that emphasizes laboratory-based sciences and a physical diagnosis; and a bedside presentation. Today, however, a new model has emerged: desktop medicine. This term describes how a desk with a networked computer is transforming medical science and, in turn, medical practice. The desktop is the space in which researchers discover risk factor–based diseases and where physicians and patients go to gain information to diagnose and treat diseases. In developed nations, desktop diseases such as dyslipemia occupy a substantial portion of a physician’s practice, are leading causes of morbidity and mortality, and have attracted the attention of policy

Steven Jonas.  “Talking about Health and Wellness with Patients: Integrating Health Promotion and Disease Prevention into Your Practice.” New York, Springer Publishing, 2000.  ISBN: 0-8261-1338-9
Introduction: This book is an important contribution to the growing literature on health promotion and disease prevention. It successfully brings together the theoretical basis of health promotion and disease prevention and practical formulas for changing the behavior of patients. Clinicians will find it a well-balanced primer. In the foreword to the book, Breslow observes that most physicians now in practice were educated in the “complaint–response circumstance.” By this he means that clinical encounters are driven by responses consisting largely of diagnostic and therapeutic interventions. Such reactions are frequent in tertiary care, in which established disease is treated. By contrast, Talking about Health and Wellness with Patients focuses on primary and secondary prevention.


Maciosek,Michael V.; Coffield,Ashley B.; Flottemesch,Thomas J.; Edwards,Nichol M.; Solberg,Leif I. “Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost.” Health Affairs., 2010, 29, 9, 1656-1660
Abstract: There is broad debate over whether preventive health services save money or represent a good investment. This paper analyzes the estimated cost of adopting a package of twenty proven preventive services—including tobacco cessation screening, alcohol abuse screening, and daily aspirin use—against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million life years annually. What’s more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending. These findings suggest that policy makers should pursue options that move the nation toward greater use of proven preventive services.

Fletcher,Jason M. ; Frisvold,David ; Tefft,Nathan. “Taxing Soft Drinks And Restricting Access To Vending Machines To Curb Child Obesity.”  Health Affairs., 2010, 29, 5, 1059-1066
Abstract: One of the largest drivers of the current obesity epidemic is thought to be excessive consumption of sugar-sweetened beverages. Some have proposed vending machine restrictions and taxing soft drinks to curb children’s consumption of soft drinks; to a large extent, these policies have not been evaluated empirically. We examine these policies using two nationally representative data sets and find no evidence that, as currently practiced, either is effective at reducing children’s weight. We conclude by outlining changes that may increase their effectiveness, such as implementing comprehensive restrictions on access to soft drinks in schools and imposing higher tax rates than are currently in place in many jurisdictions.


Baicker,Katherine ; Cutler,David ; Song,Zirui. “Workplace Wellness Programs Can Generate Savings.” Health Affairs, 2010, 29, 2, 304-311
Abstract: Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.

RM Merrill1, DE Bowden, SG Aldana. “Factors Associated with Attrition and Success in a Worksite Wellness Telephonic Health Coaching Program.”  Education for Health, Volume 23, Issue 3, 2010
Abstract: Objectives: This study identifies factors associated with attrition and improvements in body mass index (BMI) in a telephonic health coaching program. Methods: A cohort study design was used with 6,129 employees aged 21-88 years, enrolled in telephonic health coaching sometime during 2002 through 2008. Results: Attrition through 3, 6 and 12 months of follow-up was 13%, 17% and 36%, respectively. Those currently making changes in physical activity or nutrition had the highest BMI (kg/m2), lowest levels of exercise and the poorest overall health at baseline. They were also most likely to continue with health coaching through 12 months. Those not ready to make changes at this time or having maintained an appropriate level of physical activity or nutrition for more than six months were least likely to continue with health coaching through 12 months. They also had the lowest BMI, highest levels of exercise and the best overall health. Among those continuing with health coaching through 12 months, the percent decrease in BMI between baseline and 12 months was: 1.5% for normal weight, 2.7% for overweight, 4.1% for class I & II obesity and 7.2% for class III obesity; 4.3% for high confidence to lose weight, 3.5% for medium confidence to lose weight and 3.1% for low confidence to lose weight; and 3.8% for very good or good general health, 4.5% for average general health and 6.8% for poor/very poor general health. Conclusions: Attrition in the telephonic health coaching program is greatest among those least in need of behavior change. Of those who continued in the program, the greatest decrease in BMI occurred in those in greatest need for behavior change.

Murphy,Brigid M.; Schoenman,Julie A.; Pirani,Hafiza. “Health Insurers Promoting Employee Wellness: Strategies, Program Components and Results.”   American Journal of Health Promotion, 2010, 24, 5, e1-e10,
Abstract: Purpose To examine health insurance companies’ role in employee wellness. Approach Case studies of eight insurers. Setting Wellness activities in work, clinical, online, and telephonic settings. Participants Senior executives and wellness program leaders from Blue Cross Blue Shield health insurers and from one wellness organization. Methods Telephone interviews with 20 informants. Results Health insurers were engaged in wellness as part of their mission to promote health and reduce health care costs. Program components included the following: education, health risk assessments, incentives, coaching, environmental consultation, targeted programming, onsite biometric screening, professional support, and full-time wellness staff. Programs relied almost exclusively on positive incentives to encourage participation. Results included participation rates as high as 90%, return on investment ranging from $1.09 to $1.65, and improved health outcomes. Conclusion Health insurers have expertise in developing, implementing, and marketing health programs and have wide access to employers and their employees’ health data. These capabilities make health insurers particularly well equipped to expand the reach of wellness programming to improve the health of many Americans. By coupling members’ medical data with wellness-program data, health insurers can better understand an individual’s health status to develop and deliver targeted interventions. Through program evaluation, health insurers can also contribute to the limited but growing evidence base on employee wellness programs.

Reference from Responding to Healthcare Reform

“Institute of Medicine (IOM). 2009. “Initial National Priorities for Comparative Effectiveness Research Report Brief.” [Online brief; published June, 2009.] www.iom.edu/~/media/Files/Report%20Files/2009/ComparativeEffectivenessResearchPriorities/CER%20report%20brief%2008-13-09.ashx.
the American Recovery and Reinvestment Act, the Institute of Medicine (IOM) was asked to recommend national priorities for research questions to be addressed by comparative effectiveness research (CER) and supported by ARRA funds. The IOM committee identified three report objectives: 1) establish a working definition of CER, 2) develop a priority list of research topics to be undertaken with ARRA funding using broad stakeholder input, and 3) identify the necessary requirements to support a robust and sustainable CER enterprise. The results of the work provide the initial list in the report brief.

Maciosek, M. V., A. B. Coffield, T. J. Flottemesch, N. M. Edwards, and L. I. Solberg. 2010. “Greater Use of Preventive Services in U.S. Health Care Could Save Lives at Little Or No Cost.” Health Affairs 29 (9): 1656.
Abstract: There is broad debate over whether preventive health services save money or represent a good investment. This article analyzes the estimated cost of adopting a package of 20 proven preventive services—including tobacco cessation screening, alcohol abuse screening, and daily aspirin use—against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million life years annually. What’s more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of US personal healthcare spending. These findings suggest that policymakers should pursue options that move the nation toward greater use of proven preventive services.

Migliori, R. 2010. Keynote speaker at Midwest Healthcare Business Intelligence Summit, October 19.

Probart, C., E. T. McDonnell, L. Jomaa, and V. Fekete. 2010. “Lessons from Pennsylvania’s Mixed Response to Federal School Wellness Law.” Health Affairs 29 (3): 447.
Abstract: Federal legislation aimed at tackling the nation’s soaring childhood obesity rate through changes to school meals and nutrition and wellness programs has met with mixed results. An examination of Pennsylvania’s response to the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004, one of the most comprehensive state responses, found improvements to the nutritional quality of foods offered à la carte in conjunction with school meal programs. However, multiple weaknesses remain. Consistent wellness policy implementation steps were not followed, and there was inadequate statewide enforcement. Despite this, Pennsylvania can offer lessons for other states in moving forward with programs to promote good nutrition and wellness.

Samuels, S. E., L. Craypo, M. Boyle, P. B. Crawford, A. Yancy, and G. Flores. 2010. “The California Endowment’s Healthy Eating, Active Communities Program: A Midpoint Review. American Journal of Public Health 100 (11): 2114–23.

Schmidt, H., K. Voigt, and D. Wikler. 2010. “Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives.” New England Journal of Medicine 362 (2)
Excerpt: “Chronic conditions, especially those associated with overweight, are on the rise in the United States (as elsewhere). Employers have used carrots and sticks to encourage healthier behavior. The current healthcare reform bills seek to expand the role of incentives, which promise a win–win bargain: employees enjoy better health, while employers reduce healthcare costs and profit from a healthier workforce. However, these provisions cannot be given an ethical free pass. In some cases, the incentives are really sticks dressed up as carrots. There is a risk of inequity that would further disadvantage the people most in need of health improvements, and doctors might be assigned watchdog roles that might harm the therapeutic relationship. We believe that some changes must be made to reconcile incentive use with ethical norms.”
US Preventive Services Task Force. 2011. “Recommendations.” [Online information; retrieved 1/7/11.] www.uspreventiveservicestaskforce.org/recommendations.htm
The US Preventive Services Task Force (USPSTF) is an independent panel of non-federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive healthcare services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of “Recommendation Statements.”

 The Wall Street Journal. 2009. “How Safeway Is Cutting Health-Care Costs.” [Online article; published 6/12/09.] http://online.wsj.com/article/SB124476804026308603.html.
Steven A. Burd, CEO of Safeway, wrote an article for The Wall Street Journal about their wellness program.

 “At Safeway we believe that well-designed healthcare reform, utilizing market-based solutions, can ultimately reduce our nation’s healthcare bill by 40%. The key to achieving these savings is healthcare plans that reward healthy behavior. As a self-insured employer, Safeway designed just such a plan in 2005 and has made continuous improvements each year. The results have been remarkable. During this four-year period, we have kept our per capita healthcare costs flat (that includes the employee and the employer portion), while most American companies’ costs have increased 38% over the same four years.”

Yabroff, K. R., C. N. Klabunde, G. Yuan, T. S. McNeel, M. L. Brown, D. Casciotti, D. W. Buckman, and S. Taplan. 2010. “Are Physicians Recommendations for Colorectal Cancer Screening Guideline-Consistent?” Journal of General Internal Medicine[MSOffice1] . Feb;26(2):177-84. Epub 2010 Oct 14.
In 2010 a study found that about 40 percent of the doctors followed some of the practice guidelines, while the remaining 40 percent ignored practice guidelines. The National Cancer Institute and HealthLeaders Media published press releases covering the study:




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