20020919Disease Management and Coordinating Care — Testimony to the Senate Special Committee on Aging, September 19, 2002

Disease Management and Coordinating Care — Testimony to the Senate Special Committee on Aging, September 19, 2002

September 19, 2002

The American Dietetic Association (ADA) commends the committee for its attention to disease management and coordinating care. We recommend that these two approaches to patient care be more fully integrated into the nation’s health care system, particularly in the Medicare program that primarily serves the nation’s population of older Americans.

The American Dietetic Association is the world’s largest food and nutrition professional association. Now 85 years old, ADA is dedicated to serving the public through the promotion of optimal nutritional health and well being. The work of the association and the services of its nearly 70,000 members are based on rigorous academic instruction, supervised practice and continuing education relying on peer-reviewed nutrition research and resources representing significant scientific consensus. In addition, ADA is a proponent of outcomes-based practice and has been a leader in developing evidence-based Practice Guidelines and protocols for nutrition services and in disseminating those guidelines to practitioners.

As has been noted, a disproportionate percentage of health care dollars today are spent on a relatively small percentage of patients with chronic diseases such as arthritis, diabetes, hypertension, heart disease, and osteoporosis among others. Many of these patients - perhaps half of the Medicare population -- suffer from several chronic conditions at the same time, complicating treatment and raising the risks of poor health outcomes. Addressing the health care needs of patients with chronic conditions is important today for many reasons, but as the U.S. population ages it becomes a more pressing economic consideration. By 2010, 120 million Americans - some 40 percent of the population is projected to be diagnosed with a chronic disease or condition.

In the area of nutrition, research documents the value of nutrition services in the management of certain diseases and conditions. For example, the introduction of medical nutrition therapy (MNT) in the Medicare Subpart B program will provide America’s senior citizens with access to professional treatment that can assist them in managing diabetes and kidney disease. MNT is a tool to help prevent further complications. Patients who receive MNT services are likely to require fewer hospitalizations and medications and to have reduced incidence of complications.

This is a significant advancement within the U.S. health care system. By authorizing MNT, Congress took an initial step toward management - rather than simple treatment - of diabetes and kidney disease. The implications of that shift are monumental to patients, as well as to the taxpayer. The evidence shows that MNT can delay the progress of kidney disease and even forestall dialysis. Not only the patient’s quality of life enhanced, but also the additional months where dialysis isn’t necessary reduces the cost burden on taxpayers.

There is extensive data to support cost-effectiveness of nutritional interventions for hypertension, dyslipidemia and heart failure as well. Medical nutrition therapy for cardiovascular disease has proven results of fewer hospitalizations and lower incidents of complications. In addition, a study published in the Journal of the American Dietetic Association on the impact of dietary interventions on cardiovascular risk factors in men showed that for every $1 spent on MNT, there is a $3 to $10 cost savings realized by reducing the need for drug therapy.

Independent of any other benefit associated with MNT, expanded coverage to a broader range of conditions is justified, said the Institute of Medicine in a study commissioned by Congress. Together, these statements show that nutrition therapy provided by dietetic professionals is an effective disease management strategy and that it is practical.

We urge Congress to assure that the Centers for Medicare and Medicaid Services (CMS) has the resources and support to initiate work -- including outcomes-based disease management demonstration projects - that can be evaluated and emulated, where appropriate.

We also commend this committee for its valuable work attending to the needs of the aging. Hearings in March 2001 documented the role of nutrition in older Americans’ health status. According to the Institute of Medicine, poor nutritional status, excessive or inadequate intake of nutrients, is a major problem in older Americans. Inadequate intake is estimated to affect 37 to 40 percent of community dwelling individuals over age 65. Dietary quality ratings of free-living Americans age 65 years and older, as measured by the Healthy Eating Index, show that roughly 80 percent had diets that were ranked as needing improvement or that were poor. (AOA)

Healthy aging for all Americans requires adequate nutrition to maintain health, prevent chronic diet-related disease, and treat existing disease. Those seniors who routinely eat nutritious food and drink adequate amounts of fluids are less likely to have complications from chronic disease or to require care in a hospital, nursing home or other facility. Thus, it makes sense to emphasize nutrition screening for seniors in a disease management strategy. ADA has been involved in a physician education project through the Nutrition Screening Initiative to help implement the principles of disease management among older Americans. A survey of 600 older Americans with chronic conditions led to the development of an easy-to-use nutrition manual for physicians and older adults. A Physician’s Guide to Nutrition in Chronic Disease Management for Older Adults gives physicians nutrition screening tools and interventions for eight different chronic diseases. The guide also includes a corresponding patient handout.

ADA commends the Senate Special Committee on Aging for its ongoing efforts to address these issues and to develop a base of information and analysis that can improve health care for older Americans. The provision of effective disease management programs can make a difference in the lives of Medicare beneficiaries and more effectively manage health care resources. We believe it is a sound strategy to incorporate a broader disease management component within the U.S. health care system.