Chronic Diseases Inflate State Health Costs - Diabetes and Health Insurance in New Mexico

Chronic Diseases Inflate State Health Costs
April 16, 2009
Sen. Dede Feldman

Excerpted from the Albuquerque Journal

They may not be as timely as electronic medical records, or as controversial as the different paths to universal health care, but those ordinary chronic diseases - diabetes, obesity, asthma, heart disease, cancer, arthritis - are major cost drivers in New Mexico's health-care system.

Preventing, or at least managing, them may be the most important health-care reform of all.

But, one thing I've learned after more than a decade in the Legislature, is that it will take a village to prevent their ravages and control their ever-increasing costs. Fortunately, that village is beginning to assemble under the banner of the "Healthy New Mexico Task Force" and, with the help of New Mexico First, it will devise a five-year strategic plan to mobilize the community - not just doctors and insurers, but families, teachers, gardeners, restaurateurs, bicyclists - in short, all of us.

This planning process started at a forum facilitated by NM First in Las Cruces April 3 and will continue at Albuquerque's Convention Center from 8:30 a.m. to 4:30 p.m. Friday. The public is welcome.

The effort comes none too soon. Chronic diseases are responsible for six out of every 10 deaths in New Mexico. Nearly 890,000 cases of seven chronic diseases were reported in New Mexico in 2003, accounting for an estimated $7 billion in treatment costs and lost productivity. That's almost twice the budget for the state of New Mexico in that year!

Policy experts Ken Thorpe and David Howard estimate that nearly all the growth in Medicare spending between 1987 and 2002 may be attributed to five or more chronic conditions. And costs are going up as our population ages.

The Department of Health tells us that many chronic diseases are at least partly preventable, because they're linked to behaviors that can be changed - smoking, lack of physical activity and poor nutrition. The federal Centers for Disease Control and Prevention identify four factors key to preventing chronic diseases: physical activity, healthy foods, tobacco control and clinical preventive services.

Access to preventive services like regular screenings, lifestyle and dietary counseling means getting more people access to basic health care either by expanding coverage or by making care available through clinics or other means. It means having enough doctors, nurses and other professionals to provide the care.

At the legislative level we have tried to gradually expand coverage through Medicaid, the State Children's Health Insurance Program, the State Coverage Insurance and the New Mexico Medical Insurance Pool. One simple reason is that people who have insurance are more likely to seek help earlier in the disease process, and not just show up at the emergency room.

Since one-on-one counseling from a trusted health professional is key, we have also tried to increase the number of physicians in the state through loan forgiveness, loan for service, the BA-MD program at the University of New Mexico and a new tuition waiver for medical students who pledge to become primary-care doctors in rural areas.

We also passed a bill to get the Human Services Department to implement a Medicaid waiver that provides for a "medical home" model emphasizing an integrated approach that includes prevention and continuous care. We also have encouraged the use of community health workers as a good mechanism to check to see whether patients are taking their meds and getting exercise.

Budgetary constraints have reduced the growth of state efforts this year, but there is much cause for hope at the grassroots level. New Mexico communities have recently increased access to local, healthy foods through farmers' markets, nutrition programs, mobile food pantries, healthy cooking classes and gardens for communities and schools. The Department of Education has restricted access to less nutritious foods at public schools and required school districts to develop and implement local wellness policies.

Las Cruces is engaged in a community-wide obesity prevention effort, which is creating opportunities for families to be physically active and make healthy food choices. "Healthy Kids Las Cruces" is getting kids to walk to school, quit drinking soda and learn how to cook. Other communities are developing bike and pedestrian trails and encouraging exercise.

In Albuquerque, the Prescription Trails Program (Rx Trails) provides a Spanish and English version of a Prescription Pad and a walking trail guide for the city and South Valley organized by Zip Code. This prescription for fitness is a collaboration between the Albuquerque Alliance for Active Living and New Mexico Takes on Diabetes. Santa Fe is planning a similar initiative.

We need many more of these community efforts, especially to stem a rising tide of obesity, which garnered national attention with the new and alarming statistic that almost one in five 4-year olds is obese.

Attending the Chronic Disease Town Hall this week in Albuquerque is one way to get active and address this problem. Call 841-5836 for more details.

Sen. Dede Feldman, D-Albuquerque, chairs the Interim Health and Human Services Committee.