Disease Management
Colloquium
Philadelphia, PA
May 7-9, 2007
International DM and Approaches
Lucia S. Rosenberg
Senior Vice President of Product Development
U. S. Preventive Medicine
lrosenberg@uspreventivemedicine.com
Warren E. Todd, MBA
Executive Director
International Disease Management Alliance
wtodd@dmalliance.org
Our agenda….this morning
Part 1
•
Welcome – International Participants
•
A World in Crisis/the Bi-Modal Threat…can we change in time
Part 2
•
The Status of DM in the United States…impact on Int’l
•
Is it Working in the US – Early outcomes feedback
•
Lessons Learned from the US DM Experience
•
The Global DM Experience – different models of DM in Europe and around the
world
•
Critical Success Areas: behavior change, technology, measurement, and policy
change. The Ultimate Solution – disease prevention.
•
Recommendations for “moving the agenda”
Some of Our
International Guests
• Dr. Roberto Albuquerque, MD, Medlar – Brazil
• Guus Asijee, Alkmaar – The Netherlands
• Carlos Suslik- IBMEC-SP – Brazil
• Nelson Teich, MD, MedInsight – Brazil
• Juiliana Vessani, Axismed - Brazil
Essentially…We Have A Dual World Crisis
of Chronic Disease and Obesity
Aging/Chronic Disease
Obesity/Metabolic Syndrome
Obesity/Unhealthly Lifestyles
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1995, 2005
(*BMI 30, or about 30 lbs overweight for 5’4” person)
1995
1990
2005
Source: CDC
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
USA # 1 Breakfast Export…885 Calories
3-28-05
+
+
Enormous Omelet Sandwich - Burger King®
Clinicians…
Beware!!
-760 total calories
-450 calories from fat
-2080 mg Sodium
Did taste Great!!
Coffee
Juice
USA # 1 Lunch Export…1580 Calories
+
+
Classic Triple with cheese
…enough to satisfy any hunger
-970 total calories
-530 calories from fat
-2060 mg Sodium
Wendy’s® - 2005
Biggie® French Fries
…piping-hot & golden brown
-490 total calories
-210 calories from fat
-480 mg Sodium
Medium Cola Soft Drink
..the perfect complement
-120 total calories
The Big Four….McDonald’s
30,000 facilities in 118 countries…..
•
•
•
•
Moscow - Pushkin Square facility serves 40,000 every day
Kuwait - opening in 1994 has 15,000 customers lined up
China – 350 facilities & workforce of 38,000
Hong Kong – 158 franchises [1 per 42k residents which is close
to the US at 1 per 30K residents]
• Japan – 3,000 franchises
• India – planned investment of $75 million to triple the number of
facilities [Maharaja Mac is lamb-based]
Source: Food Fight by Kelly D. Brownell, PhD, Yale Center for Eating & Weight Disorders, 2004
The Other Big Three….
Donuts & Pizza & Fried Chicken
Fried Chicken – KFC [Kentucky Fried Chicken] 1st foreign fast food chain
allowed to enter China with 500 outlets to grow to 5,000…KFC is the most
recognized foreign brand in China…over Coke,Nestle, and Mickey Mouse!
Dunkin Donuts Sells 6.4 million donuts per day [enough to circle the earth
twice – 2.3 billion/year]
• 1,000th facility opened in Thailand in 1995
• 5,000th facility opened in Bali, Indonesia in 2000
Pizza – Domino’s & Pizza Hut vie for international leadership
• Domino’s – 2,094 outlets in 61 countries
• Pizza Hut – 4,000 outlets in 90 countries
Source: Food Fight by Kelly D. Brownell, PhD, Yale Center for Eating & Weight Disorders, 2004
+ 25 Lbs
The Global Obesity Crisis…
Centers for Disease Control and
Prevention has declared that obesity is
the No. 1 health threat in the United
States today.
[65 percent of U.S. adults are considered overweight
with 38.8 million American adults classified as obese]
Obesity.. in China?
“Obesity has taken the place of famine as one of China's top concerns”
200
In Shanghai
over 15% of
primary school children
are obese vs. 8%
for the country
180
160
140
200
Million
120
100
80
90
Million
60
60
Million
40
20
30
Million
0
1992
2002
2006
Source: 8/4/2005, South Asia News @ www.Onlypunjab.com
2015
Obesity in China….
An Obesity Epidemic….
•
•
•
•
•
•
•
Rate of obesity in China increased 97% in 10 years
Obesity levels have soared from 10% in 1982 to 15% in 1992 and
25% in 2004
18% of the Chinese population are now overweight
50% of Chinese adults between 39-59 are overweight
18 million adults in China are obese, 137 million are overweight.
30% of people in major cities are overweight [maybe as high as
60% in Beijing]
Overweight adolescents have 70% greater risk of becoming
overweight or obese as adult
Impact on Chronic Disease…
•
•
•
100 million people in China suffer from high blood pressure and 26
million with diabetes
64 million have metabolic syndrome-a condition
A BMI index increase of 2 points, increases the risk for coronary
heart diseases and stroke increase by 15.4% and 6.1%
Obese individuals are at increased risk for many diseases
and health conditions, including the following:
Hypertension (high blood pressure)
Osteoarthritis
Dyslipidemia
(high total cholesterol or high levels of triglycerides)
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Sleep apnea and respiratory problems
Some cancers (endometrial, breast, and colon)
Source: CDC
Chronic Disease
Chronic diseases
 Cardiovascular disease, mainly
heart disease, stroke
 Cancer
 Chronic respiratory diseases
 Diabetes
Myths:
Reality:
1.
It mostly high income countries
1.
FALSE
2.
Low/Middle income countries should focus on
infectious disease vs. chronic disease
2.
FALSE
3.
It affect mainly rich people
3.
FALSE
4.
It primarily affect older people
4.
FALSE
5.
It primarily affect men
5.
FALSE
6.
It are the results of unhealthy lifestyles
6.
FALSE
7.
Chronic disease cannot be prevented
7.
FALSE
8.
Chronic disease prevention is too expensive
8.
FALSE
9.
1/2 truths: “my grandfather smoked and was
overweight and he lived to be 96, therefore
I do not need to worry
9.
½ FALSE
10.
Everyone needs to die of something
10.
True…but ideally not slowly
and painfully
Importance of Controlling Chronic Disease
Chronic Disease is
Also Important in
Low & Low Middle
Income
US Healthcare Spending Will Double in this Decade
$2.6
Trillion
$3,000
National Health Expenditures (in Billions)
$2.6 Trillion by 2010
$2,500
- Chronic conditions attribute to
60% of US healthcare Costs
$2,000
$1.14
Trillion
$1,500
$1.5
Trillion
$1.3
Trillion
$441
$888
Billion
$1,000
$259
$558
Billion
$903
$227
$211
$148
$500
- 16% of Gross National Product
$89
$174
$119
$296
$149
$377
$176
1993
Consumer out-of-pocket payments
Medicare
Medicaid - State Portion
1998
$240
$203
2000
- 60 Million Americans suffer
from multiple chronic diseases
$531
$438
$403
$1988
- ½ of Americans suffer from
at least one chronic disease
2002
Private Health Insurance
Medicaid - Federal Portion
Other State & Local
2010
- US population over 60 will
increase from 40 to 70 million
in next decade
Other Private Funds
Other Federal
Source: HCFA Office of the Actuary, National Health Statistics Group, as tabulated in Health Affairs, March/April 2001
We are not doing a good job!
• People with chronic conditions
only receive 56.1% of
recommended care*
• Only 24% of people with
diabetes received three or
more HbA1c tests in a two
year period
• Only 45% of people presenting
with an MI received betablockers
Condition
% Not Receiving
Recommended Care
Diabetes
54.6%
Hyperlipidemia
51.4%
Asthma
46.5%
COPD
42%
CHF
36.1%
Hypertension
35.3%
CAD
32%
* Source: McGlynn, Asch et al, The Quality of Health Care Delivered to Adults in the US NEJM 2003; 348:2635-48
The portion of GNP spent on health care is greater than
any other nation in the world.
US = 16.7%
UK = 11%
Germany = 9%
Yet
Less than 4% of the US Health Care Dollar
is spent towards Prevention
Bi-Modal Healthcare Crisis
I N N O VAT I O N
Boomers
Next
Generation
Obesity
Prevention
& DM
18-50 Age Group
?
Chronic
Disease
Disease
Management
& Prevention
50-90 Age Group
Life
Expectancy
Worker: Retiree Ratios
Year
Average Life
Expectancy
1935
Ratio of
Worker:Retirees
25:1
1950
16:1
68 Years
2000
3.3:1
76 Years
2025-2030
< 2:1
> 78 Years
Source: Wall Street Journal, May 18,2000 A.26
61 Years
Vulnerability to Aging in Developed Countries
Public Benefits to the Elderly as % of GNP
33.1
Source: Watson Wyatt Report on Aging; March 2003
Healthcare Crisis….
•
•
•
•
Bottom-line.…Our leaders are trying hard.
We have the knowledge and technology
Changing healthcare is very difficult
The rewards are HUGE but political as it is a matter of
how to allocate resources & requires major policy
changes
• Must benefit and tap into global lessons learned. The
answer is “global collaboration” to correct decades
of lifestyle problems….together we can do it.
• Disease management is a merely a “catalyst for
change”
The Past: US Model of DM
Disease Management
Future: Global Experience - Catalyst for Change
So…..How are we doing?