Eating our way to lower health costs
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America spends more money on healthcare than any other nation – about 17 percent of the country's entire economic output.

Most of that money goes towards treating chronic diseases like cancer, heart disease and diabetes. Eighty-six cents of every dollar America spends on healthcare can be traced back to chronic disease.

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Short of curing these chronic diseases altogether — a tall order — effective ways of reducing the costs they impose have been hard to come by. But there's one that's been hiding in plain sight for years — and that's simply prescribing better nutrition for patients.

Poor nutrition exacerbates chronic illness and that drives up health costs. According to a new study published in the scientific journal PLOS ONE, malnutrition associated with just eight common chronic diseases costs our medical system $15.5 billion a year, in direct medical costs alone.

Clinically speaking, people who are malnourished simply aren't getting the nutrients their bodies need to function properly. It's especially common among people over 65 years old. Up to one in two older adults are malnourished or at-risk of malnutrition upon admission to the hospital. Yet, malnutrition too often goes undetected and untreated.

On the other hand, when hospitals do emphasize the value of nutrition, the results are promising. One recent study, published in the Journal of Nursing Care Quality, found that the Cleveland Clinic's Akron General Medical Center was able to reduce the length of stays, readmissions, and costs of care after implementing a malnutrition protocol.

So, why is there this gap in malnutrition care?

One reason is that the healthcare system does not have a standard approach to dealing with malnutrition. This needs to change. Policymakers have a role by encouraging Medicare and other programs to look at how they can incentivize standardizing malnutrition care as a way to improve outcomes for patients and save the health sector money in the process.  

In healthcare policy, a lot of time is spent discussing the importance of quality and paying for value, and malnutrition care needs to be part of that discussion.

It is important to remember the impact – especially on older adults - of not addressing this issue. Left untreated, malnutrition compounds the unique health problems faced by seniors. As adults age, they naturally lose muscle mass — the component of their bodies that enables them to heal quickly, fight infection, and perform basic tasks. Malnutrition accelerates this loss of muscle mass and weakens the body's immune system which leaves them vulnerable to falls and illnesses.

In many cases, patients aren't even aware that they're malnourished. Seniors and their families tend to see the signs of malnutrition — weight loss, fatigue, or a lack of appetite — as the natural progression of growing old. Consequently, many malnourished seniors never mention their symptoms to their physicians.

Older adults may intuitively know that not eating enough — or not eating healthy and varied foods — puts them at risk of being diagnosed with malnutrition.  But they may not think about how such a diagnosis can threaten their health and ability to live independently.

Physicians, meanwhile, rarely screen for weight loss or poor appetite, focusing instead on primary conditions, like heart disease or diabetes.

This dynamic of both patients and physicians focusing on more acute concerns is unlikely to change without systemic action, such as new policies that raise awareness and provide new tools to physicians and healthcare providers to address malnutrition.

A promising proposal for policymakers to consider comes from the DefeatMalnutrition.Today coalition — a group of over 40 healthcare and older adult organizations. The coalition recommends that nutrition be recognized as a new "vital sign" – just like blood pressure or pulse rate – and that the Centers for Medicare and Medicaid Services adopt measures of quality care for malnutrition in value-based payment programs.  

Measures like these are highly effective and provide a proven return on investment.

Identifying and treating patients for malnutrition may sound simplistic, but it would represent a radical improvement in the way the U.S. healthcare system currently addresses the condition. Doing so would substantially reduce our nation's healthcare costs — and improve the quality of life for millions of people.

Dr. Scott Goates, PhD., M.S., is a health economist in Abbott’s nutrition division. His work involves the design and execution of clinical and observational studies on the health and economic value of nutrition. Prior to joining Abbott, Dr. Goates worked as a health economist in the Office of the Associate Director for Policy at the Centers for Disease Control and Prevention.  Dr. Goates holds a PhD. in Economics and a Masters in Statistics from Washington State University.