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State health commissioner touts prevention at LIA meeting

Dr. Nirav Shah, commissioner of the New York

Dr. Nirav Shah, commissioner of the New York State Department of Health, testifies before a joint budget hearing on health and Medicaid on Jan. 30, 2013. Credit: AP /Mike Groll

A health system that focuses more on prevention and less on treating illness will be less expensive and have better outcomes, the state health commissioner told Long Island business leaders and hospital officials Tuesday.

"Our $2.7 trillion system is perfectly designed to deliver health care," Dr. Nirav Shah said at a Long Island Association breakfast meeting in Melville. "Or do we want health? There's the rub."

Citing previous studies, Shah said 5 percent of patients consume 50 percent of health care dollars, especially in the last three months of life.

Shifting the emphasis from expensive hospital treatments to keeping people healthy can achieve "huge savings," he said.

That happens by "investing in ecosystems" of health care that provide coordinated care and making it in the hospitals' best interests financially to keep people out of inpatient beds.

He cited the state's Medicaid Redesign Team, created in 2011 to reduce costs to the state's $50.5 billion health insurance program for low-income people.

By cutting waste and ensuring that patients get the appropriate level of treatment, the state cut $4 billion in Medicaid costs in the first year and is "on track" to save $34 billion over the next five years, Shah said.

Two years ago, he said, 23 percent of elective cardiac catheterizations for the state's Medicaid patients were "inappropriately done" according to medical guidelines. By showing cardiologists the data and telling them Medicaid wouldn't pay for the procedures, that rate has been cut to 8 percent and has resulted in $4 million in savings "just in that area," the commissioner said.

Overall, he said, Medicaid costs, which were rising 13 percent a year, are down to a 4 percent a year increase.

To improve health further and save money, he said, leaders need to focus more on the environment and the health choices people make. Citing a 2007 article in the New England Journal of Medicine, he said close to 60 percent of preventable deaths are linked to social and behavioral environments.

"Our ZIP code may be more predictive than our genetic code in determining how long we live," he said.

Obesity is a growing health issue, he said. More people are dying in the world "related to problems from overnutrition rather than undernutrition," Shah said.

"We are facing the possibility that our children will not live as long as we do because of overweight," he said.

Finding solutions, he said, will not be easy but could include making streets safer for walkers, making parks cleaner, keeping gyms open at night for kids, having more bikeable trails or instituting "walking school buses."