It’s been almost 20 years since the first results from the Adverse Childhood Experiences Study (ACE) were published. If you aren’t familiar with it, the ACE study is long-term study of over 17,000 participants that explores the effects of childhood maltreatment on later health and well being. The study has found that certain experiences are major risk factors for certain illnesses, death, and poor quality of life (see Making The Link – Trauma & High-Needs Consumers).
I was reminded of the ACE study as I read some recent coverage of Alzheimer’s disease. Last week, we covered two related articles in OPEN MINDS Weekly News Wire – Disadvantaged Neighborhoods May Have Increased Alzheimer’s Risk and Lifetime Stressful Experiences Worsen Risk Of Developing Alzheimer’s. The short summary – stress and stressful experiences increases the risk of developing Alzheimer’s disease. On a related note, there was a lot of press in the past two weeks about a study published in the Lancet in July Dementia Prevention, Intervention, and Care. According to the study, about one third of dementia cases are attributable to preventable risk factors – including lack of education, high blood pressure, obesity, diabetes, hearing loss in mid-life, smoking, lack of physical exercise, social isolation, and depression.
And Alzheimer’s disease and dementia isn’t the only area where we see the effects of stressors – violence, poverty, abuse – on health status:
- Poverty In Early Childhood Appears Associated With Stunted Brain Development
- Childhood Emotional Abuse A Risk Factor For Problem Opioid Use
- Children Who Witness Violence Are Three Times More Likely To Inject Drugs As Adults
- 81% Of Women Who Experience Domestic Violence Also Have A Chronic Health Condition; Compared To 70% In The U.S. Population
- Percentage Of Children With SED Twice As High Among Poor Families
- Living In High-Poverty Neighborhoods Linked To 24% Higher Chance Of Readmission
- Genetic Changes Linked To Poverty Put Consumers At Higher Risk Of Depression
These findings are in keeping with the emerging research findings in epigenetics – the effect of what a person does and what happens to that person on their genetic makeup. Research shows that people who are frequently exposed to traumatic episodes have changes in how their brain functions and their genetic make-up – see What Is Epigenetics? and Traumatic Consequences. (For background, you may want to check out Understanding The Effects Of Maltreatment On Brain Development and Genetic Changes Linked To Poverty Put Consumers At Higher Risk Of Depression).
What surprises me is both how strong the evidence is and how little we see service development focused on these issues. We have reported on some initial focused services in these areas – Mindfulness-Based Stress Reduction Therapy Decreases PTSD Symptom Severity Among Veterans and PTSD Symptoms Reduced 43% With New Web-Based Program. But there is not a lot out there yet.
From reimbursement perspective, there is limited coverage of programs that are more “preventative” in nature. There is limited coverage by the Centers for Medicare and Medicaid Services (CMS) for preventive cardiac rehabilitation programs (Medicare Reimburses For Intensive Cardiac Rehabilitation: A Future With Provider Supported Non-Traditional Treatment) and a recent preventive diabetes program (Medicare To Expand Payment For Diabetes Prevention Programs). And there are some pay-for-success and pilot measures in the works – New Medicaid Chronic Disease Prevention Programs Announced; Two Focus On Mental Illness and Michigan Medicaid & National Kidney Foundation To Test ‘Pay-For-Success’ Model For Diabetes Prevention.
The good news is that there is a continuing focus on integrated approaches to coordinating health, mental health, and social service needs – see TACOs, Anyone?; Whole Person Care Takes Another Step Forward; Can Your Organization Screen For Social Determinants?; and The Housing To Heath Care Evolution. These represent new opportunities for specialty provider organizations to create innovative partnerships with payers and health plans – developments that we will be covering in the months ahead.
For more, on those innovative partnerships, join me at The 2017 OPEN MINDS Executive Leadership Retreat on September 26 for the keynote address from Martha R. Temple, Senior Vice President, Behavioral Health Services, Optum, “The Future Of Health Plan/Provider Organization Business Relationships.”
And, if your organization is sponsoring an innovative program that addresses social determinants and stress, be sure to let us know. We’re planning a series of profiles of innovative approaches to address these issues in the months ahead.