The American Hospital Association recently published a report on how the aging of the “baby boomer” generation will affect our healthcare system over the next 25 years. Not surprisingly, the news isn’t good. In general, it predicts dramatic growth in chronic diseases, with the prevalence of diabetes, for example, increasing from 30 to 46 million by 2030, that of arthritis from 46 to 67 million, an increasing “epidemic” of obesity, with 21 million obese in the boomer generation alone, costing Medicare one-third more than lighter patients.

Falls are predicted to rise, with one-third of adults 65+ falling each year, and 20-30% of those suffering moderate to severe injury as a result, including decreased mobility and independence, where boomers intend and expect to be even more active in their retirement than those now enjoying their post-working years. The net result will be the doubling of physician visits and hospital admissions, and the creation of severe shortages in physicians, nurses, and hospital beds.

The report notes that current healthcare expenditures for those with no chronic conditions average $850 per consumer; $2241 for those with one such condition, $4256 if two; $6178 if three; $8518 if four; and $12,699 if five or more. It predicts that 56% of all hospital inpatients will be 65+ by 2030 compared to 35% currently. This will be the result of the continued shift toward outpatient treatment among younger patients, and increasing illness among, as well as the percentage of the population 65+.

The shortage of registered nurses is expected to reach 1 million by 2030, with 130,000 more specialists, particularly those in chronic diseases and treatment of elderly, such as orthopedists to treat all the joint and other orthopedic injuries that will arise, plus 60,000 primary physicians. Hospitals are already responding and proactively anticipating the dramatic increase in need by building new and expanding existing facilities, joining with the educational system to train more nurses, and preparing for more obese patients, for example.

The AHA has long included a significant commitment to prevention and proactive health in its official mission. Its website includes a vision statement that calls for: “…a society of healthy communities where all individuals (emphasis mine) reach their highest potential for health.” This vision is echoed on the <a href=”http://www.ama-assn.org”>American Medical Association’s website</a>, whose members are “Physicians Dedicated to the Health of America”, to: “…improving the public health through promoting healthy lifestyles.”

After describing what the AHA apparently considers the inevitable increase of disease and injuries it will be forced to treat by 2030, it mentions, pretty much as an afterthought, that its members are sponsoring community fitness and nutrition programs, as well as classes and screening programs, along with end-of-life management efforts. But it does not mention the potential for proactive health management (PHM) efforts, including those sponsored by governments, insurers and employers, to substantially reduce the cataclysmic increase in chronic disease and injuries that it predicts, nor how much hospitals might do so as both employer and provider.

There are an increasing number of hospitals actively engaged in PHM efforts with their own employees. By improving their employees’ health, they can at least mitigate the severe shortage of most of the clinician categories of workers upon which they depend by making them more productive. By the same token, by engaging in PHM as a revenue-generating service for other employers in their markets, hospitals can mitigate the increasingly stingy payments they receive compared to the ever-increasing costs of sickness care services.

Physicians have been proving the value of PHM efforts in retainer medicine, such as the 150 or so MDVIP practices operating in 16 states. Their patients generally use less than half the amount of inpatient hospital and ER services as do patients in traditional practices. As these kind of practices grow, and primary physicians in traditional practices gain bonuses for managing their patients’ health, primary practice should become a more attractive career choice, and the explosive growth in demand that hospitals are counting on in their futures may not pan out.

Some hospitals are “hedging their bets”, or at least gaining an alternative source of revenue by offering PHM to employees already. Northwestern Medical Center in Chicago, for example, operates a Wellness Institute offering such services. Mayo Clinics Health Solutions offers a wide range of PHM services to over 70 employers, as well as an executive health program aimed at maintaining and improving the health of leaders.

Just recently, U.S. Preventive Medicine, Inc. in Texas, announced that in addition to its Centers for Preventive Medicine programs for consumers, it is offering a Prevention Plan that its hospital partners can offer to local employers. Both programs generate revenue not available through traditional sickness care nor community-benefit flu shot, screening and similar proactive health programs aimed mainly at those who are medically underprivileged.

It is logical and appropriate that hospitals seek to improve their images as essential providers of sickness care, that deserve adequate payment for their vital services, and the ability to expand their capacities to meet increasing demand. But it is equally logical that they look for more ways to be truly part of a “Health System” that is not focused 95% on sickness, but somewhere near halfway focused on promoting and protecting health.