November 16, 2008

What does the Obama presidency mean to the sleep apnea patient?

I am not aware that President-elect Obama spoke directly to the question of sleep apnea during the campaign, but it is possible to infer from his major speech on the subject of health care and from his plan on health care reform some areas where the sleep apnea patient could benefit from the reforms he is planning.

Early in the plan he discusses the need to support disease management programs. He states "Over seventy-five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease, and high blood pressure."

These are all co-morbid conditions with untreated sleep apnea. One wonders if early intervention on sleep apnea would not decrease the economic burden with these life-threatening conditions.

He goes on to say "[M]any patients with chronic diseases benefit greatly from disease management programs, which help patients manage their condition and get the care they need."

Obstructive Sleep Apnea (OSA) is certainly a chronic disease. For many it starts at a young age and stays with them their entire life. A life shortened needlessly because of cardiovascular disease.

OSA is a condition that would benefit from being treated according a disease management model. A model where there is a continuum of care from awareness through diagnosis/treatment and long-term follow-up. I offered an "ideal" treatment pathway in an 2007 article I wrote for Sleep Review.

Further in the same section of the plan Obama states that he "... will support providers to put in place care management programs and encourage team care through implementation of medical home type models that will improve coordination and integration of care of those with chronic conditions."

The challenge here is to get sleep apnea recognized as a chronic condition in which disease management strategy would be appropriate.

Elsewhere in the plan, Obama discusses moving away from paying physicians based on the volume of services provided and towards payment based on the quality or effectiveness of care.

For the OSA patient could mean something beyond just a reduction of the number of apneas and hypopneas. Effectiveness of care may be measured in improvement in resting blood pressure and elimination of daytime sleepiness.

He also discusses the use of comparative effectiveness reviews and research as keys to eliminating waste and missed opportunities for improved treatment.

As new technologies are developed for the treatment of OSA, comparative effectiveness research will help physicians and patients better understand which treatment will provide greater efficacy.

OSA is a chronic condition that affects all segments of our society, but it disproportionately affect the minority populations in the United States. Another element of the Obama plan is to tackle disparities in health care. If sleep apnea can be effectively diagnosed and treated, it will certainly accrew additional benefits, such as reduced health care utilization and improved quality of life. Finally, the health care reform proposed by the Obama campaign includes coverage for pre-existing conditions. This is an important benefit for the treated apnea patient who no longer need worry about continuing their treatment should they need to change insurance carriers.

Health care reform is on the agenda for the upcoming Congress, so change is coming. There is an opportunity for the reform to include sleep apnea. Seize the moment to let President-elect Obama know that recognizing sleep apnea is a serious condition and needs to be included in reform considerations.

Contact your Member of Congress and let them know that sleep apnea is a serious condition and needs to be included in health care reform considerations.

Contact your Senators and them know that sleep apnea is a serious condition and needs to be included in health care reform considerations.

The ASAA published a position paper on sleep apnea as a public health concern, click here.

All the best,