“Our nation is currently spending $1.5 trillion a year for health care, and it is not getting its money's worth,” Chancellor Ralph Snyderman, MD, told thousands of physicians in his November 2002 Chair’s Address to the Association of American Medical Colleges. More than 75 percent of each health care dollar is spent treating late-stage chronic disease, which is often preventable, he pointed out—yet physicians are not adequately reimbursed for preventive care. Meanwhile, health care costs skyrocket even as millions of Americans remain uninsured.

Can the crisis in health care be resolved? Leaders at Duke believe they’ve identified a potential solution: prospective health planning (PHP). By creating new models of care that use scientific and genomic advances to predict and prevent disease on an individual level, leaders say, caregivers could radically improve people’s health while controlling costs. The PHP initiative took off in earnest over the past year: In September 2002, Duke and the Centers for Medicare and Medicaid Services launched a pilot study of PHP to test its effectiveness; Snyderman called on the AAMC to form a national Institute on Prospective Care; and Duke leaders introduced the PHP concept to physicians and policymakers nationwide through editorials in Science, newspapers, radio programs and other media.

One of numerous Duke initiatives to improve health care locally and nationally, prospective health planning is a major example how the medical center has been working over the past decade to fulfill its broad mission of improving societal health.