In the debate over health care reform, lawmakers have pledged to put a greater focus on prevention and wellness programs.

To make good on that promise, lawmakers need to overhaul prevention programs and payment systems in Medicare, the government health insurance program for older Americans and the largest payer of adult health care services.

That is the advice of Lenard Lesser, M.D., a family physician and first-year Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of California in Los Angeles.

“While policy-makers emphasize increased use of preventive care as central to health reform’s ability to lengthen lives and save costs, busy clinicians still lack financial incentives to coordinate and effect evidence-based prevention,” Lesser and co-author Andrew Bazemore, M.D., M.P.H., write in the December 30 issue of JAMA, the Journal of the American Medical Association.

In the article, Lesser and Bazemore urge lawmakers to make three key changes to Medicare: expand coverage for effective preventive services; provide coverage for coordination of preventive care; and allow Medicare to discontinue coverage of unnecessary and costly services that are potentially harmful to patients.

“Translating that commitment to investing in preventive care into improved health will require a strategy for separating effective prevention from that which is ineffective or even harmful, and aligning payment strategies with practices supported by the best evidence,” they write.

As a clinical scholar, Lesser focuses on policy solutions to obesity and poor nutrition. He also currently works on food policy and nutrition advocacy with the National Physicians Alliance.