President Michael Milken of the Milken Institute posed perhaps the most important question during arguably the most important session of the Institute’s Future of Health Summit last week. Given that we’ve been talking about the health and economic burden of chronic disease for decades, he asked, when are we finally going to make progress?
He is right. Chronic diseases such as heart disease, stroke, cancer, diabetes, and chronic obstructive pulmonary disease have long accounted for the vast majority of deaths and healthcare expenditures in the United States. More recently, our nation’s suboptimal state of health has contributed to poor Covid-19 outcomes. Preventable risk factors such as unhealthy diet, smoking, lack of physical activity, social isolation and poor mental health continue to drive chronic disease.
Many of these risk factors stem from insufficient attention to social determinants of health such as nutrition and housing, as well as underinvestment in public health and primary care.
But what role does the healthcare system play in addressing chronic disease, and how do we leverage the $4.1 trillion it spends each year? The answer can be summed up in one word: prevention.
The truth is that the health care system focuses almost exclusively on chronic care management, as opposed to chronic disease prevention. My clinical career has been no exception. Influenced by caring for so many patients with multiple chronic conditions, my main policy goal in government was to improve the health status and quality of life of people with multiple chronic conditions. .
Through the HHS Multiple Chronic Disease Policy Framework, we have made significant progress in launching innovative payment and delivery models, empowering individuals through self-management programs, training healthcare providers to caring for this population and expanding research in this area.
But as I later realized and wrote in my book Prevention first, these activities were not sufficient to combat chronic diseases. Somehow, I concluded that we had failed the public by not partnering with them to prevent these conditions in the first place.
So how could health care shift the paradigm from a single focus on chronic disease management to also prioritizing chronic disease prevention? Two actions: changing incentives and expanding evidence-based prevention interventions, whether they occur in clinical or community settings.
First, healthcare providers should be incentivized with payment-related quality measures to prevent the onset of chronic disease. Health status measures related to the incidence of chronic diseases and the prevalence of risk factors for chronic discs should be developed and used by health insurers. Increasing health care entities’ accountability for health status metrics will catalyze the clinical and community connections needed to keep vulnerable Americans healthy and reduce avoidable health care costs.
Second, there are a number of prevention programs that focus on areas such as preventing diabetes, reversing heart disease, promoting physical activity, completely quitting smoking, and preventing falls, to to name a few, which are vastly underutilized; while thousands of Americans currently benefit, millions could benefit if these programs were properly reimbursed, promoted and scaled by health insurers.
Preventing chronic disease may not save health care resources in all cases, but it will make us a healthier country with increased productivity – and that in itself should be enough.
Milken worried that we would continue to talk about chronic disease for years to see a worsening health and economic burden. It’s time to stop talking and start making the changes our country desperately needs.
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