The Partnership to Fight Chronic Disease proposes the following public policy recommendations to help our nation’s leaders address the growing epidemic of chronic disease and highlight commonsense reforms that will help the nation address this challenge. The greatest opportunity to manage health care spending in America is to focus on the primary driver of health care costs, premature deaths, and avoidable disability: chronic diseases such as heart disease, asthma, cancer, and diabetes. We also must recognize and address the vulnerabilities the COVID-19 pandemic revealed in our health care system and build upon our strengths which enabled the U.S. early access to effective vaccines and treatments.
Preventing and better managing chronic diseases and infectious disease outbreaks depends upon having a nimble, robust, and innovative health care ecosystem that emphasizes prevention of disease onset and progression, facilitates access, and promotes health equity. This focus will address rising health care costs while increasing productivity and helping Americans live healthier lives.
Recent reforms have focused on improving accessibility to health care coverage, but this will not be sufficient if additional steps are not taken to address the rising burden of chronic disease in America. Treating people with chronic and mental health conditions now accounts for 90 cents of every dollar spent on health care[1] and chronic diseases are our leading causes of death and disability. Seven in 10 adults in the U.S. are overweight or obese.[2] Six in ten adults in the U.S. live with at least one chronic condition and one in four U.S. adults have two or more chronic conditions.[3]
Health care costs are increasing, but spending is highly concentrated. Ten percent of the population – often people living with multiple chronic conditions – account for $2 out of $3 dollars spent on medical care.[4]
These facts squarely place the focus on improving health care and lowering overall costs where it should be: reducing the human and economic burden of preventable and manageable chronic diseases and infectious disease outbreaks.
Meaningful reforms start by asking how we want our health care system to function and then focus on how we can achieve it.
America needs health care that:
· Prioritizes Prevention and Management of Chronic Conditions. Our health care system needs reforms that align incentives to encourage payers, providers, employers, and individuals to better prevent, detect, treat, and manage chronic diseases – both physical and mental – before they become an acute problem. Special attention should be paid to people living with multiple chronic conditions as their treatment accounts for two out of three dollars spent on health care.[5]
· Encourages Continued Innovation in Treatment and Delivery of Health Care. Our health care system must be structured to improve the health of Americans by supporting innovations that enhance the quality of care delivered and health outcomes achieved. Continued research is needed in these areas, as well as improving care coordination and leveraging the potential of health IT and real-world data. As the COVID-19 pandemic has demonstrated in real-time, having a robust, nimble, and responsive biomedical ecosystem that supports innovation is essential to saving lives and promoting health in the U.S.
· Improves Access to Recommended Care for All. To put Americans in the best position to effectively and efficiently prevent and manage disease, every American should have coverage that provides affordable access to care recommended by his or her health care provider. Improving access must also work to eliminate structural racism and bias in the health care system that continues to perpetuate health disparities and limit opportunity for many.
· Promotes Health Across Generations for All. Younger Americans are suffering from preventable chronic diseases at higher rates than their parents. Preventive efforts in childhood should emphasize healthy behaviors to encourage lifelong health promotion. Poor health lowers earning potential in adulthood and depresses our economy overall. Older Americans are entering Medicare with higher rates of chronic diseases and an alarming and growing number have more than one chronic condition. That means higher medical costs for Medicare and a lower quality of life for seniors. Preserving affordable access to care within Medicare should include preserving choice in treatment options and addressing out-of-pocket costs for beneficiaries.
· Translates Knowledge into Action. In communities across the nation, people have developed innovative programs that promote wellness and prevent and manage disease. We aren’t doing enough to tap into that knowledge and replicate programs that work nationwide. We must also put knowledge to better use to address social determinants of health, promote health equity, and eliminate health disparities in burden of disease and health outcomes.
These principles translate into actionable reforms and specific ideas for change that will work to improve health for all Americans.
[1]CDC, “Health and Economic Costs of Chronic Diseases” available online.
[2]KM Flegal, MD Caroll, et al, “Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010,” JAMA 2012: 307(5): 491-497, available online.
[3]CDC, “About Chronic Diseases,” available online.
[4] AHRQ, Multiple Chronic Conditions Research Network, available online.
[5] AHRQ, Multiple Chronic Conditions Research Network, available online.