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Chairman Michael Milken of the Milken Institute asked 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 burdens of chronic diseases for decades, he asked, when will we finally realize some progress?
He’s right. Chronic diseases such as heart disease, stroke, cancer, diabetes, and chronic obstructive lung disease have long accounted for the vast majority of deaths and healthcare spending in the U.S. More recently, our nation’s suboptimal health status contributed to poor outcomes from Covid-19. Preventable risk factors such as unhealthy diet, tobacco use, lack of physical activity, social isolation, and poor mental health continue to drive chronic diseases.
Many of these risk factors stem from insufficient attention to the social determinants of health such as nutrition and housing as well as an underinvestment in public health and primary care.
But what role does the health care system play in tackling chronic diseases and how do we leverage the $4.1 trillion it spends annually? 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 was no exception. Influenced by taking care of so many patients with multiple chronic conditions, my signature policy focus in government was to improve the health status and quality of life for individuals with multiple chronic conditions.
Through the HHS Strategic Framework on Multiple Chronic Conditions, we achieved meaningful progress through launching innovative payment and delivery models, empowering individuals through self-management programs, training health care providers to care for this population, and expanding research in this area.
But as I later realized and wrote in my book Prevention First, those activities weren’t enough in addressing chronic diseases. In a way, I concluded that we had been failing the public by not partnering with them to prevent these conditions in the first place.
So, how could health care change the paradigm from a sole focus on chronic disease management to also prioritizing chronic disease prevention? Two actions: change the incentives and scale evidence-based prevention interventions, whether they occur in the clinical or community setting.
First, health care providers should be incentivized through quality measures tied to payment to prevent the occurrence of chronic diseases. Health status measures related to the incidence of chronic diseases and the prevalence of chronic disk risk factors should be developed and utilized by health insurers. Increasing accountability of healthcare entities for health status measures will catalyze the clinical-community linkages necessary to keep vulnerable Americans healthy and reduce preventable healthcare costs.
Second, there are a number of prevention programs focused on areas such as diabetes prevention, heart disease reversal, physical activity promotion, comprehensive tobacco cessation, and falls prevention, to name a few, which are significantly underutilized; while thousands of Americans currently benefit, millions could benefit if these programs were adequately reimbursed, promoted, and scaled by health insurers.
Chronic disease prevention may not save health care resources in all cases, but what it will do is make us a healthier country with increased productivity – and that in and of itself should be enough.
Milken was worried that we’ll continue to keep talking about chronic diseases for years on end only to see worsening health and economic burden. It’s time to stop talking and start making the changes our nation desperately needs.
