Chronic Disease: The Financial Crux Of The Healthcare Crisis

A guest post by Val Jones, MD.

On the eve of our second presidential debate, I had the chance to interview Dr. Ken Thorpe, Executive Director of the Partnership to Fight Chronic Disease (PFCD), about America’s healthcare crisis. Here’s what he had to say (click here to listen to the podcast):

1. I was part of a press conference call with you and former Secretary of HHS, Tommy Thompson last week. I learned that the economic burden of chronic disease is the rough equivalent of two Wall Street bailouts a year. Can you describe the scope of the crisis to our listeners?

About 75% of what we spend on healthcare is associated with chronically ill patients. That’s about 1.6 trillion dollars per year. Chronic disease accounts for the biggest source of spending in the healthcare economy, and it’s also the fastest growing ““ as more and more people are living with chronic illnesses. If we’re really serious about getting to the bottom of the healthcare affordability crisis, we’ll have to first address the chronic disease issue.

2. We’re starting to hear that healthcare is an economic security issue, do you agree, and if so, what is the link between healthcare and economic security?

There’s no question that healthcare is a major part of the economic security issue for several reasons. First of all, from an employer standpoint, they’re seeing health insurance premiums becoming a growing share of their cost of doing business. And it’s an area that they can’t control very well. For workers, insurance is crowding out increases in wages and eats up a rising share of a family’s income. At the federal level, healthcare costs (through Medicare and Medicaid) are on a trajectory to consume an ever increasing share of our economy unless we do something to curb the chronic disease burden.

3. During the presidential debate tomorrow, I’m hoping that Senators Obama and McCain discuss their views on our healthcare crisis – and that we get beyond the “who’s going to pay” issue. What are you hoping they’ll address?

I agree. I think the public is interested in hearing from the candidates on healthcare and economic issues, but they want specifics. They don’t want double-talk or finger pointing about who’s right and who’s wrong. They just want to understand what the candidates are proposing and what it means for them. How are they going to keep high quality healthcare and also afford it?

4. It seems that when the politicians in Washington talk about health care reform, they focus on the issue of the uninsured. Yet, when you look at the polls (including the most recent Kaiser Health08 Poll), voters want to hear candidates talk more about affordability or cost. Why the disconnect?

I think the politicians have been a little slow on the uptake on this issue until recently. The flip side of the uninsured issue is that 250 million Americans (85% of us) have health insurance and 96% of voters have health insurance. For them, the main issue is affordability. I think both candidates are aware of this, and it would be really helpful for the public to hear exactly what they’re proposing.

5. Do you think Americans understand the role of chronic disease in driving healthcare costs?

I don’t. The polling we’ve done suggests that only 15% of the American public understands the dominant role that chronic diseases play in terms of health status (morbidity) and healthcare spending. What we’ve tried to do at PFCD is help people to understand that if we’re going to reduce healthcare spending, we have to find new, innovative ways to reduce the share of Americans with chronic diseases and do a better job of managing them.

6. Can you give me a few examples of policies that would help to advance the notion of turning our “sick” care system into a true “health” care system?

We have to focus on primary prevention and finding ways to decrease smoking rates, improve nutrition, and start to bend the curve on the obesity epidemic in this country. Obesity rates have doubled since 1985 ““ so that 35% of Americans are now clinically obese. I think reversing this trend must begin in schools, followed closely by community-based interventions, with assistance from employers and productivity management initiatives.

7. Can you be more specific about initiatives that have worked?

Large employers like Citibank, Bank of America, and Johnson and Johnson have begun initiatives where employees are encouraged to get a health risk appraisal (so they understand their health risks) and then they’re offered a personalized list of activities that could help them reduce or maintain their current risk levels. Financial incentives, a culture of health in the employment setting, and having resources (like nurse practitioners) available at work sites can cut costs. Programs like this save $1.50 to $5.00 for every dollar spent.

Another good example is Hannaford Brothers grocery stores in the northeast. They’ve provided heart-healthy labeling on their food items. The higher the number of stars on the label, the healthier they are to eat. Primary care physicians in the community have pitched in to encourage patients with diabetes and other chronic diseases to purchase food with higher star values. Interestingly, the grocery stores have lost money on the no-star products, but have made up for the losses with lower healthcare costs for their employees.

8. As a physician, I’m very concerned about our dwindling primary care base and I think that prevention begins with a strong doctor-patient relationship. Unfortunately financial incentives reward procedures rather than patient education. In your view, are politicians sufficiently aware of this problem?

I think that politicians are aware that there’s a growing mismatch between the clinical needs of chronically ill patients and where our healthcare dollars are invested. Two things are likely to happen. First of all, MedPAC (which is the congressional advisory group that makes non-partisan recommendations to the congress on Medicare policy) will continue to call for ways to rebalance payments to primary care physicians versus specialists.

Second, we also have to build healthcare delivery models where we have the primary care physicians coordinating care, but we also have nurses and nurse practitioners executing on aspects of that care in order to extend the capacity of our physician base in the near term. We need more financial incentives for doctors to select primary care residency positions, and we need to have dieticians, mental health professionals, behavior modification specialists, nurses, and others helping the primary care physicians to influence their patients for the better.

9. What is the main message that the Partnership to Fight Chronic Disease is trying to get across to the American people?

Americans need to appreciate the dominant role that chronic diseases play in driving healthcare costs and impairing the health status of the population. They also need to know that there are things that we can do about this politically. We have a 110 member, bi-partisan organization that includes everyone from the Chamber of Commerce to the Labor Unions. No matter who’s in office, there’s an opportunity for us to encourage major health reform to improve the quality and affordability of care.

To listen to the podcast, click here.

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