Chronic disease is the plague of the 21st century, affecting nearly 150 million Americans who suffer from diabetes, heart disease, mental illness, autoimmune disease, asthma, HIV/AIDS, and other persistent ailments. Nearly 30 million people live with five or more chronic conditions. All told, chronic disease costs us about $1 trillion each year.
Our nation is not going to balance its health care budget, nor enable citizens to live the long, productive lives they deserve, until we get a handle on chronic disease. Fortunately, we are on our way thanks to recent health plan innovations.
The Affordable Care Act (ACA) changed how the U.S. funds health care, shifting from volume-based to value-based payments. Insurers and providers today are rewarded for keeping patients well and effectively controlling any preexisting conditions. This involves increased access to preventive care, and all health plans now offer members annual checks-ups and recommended screenings at no out-of-pocket cost.
What’s more, health plans are actively encouraging members to take advantage of their benefits. Very common is the use of care coordinators, including community health workers who might help a patient find a nearby primary care doctor or get them onboard with a chronic disease management program. Many health plans also offer digital health coaching to propel and support patients’ own wellness efforts, as well as 24/7 nurse helplines and provider teleconferencing to answer patients’ needs right away, without a trek to a hospital.
The return on the modest investment in these programs is high. By identifying and treating disease early, we delay progression, avoid complications, and reduce the need for more expensive care. This helps stretch available healthcare dollars and, most importantly, works better for patients.
Most surprising may be the degree to which insurers have embraced the social determinants of health. Substantial research has confirmed what we in the public health sphere have long suspected, that various non-medical factors like housing, transportation access, nutrition, socioeconomic status, and social engagement, have a direct effect on physical well-being. Some communities, including low-income senior citizens and people of color, can find themselves at a distinct disadvantage, at greater risk of disease, disability, and death.
It’s good to see that health plans are incorporating non-traditional benefits to address these disparities. Examples include free transportation to medical appointments or meal delivery after hospital discharge. Care coordinators are also linking members with services beyond the health plan, such as tapping an electric company’s program to upgrade a heating system, so a senior stays warm through winter, or involving Meals on Wheels to improve their day-to-day nutrition.
The availability of in-home care is also on the rise, and not just for clinical purposes. As social isolation has been proven to accelerate cognitive decline and increase disease and mortality risk, simple things like sharing lunch and conversation with another person can truly be the best medicine. Health plans are implementing companion programs to organize regular home visits for seniors and turning their clinics into community centers with activities and even cafés open to all members.
Innovation is happening throughout the U.S. healthcare system, but it is particularly prevalent in Medicare Advantage. This program, which allows Medicare beneficiaries to choose a private health plan, is playing a leading role in modernizing and improving healthcare. Fortunately, advancements there are being incorporated into employer-based and individual health plans as well.
Transformation doesn’t happen overnight, but due to the ACA’s reforms, America’s health care system is on the right road, delivering more affordable, proactive, whole-patient care that not only improves health outcomes but also enhances people’s lives.
Dr. Hector Balcazar is Dean, College of Science and Health at Charles R. Drew University of Medicine and Science in Los Angeles.