Chronic disease is taking a devastating toll on this country, causing seven of every 10 deaths and accounting for 75% of the $2 trillion spent each year on healthcare, according to the Centers for Disease Control and Prevention. And a new, broad-based coalition is warning that this burden will only increase unless steps are taken to transform the current healthcare delivery model from one that focuses on acute care to a system that emphasizes prevention.
The Partnership to Fight Chronic Disease (PFCD), a group representing more than 50 organizations from healthcare, labor, and business, is launching an aggressive campaign aimed at nurturing innovative solutions to the problem at both the state and national levels, and making sure that the issue is a centerpiece of the debates leading up to the next presidential election.
Leadership is critical
Leading the coalition’s effort is Richard Carmona, MD, MPH, FACS, the 17th Surgeon General of the United States, and Kenneth Thorpe, PhD, chair of the Department of Health Policy & Management in the Rollins School of Public Health at Emory University in Atlanta and a former White House health policy advisor. But the group also includes representatives from provider organizations, healthcare insurance companies, pharmacy associations, the DM industry, and labor groups. Although there are areas of disagreement among many of the participating organizations, they have nonetheless reached consensus about a number of specific goals.
“One is for the [presidential] candidates to talk about the cost of healthcare and then have them put into place proposals that attack the real, true problems,” says Thorpe, noting that the PFCD wants to see specific proposals for curbing the prevalence of chronic disease, and system reforms that will address the need for health information technology as well as fundamental changes in the healthcare delivery model. “The idea is to see if we can have an influence on the construction of the healthcare reform proposals, or at least the way [policymakers and candidates] think about it,” he says. What is clear is that the delivery model and the payment system currently in place are not effective for managing patients with multiple conditions, he adds.
Further, Thorpe notes that it will take leadership to lay out what the best delivery model should look like and how the country should pay for it. “It is not going to evolve on its own,” he says. “Leadership has got to come out of Congress and the President, and the reform changes have to be driven through the Medicare program and then secondarily through the Federal Employees Health Benefit Program. That way, you can leverage the changes to the commercial market countrywide.”
Early intervention worth considering
Success in managing chronic disease in the Medicare population is important, but policymakers should also consider the clinical and financial opportunities presented by addressing chronic disease at an earlier stage, according to Tracey Moorhead, the president and CEO of the Disease Management Association of American (DMAA), another group that is participating in the PFCD.
“Medicare is, I believe, playing catch-up with DM programs that have been proven successful in a variety of state Medicaid programs and populations and also certainly in the commercial sector,” she says. “We have any number of case studies and peer-reviewed literature in commercial populations and also a growing body of evidence that some of the very innovative state Medicaid DM programs are showing that DM is an effective intervention for both improving healthcare outcomes and reducing healthcare costs in unique populations.”
Moorhead adds that she believes many of these successes can be transferred to appropriate segments of the Medicare population.
Conventional wisdom would suggest that prevention programs implemented at the pediatric stage stand the best chance of improving outcomes and controlling costs. The problem is that there are no data to support this supposition, notes Moorhead. “The type of dynamic, financial, long-term scoring model that you would need to estimate that isn’t currently used by the federal government,” she says.
However, without long-term data about early intervention, the evidence is clear that chronic disease is often preventable. Consequently, Moorhead would like to see policymakers address the need for more preventive interventions and education. “Helping people to understand the need for—and how to live—a healthy lifestyle would be an excellent first step,” she says.
For example, Moorhead would like to see coverage for regular screenings for diabetic conditions, education for healthy behaviors, and recognition that DM programs that affect the prevalence and severity of chronic disease can influence clinical outcomes as well as costs.
Support builds for medical home concept
Consensus is building among coalition members that the medical home concept—an approach that prioritizes coordination of care from a central, primary care base— offers the best approach toward prevention and effective management of chronic disease, according to Thorpe.
He points out that provider groups such as the American Academy of Family Physicians and the American College of Physicians favor the approach, because it integrates the PCP into the delivery model.
However, he acknowledges that this type of model simply doesn’t exist today, because the system of reimbursement does not support it and the technological tools are not in place to give the physicians the ability to effectively manage such a model. “It has to have some leadership saying that this is the best practice model, and we want to have it widely diffused,” he says.
Moorhead emphasizes that DMAA supports the concept as well, noting that every patient, and particularly those with chronic diseases, should have a medical home. “Our concern as an organization representing the DM industry is that many of these patients see five, six, or more physicians of varying specialties, and the role of DM is to play the coordinator . . . to insure that all of the players on a healthcare team serving one patient are coordinated and communicating,” she says.
Thorpe says the problem with current DM programs is that they tend to work around the PCP, and as a consequence, physicians are highly resistant to such efforts. However, Moorhead maintains that most of the prominent players in the DM arena now fully appreciate the importance of establishing a collaborative relationship with the physician, and they are actively engaged in nurturing such relationships. “The medical home should reside with the physician,” she says.
States offer an immediate opportunity
In addition to making sure that the presidential candidates address healthcare reform, the PFCD is also working to establish state chapters to nurture many of the reform efforts that have already begun at the state level.
Thorpe points out that policymakers in Vermont have taken steps to promote adoption of the medical home practice model on a statewide basis. And other states such as New Jersey and Illinois are considering similar reforms. “There are governors out there saying that they need help in trying to figure out how they are going to control health care spending,” he says. “They are moving on this, so we think by establishing state chapters we can have an immediate impact.”
Editor’s note: For more information about the PFCD, visit www.fightchronicdisease.org