Closing Gaps in Health and Health Care | Future of Health Summit 2023

Summit Context & Theme:

• The 2023 Milken Institute Future of Health Summit operates under the theme "Closing the Gap, Better Health for More People."
• The event emphasizes that collaboration across sectors (government, industry, academia, philanthropy, patient advocacy) is essential to address widening health inequities.

U.S. Health Status & Inequities:

• Despite spending over $4.1 trillion annually (the highest globally), U.S. health outcomes are declining.
• U.S. life expectancy has dropped to 76.4 years, the lowest level in two decades, returning to mid-1990s levels.
• In 25% of U.S. counties, mortality rates are higher than they were 40 years ago, with the decline concentrated in the interior, Midwest, and South.
• The mortality gap between the wealthy and the poor is widening significantly.
• Americans in both the poorest and wealthiest communities have shorter lifespans than peers in Canada, France, and Japan.
• Chronic diseases (heart disease, cancer, diabetes, liver disease, obesity) are primary drivers of poor life expectancy for adults aged 35–64, independent of pandemic, opioid, or gun violence deaths.
• Health burdens are translating into economic tolls, including increased poverty, unemployment, and inadequate housing.

Aging Population & New Initiatives:

• By 2030, one in six people globally will be aged 60 or over, with the most rapid growth occurring in low- and middle-income countries.
• The Aging Innovation Collaborative was launched with a $3 million seed contribution from the National Investment Center for Seniors Housing and Care (NIC).
• The collaborative aims to identify scalable solutions for housing and support services for older adults and fast-track their implementation.
• NIC CEO Ray Broughan stated that the current healthcare, housing, and community systems are "not adequately prepared" to meet the opportunities and challenges of an aging population.

Panelist Organizational Roles & Capabilities:

• United Way Worldwide: Operates 60% of the national 2-1-1 call centers, touching 20 million Americans annually for healthcare, mental health, and social service navigation.
• Beringer Ingelheim: A 140-year-old research-driven pharmaceutical company with ~10,000 employees developing treatments for oncology, depression, and metabolic diseases.
• New York City Department of Health: The NYC Health Commissioner announced the "Healthy NYC" initiative to organize public, private, and nonprofit sectors around specific life expectancy targets.
• Guardant Health: A precision diagnostics company providing blood tests for cancer management and screening; currently managing 20% of advanced cancer patients in the U.S. via their tests.
• Geisinger: A "payvider" (integrated payer and provider) system in Pennsylvania that utilizes longitudinal data to focus on preventive care and upstream interventions.

Barriers to Preventive Care & Innovation:

• Fee-for-service payment models drive care downstream, creating disincentives for investing in upstream activities like food security, housing, or long physician visits.
• Regulatory Delays: Government-funded committees like the U.S. Preventive Services Task Force are underfunded with flat funding for five years, leading to guideline updates occurring every 5–8 years, delaying commercial payer coverage for new tests.
• Spending Imbalance: Of $4.3–$4.5 trillion in U.S. healthcare spending, approximately $3.2 trillion treats the sick/delays symptoms, while only ~$1 trillion is spent on prevention/wellness.
• Last-Mile Access: Even with FDA approval, innovations can take 5–7 years to reach patients due to coverage hurdles and lack of alignment between regulatory bodies and commercial payers.

Specific City & National Initiatives:

• NYC Life Expectancy Data: New York City lost 4.6 years of life expectancy in 2020 alone; the U.S. overall has flatlined for a decade and remains two to three years behind 2019 levels.
• Healthy NYC Strategy: The initiative targets three buckets: reducing overall risk, reducing premature death (below age 65, disproportionately affecting communities of color), and addressing excess death drivers (overdoses, suicide, violence, chronic illness, diet, maternal mortality).
• NYC Public Health Corps: Deployed over 100 community-based organizations with federal emergency funds to perform community health work, vaccination, and care enrollment.

Industry Perspectives on Pricing & Access:

• Pharmaceutical companies argue that high prices reflect the high investment and R&D costs over 5–7 years required to make a product accessible.
• Industry representatives emphasize that system efficiency and outcome measurement (not cost) should drive value, noting that current cost-focused models veil the true value of innovations like depression treatments or heart failure management.
• Beringer Ingelheim advocates for patient education and prevention to reduce the progression of patients to a state requiring pharmaceutical intervention.

Systemic Challenges & Misinformation:

• NYC Health Commissioner Ashwin Vasan identified misinformation as a major driver of declining life expectancy, noting the pandemic highlighted the need for a "misinformation unit" to counter hyper-local, factually incorrect messaging.
• Angela Williams (United Way) noted that the U.S. lacks the "will" to work together, despite having the assets (e.g., 2-1-1 network) to solve problems.
• Current health systems operate under fee-for-service incentives that favor commercially insured populations, widening inequities.
• The panel highlighted that 20 million calls are made to 2-1-1 annually, yet United Way receives no federal funding to operate these critical data hubs, limiting their ability to act as a "canary in the mine shaft" for community trends (e.g., detecting baby formula shortages before federal agencies).

Future-Forward Statements & Innovation Trends:

• GLP-1 Obesity Drugs: Hubertus von Bonbach identified metabolic diseases and GLP-1 mechanisms as key areas addressing multiple comorbidities.
• Mental Health Innovation: Von Bonbach predicts significant breakthroughs in mental health within the next five years, citing a lack of innovation in the field over the last 40 years.
• Early Detection: Guardant Health's Amirali Talasaz emphasized that early detection of neurodegenerative diseases (Alzheimer's, Parkinson's) and precancerous conditions will shift the center of gravity from treating sickness to promoting wellness.
• Data & AI: Panelists agreed that leveraging AI to mine data silos is a key driver for efficiency, though data ownership remains a patient-centric issue.
• Industrial Policy: NYC Commissioner Vasan called for a national "industrial policy for health" similar to the CHIPS Act, requiring government to set superordinate goals and unlock capital to drive private sector innovation.

Call to Action:

• Panelists urged attendees to commit to at least one public-private partnership to move the needle on American healthcare within the next 12–24 months.
• Geisinger's Dr. Jay Wonru noted that readmission rates have successfully dropped when government anchored them as quality measures, proving that "islands of excellence" can exist within a fragmented system.
• The consensus is that trust must be rebuilt through equitable clinical trial enrollment and community-centric delivery of care.