Panel, Conference Presentation
Poised to Break the Bank: Paying for Chronic Disease
Milken InstituteAllison, Anand, Tom, Nancy, Paul Davis, Eric, Michael Golinkoff, John Rother, Megan Golden, Jess Leifer, Stephanie Cousins
- Chronic disease management outcomes are predicted to improve and costs to reduce over the next 15 years by matching individual acuity with intervention intensity and framing prevention as health promotion focused on present family benefits.
- Substantial demand is anticipated for food pharmacy and community-based interventions, such as the Diabetes Prevention Program at the YMCA, to address uncontrolled diabetes and food insecurity affecting millions of Americans.
- Healthcare cost reductions are expected in capitated environments, particularly for Medicare, where shifting services to lower-cost nutritionists and behaviorists is viewed as the natural course of action compared to fee-for-service models.
- Significant challenges to preventive care adoption exist in fee-for-service settings and due to insurance churn with employer tenures of five to six years, which prevents payers from capturing long-term savings.
- Financial models require a shift from annual payments for chronic therapies to transformative value-based pricing for gene and cell therapies to drive the development of cures for monogenic disorders like sickle cell disease and diabetes.
- The industry expects a substantial increase in gene therapy programs in development, with a trend continuing from the levels observed five to 10 years ago, necessitating creative financial solutions for broad access.
- Aligning incentives and improving data access across approximately 200 different sources is projected to facilitate the identification of optimal genotypic therapeutic interventions for patients.
- Policy and prevention strategies must look upstream beyond clinical treatment, involving multi-sector collaboration to mobilize communities for access to healthy foods, physical activity, and safe environments for discussing mental health.
- Measuring productivity suggests health intervention benefits for employers will exceed medical cost savings, offering a mechanism to lower Medicaid rolls by increasing workforce capability.
- Mental health integration is expected to reduce opioid addiction risks and suicide rates by decreasing stigma, addressing loneliness as a health crisis, and creating safe environments for discussing anxiety and depression.
- Pain management strategies should aim to titrate pain to the appropriate level rather than total elimination, supported by a stepwise process of evidence gathering, research, and diversified investment in medications acting on different pathways.
- Three to four million individuals requiring opioid tapering need careful management to avoid suicidal ideation associated with rapid cessation, requiring better evidence and treatment uptake.
- Efforts to increase awareness of risk factors like prediabetes and elevated cholesterol will rely on strong education campaigns for both patients and providers, utilizing community and family history contexts rather than academic terminology.
- The 50-CEO roundtable will serve as an incubator for testing technology-based solutions for employee health, focusing on designing programs that maximize incentives for high-value preventive services.
- Kaiser Permanente's new medical school is expected to demonstrate the efficacy of a curriculum emphasizing prevention, nutrition, and lifestyle topics.
- Telehealth is projected to be most applicable in regions facing severe shortages of psychiatrists and PhD or master's level providers, building on leadership in behavioral health integration seen at Medicaid FQHCs, the VA, and Kaiser Permanente.