Panel, Conference Presentation
Poised to Break the Bank: Paying for Chronic Disease
Milken InstituteAllison Aubrey, Nancy Brown, Thomas Davis, Anand Parekh, Eric, Michael Golinkoff, John Rother, Megan Golden, Jess Leifer, Stephanie Cousins
- Following 2018 Farm Bill funding, food pharmacy pilots are expected to expand within the healthcare system, with Geisinger data suggesting an $8,000 cost reduction per one-point A1c drop, though long-term durability remains uncertain.
- Over the next 15 years, matching intervention intensity to individual acuity is predicted to be the optimal strategy for Medicare chronic disease management to improve outcomes and reduce costs.
- Financial incentives in capitated environments are expected to drive the shift of services toward lower-cost nutritionists and behaviorists, contrasting with the slower transition observed in fee-for-service models.
- Nutrition counseling is anticipated to move from primary care to community settings, a transition currently hindered by insufficient progress and a need for improved promotion, communication, and marketing to address low uptake.
- Willingness to fund digital health programs like Omada Health is increasing, yet the duration of their health benefits and cost reductions remains unknown pending further evidence.
- If CMS actuarial assessments hold at scale, online programs are predicted to improve health and reduce costs while addressing barriers such as transportation and discomfort in group settings through multiple modalities.
- Taxation on sugar-sweetened beverages is expected to reduce consumption and address health disparities among children, with a broader view incentivizing healthy products and disincentivizing unhealthy ones seen as the most cost-effective approach.
- Clinical interventions for the chronic disease epidemic are predicted to be critical but must be reinforced by policy systems, environmental changes, and employer engagement regarding social determinants.
- High-value service initiatives by CEO roundtables are expected to maximize no-cost prevention activities and reduce spending on low-value services, while mental health interventions addressing anxiety and depression may impact addiction rates.
- Despite payment improvements for mental health services since 2010, a severe shortage of psychiatrists persists, which telehealth and integrated behavioral health models are predicted to help mitigate.
- Multi-payer initiatives are expected to resolve payer churn issues where financial payoffs are realized by different insurers, alongside continued efforts to address gaps in quality-based purchasing measures like glycemic control.
- The number of gene therapy programs is speeding up compared to five to ten years ago, with potential monogenic interventions possible, though high short-term financial impacts may face pushback until downstream savings drive prices down.
- Creative financial solutions are required to manage short-term budget impacts for transformative cures, while shifting language from "disease prevention" to "health promotion" is predicted to make programs more attractive and proactive.
- Framing lifestyle changes around family and present-day benefits, rather than future loss avoidance, is expected to improve engagement, while measuring direct productivity benefits may reveal that these exceed medical cost savings for employers.
- Social determinants like housing and transportation are anticipated to create better health and social mobility, while addressing loneliness through non-pharmacological means is predicted to tackle the "greatest health crisis."
- Better evidence, research, and treatments are necessary to address the chronic pain and opioid epidemics simultaneously, with HHS guidelines expected to recognize that quick tapering causes suicidal ideation for millions requiring opioids.
- Interdisciplinary programs evaluating pain from mental and physical perspectives are predicted to be enormously helpful despite their current scarcity, with pain titration goals favoring the right amount over pure elimination.
- Employer-based programs are expected to facilitate screening for 130 million Americans, while strong education campaigns are needed to overcome provider and patient instincts that disease risk affects others.
- Making prevention socially focused via media to reduce loneliness is predicted to be more effective than academic terms, alongside diversifying pain research investment across different pathways and hypotheses.
- Medical school curriculum is expected to eventually include core components of nutrition, mental health, and pain management, with the new Kaiser Permanente prevention-focused school demonstrating the curriculum's power, though changing licensed physician training remains a long-term challenge.