Guest Blog Post: Addressing Chronic Disease Key to Controlling Health Costs

Reducing the growth in Medicare and Medicaid spending is a key public policy priority. Achieving this objective requires a clear understanding of the drivers of rising health care spending. In the Medicaid program, 83 percent of total spending is associated with chronically ill patients. Moreover, a substantial share of the growth in spending is traced to rising rates of chronic health care conditions like diabetes and high blood pressure.  In light of these facts, successful public policies need to design effective prevention interventions to reduce the growth in chronic disease and provide evidence-based care coordination to keep patients with chronic disease healthy. Medical management of chronically ill patients requires effective primary care and appropriate medication management.

One of the more vulnerable populations, the health of Medicaid patients is at a greater risk when barriers to access are introduced especially when compared to the general population. Administrative barriers, typically imposed as a way to save money, make it more difficult for Medicaid patients to access proper medication and can result in a patient’s failure to take their medicine at all. Non-adherence is a dangerous and very expensive side effect of barriers to access. Indeed, academic studies have found that limiting the number of prescriptions among chronically ill patients with high blood pressure, diabetes among others reduced drug spending but increased spending on hospital care, emergency rooms and clinics.  Moreover, such limits can reduce the overall quality of care provided.

We need to redouble our efforts to slow the growth in entitlement spending. However, we need to match our policy interventions with the factors driving the level and growth in spending—rising rates of largely preventable chronic disease.

Reducing spending in the Medicaid program will require two effective policies – one that reduces the number of chronically ill patients through evidence-based prevention programs, and one with effective team-based care coordination that keeps chronically ill patients healthy and out of the hospitals, ER and clinics.  Financially, chronic diseases account for both 84 cents of every dollar spent on health care and 83 percent of spending in the Medicaid program.  Even more importantly, chronic diseases are responsible for seven out of ten deaths and affect more than 130 million Americans. Through the adoption of thoughtful and strategic public policies, our elected officials can be instrumental in moving our current “sick care” system to that of a true health care system.

-By Ken Thorpe, Executive Director of Partnership to Fight Chronic Disease