VSChronic illness is pervasive in the United States. Trillions of dollars are spent and hundreds of thousands of lives are claimed by chronic disease each year.
So why do we feel like we’re going backwards, with declining life expectancy and a higher prevalence of chronic disease?
The pandemic, for its part, has been an accelerator, setting people’s health back and hampering health care more broadly in the fight against disease. But he also offered valuable takeaways and insights on how to get ahead of the disease, especially in underresourced communities.
A panel of experts met this week at the Milken Institute Future of Health Summit in Washington to discuss the many issues and gaps in chronic disease care, and how making changes upstream could improve population health. . (A STAT reporter moderated the discussion.)
“We were in a pseudo or complete lockdown for almost two years, and the impact on the psyches of patients and the mental health of people across the country, I think, helped accelerate that … because people are tired,” said Arta Bakshandeh, a doctor and medical chief. IT Manager at Alignment Health.
People’s burnout reduces their ability to manage chronic illnesses and contributes to mental health issues that do the same, he said. “It adds fuel to the fire, basically,” he said. “It’s an accelerator.”
Consider people’s behaviors during the pandemic, including increased alcohol consumption, reduced movement and exercise, added stress, and delayed preventative care and health checkups. Consider the decline of childhood vaccinations and the entry of anti-vaccine and anti-science rhetoric into the mainstream. “There’s going to be a big tsunami just around the corner, I’m afraid, on chronic disease,” said Donna Grande, CEO of the American College of Preventive Medicine.
It will take more than exhausted vendors to handle what’s to come, panelists said. The pandemic has actually helped illuminate new paths forward.
For Eli Lilly, the pandemic has been a lesson in speed, said Derek Asay, senior vice president of Lilly Value and Access. In the spring of 2020, when Lilly had identified a Covid antibody and needed to reach patients for clinical trials, the company purchased a fleet of recreational vehicles, which became mobile research units. Now, the company is using a similar method to reach patients with Alzheimer’s disease and make clinical trials more inclusive.
The Centers for Medicare and Medicaid Services and its CMS Innovation Center are trying to reinvent the use of the programs and tools they have rolled out over the past two and a half years. Telehealth is one, but the Innovation Center is also exploring value-based care arrangements that allow flexible payments to providers, said Dora Hughes, the center’s chief medical officer. “Now in this environment, we are increasingly offering lump-sum payments or capitation payments,” instead of paying providers for volume of services – a change that has helped providers stay afloat during shutdowns, she said.
A major issue in health care, but especially when it comes to chronic disease care, is the availability of reliable, robust and consistent data, panelists said. Bakshandeh envisions a future where data is “democratized”, so that it flows from the CMS to providers, physicians, patients – a unified data architecture where all involved parties can see a patient’s medical history and other key information, and act more quickly accordingly. “That would be bliss,” he said.
There are also other data gaps. Little is known or formally documented about patients’ lives outside of the health care system, about how behavioral, socioeconomic, geographic, genetic, and other factors might impact long-term health.
How do a patient’s symptoms change during the 23 hours they are away from their doctor’s office? Health technologies, like smartphone apps, blood glucose and blood pressure monitoring tools, could document this, Asay and Bakshandeh said.
The CMS, for its part, is increasing its efforts to collect demographic information on Medicare and Medicaid beneficiaries, but also on their social needs, such as housing, food, employment, etc. Medicare is also opening its arms to historically unrecognized providers, such as peer counselors, community health workers, doulas and even pharmacists, in primary and specialty care settings, Hughes said.
Community-based approaches, even seemingly non-medical interventions like adding safe walking streets and farmers’ markets, could help improve the health of entire ZIP codes, Grande said. But to do this, population-level data from local and regional hospitals and other sources must be analyzed and used.
Respond to urgent patient needs
Chronic disease often begins long before diagnosis. It begins, sometimes, in homes full of disease-causing parasites, cities ravaged by natural disasters, or cities with no doctor’s offices or grocery stores nearby.
Thus, to anticipate the national problem of chronic diseases, it is necessary to attack the problems early. As a doctor, Bakshandeh visited patients in their homes and found poor neighborhoods filled with bed bugs, cockroaches and water leaks. People couldn’t afford pest control products or plumbers, and so they developed illnesses or infections. Instead of waiting for the problems to turn into an extremely expensive trip to the emergency room, Bakshandeh thought, “Maybe I can call a plumber to fix the leak that’s causing this Legionella outbreak that’s giving you pneumonia.
Similarly, providers (and payers) should meet patients at their level of food literacy, panelists said. Misleading food labels, confusing nutritional information and little education about diet means Americans are being left behind.
“Also, doctors aren’t really trained to talk to their patients about these issues,” said Matt Eyles, CEO of America’s Health Insurance Plans. “It’s a huge gap we have. We know that a lack of nutritious or very high-calorie, very high-sodium foods contributes to the prevalence of chronic disease, but healthcare isn’t addressing it early enough. All sectors can do better, Eyles argued.
For Grande, America’s food problem is reminiscent of her tobacco problem, a political issue she worked on. Tackling poor diets will require the same kind of political will and leadership she saw in the tobacco era, and the same adjustment to social cues, like getting rid of ashtrays in public spaces. “These ashtrays have been replaced by candy dishes on the conference tables. So here you have the wrong alternative,” she said.
STAT’s coverage of chronic conditions is supported by a grant of Bloomberg Philanthropies. Our financial support are not involved in decisions about our journalism.
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