Forum Explores Dealing with Chronic Care Under ACA

Chronic health conditions remain one of the contributing factors to financial and utilization strain on the health care system, and there are a number of steps that can be taken to address them, according to a panel of experts that met recently in San Jose.

The forum, called “Chronic Disease: A Common Sense Approach to Solving Complex Health Issues,” was held Nov. 27 and hosted by the Partnership to Fight Chronic Disease. The moderator, Ken Thorpe, chairman of the partnership, said dealing with chronic conditions may be the most important health care concern of our time.

“We all know the prevalence of obesity has doubled since the early 1980s, and that doubling of obesity accounts for about 10% of health costs in this country,” Thorpe said. “Because the rise in prevalence of obesity has contributed to the rise in diabetes, as well as hyperlipidemia, hypertension and other related chronic health conditions.”

Thorpe estimated that 84% of what California and the nation spend on health care is linked to chronically ill patients. “Yet despite that high number, many of our health plans really don’t do a good job of coordinating health care services for those patients,” Thorpe said.

Now that health care reform is becoming reality nationally, he said it’s time to shift from pilot programs to implementation of the pilots that work. Thorpe cited three major efforts:

  • Reducing hospital readmissions;
  • More effective coordination of care for dual eligibles;
  • Incentivizing prevention and wellness within the health benefit exchanges.

Panelist Kent Bradley, a senior vice president and chief medical officer for Safeway, said he had a small epiphany on the way to the conference.

“Driving down here, I knew I was about to hit gridlock on Highway 680,” Bradley said. “Now, if you look at [Highway] 680 as chronic disease, we are approaching gridlock here — and health care’s perspective to that would be, build another lane.”

The real answer, he said, is to get cars off the highway — and get patients out of constant trips to the emergency department and hospital, and to stay away from expensive nursing facilities.

“Our approach … is to first say, let’s create stoplights at the on-ramps, to get fewer people on the freeway, to get people off the chronic disease path,” Bradley said.

“Our utopia is not to get rid of chronic disease, it’s always going to be with us,” he said, “but if we can get on and off that highway in an expeditious manner, and we’re not stuck in this gridlock that we now call normal. I think the real challenge is to re-describe normal.”

The first step in the Safeway approach to employee health, Bradley said, is to conduct a full biometric exam, with lipid levels, body mass index and other health risk indicators.

“And then we incentivize by lowering rates for the premium,” Bradley said. “It starts with biometrics, then financial incentives, then a multitude of programs to help people stay on the path, all to help create that new culture, that norm, of health.”

For panelist Micah Weinberg, a senior policy advisor for the Bay Area Council, the importance of promoting prevention and wellness within the health benefit exchange has to be more than including it among its essential health benefits.

 “Largely the products on the exchange are built on a fee-for-service framework,” Weinberg said. “And I’m pretty convinced that, as long as we remain in a fee-for-service framework, where we’re largely paying doctors and hospitals for the number of things we do to people, we are never going to get a handle on chronic disease.”

If consumers shop for the best price among closed networks on the exchange, he said, they won’t get the consistent health care coordination that’s crucial for chronic disease management. “And if they have high cost-sharing, that’s not going to encourage them to maintain their physician’s drug regimen.”

Thorpe said the answer is in taking the best of the pilot prevention programs and incorporating them as standard practice throughout the health benefit exchanges and the new health care reform systems.

“Many of these conditions are preventable,” he said. “If we don’t deal with underlying trends, we’re never going to be able to get a handle on rising health care spending.”

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