SAN DIEGO—As politicians and healthcare experts try to get a handle on healthcare costs and chronic disease, they may be overlooking some major factors.
Much more can be done to reduce preventable diseases, including incentivizing personal responsibility and addressing socioeconomic disparity, panelists said at the 2018 AHIP Institute & Expo in San Diego.
During one session, David Agnus, a professor of medicine and engineering at the University of Southern California, said payers and individuals need to be better incentivized to prevent diseases.
"We in our country say you can be as large as you want, you can smoke, you can sit all day and we will pay for the healthcare ramifications of your behavior," he said. "We need to bring back personal responsibility along with incentivizing prevention because we already know how to prevent diseases and we're just not doing it."
Chronic diseases, including diabetes, heart disease and cancer, are the leading cause of death in the U.S. and are among the most costly and preventable. Additionally, 86% of the country's $2.7 trillion annual healthcare expenditures are spent on people with chronic conditions, according to the Centers for Disease Control and Prevention.
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Targeting and preventing such diseases could have a major impact on ever-increasing healthcare spending. However, just motivating and incentivizing changes in behavior might not be enough for everyone.
Leana Wen, commissioner of health for the city of Baltimore, turned the conversation to socioeconomic disparities, and how they can lead to preventable diseases.
"In Baltimore, one in three African Americans live in a food desert," she said. "How can we tell them to eat better when the closest food to them is junk food? If you have to take two buses to get healthy food, that is something we should fix."
She also noted that obesity and heart disease aren't the only conditions tied to poverty.
"If you look at a map of [Baltimore] you can see the areas that have low life expectancy also correspond to areas of high poverty, high infant mortality, high cardiovascular disease and cancer," she said. "Everything correlates with each other."
The government has been slow to connect socioeconomic factors to health conditions and only started looking at such factors in payment adjustments in recent years. The 21st Century Cures Act of 2016 required Medicare to account for patient backgrounds when it calculates hospital readmission penalties, but the agency has only taken small steps since.
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Esteban Lopez, chief medical officer at Blue Cross Blue Shield of Texas, agreed with both Wen and Agnus.
"We need to understand that personal responsibility in a way that I would access healthcare might be very different from someone who has less means," Lopez said. "They might not have an opportunity to attain their highest level of health."
Investing in the future of public health
All three noted that health insurers could do better regarding chronic care and prevention.
Angus pushed for better reimbursement for new technologies that allow patients and their doctors to track their health. Wen urged for more reimbursement for care coordination while Lopez focused on health equity.
"We can improve the health equity of our communities by implementing policies today that will pay dividends in five, ten, fifteen years down the road," he said. "We need to start investing in the future of our communities and making sure that we're moving the needle of public health."