THE BLOG

A Crossroads for the Chronically Ill

12/15/2010 09:34 am ET | Updated May 25, 2011
  • Kenneth Thorpe Chairman, Partnership to Fight Chronic Disease; Robert W. Woodruff Professor and Chair, Department of Health Policy & Management, Rollins School of Public Health, Emory University

As lawmakers prepare for a new congressional session, attention is once again falling on whether and how to fix the recently-passed health reform law. Beginning in January, all eyes will be on Congress to see what changes, if any, are made and what lasting impact this could have on the future of our nation's health care system.

By most accounts, there is growing concern that a movement toward cost cutting could lead to the loss of critical services for patients suffering from chronic illnesses such as cancer, diabetes or heart disease. One such program that is particularly vulnerable is Medicare (2010 budget: $453 billion). Having already given up $400 billion in the next decade as part of the health care reform law, the one program so vital to the treatment of the chronically ill once again faces the chopping block under the aim of a new entity known as the Independent Payment Advisory Board (IPAB). IPAB, which was created as part of the Affordable Care Act, is tasked with reducing the growth in Medicare spending. The board, made up of officials only accountable to the executive branch, will likely recommend broad cuts throughout every facet of Medicare, including the services in place for the prevention and management of chronic diseases. However, this would be a grave mistake for the nearly half of all Americans who suffer from chronic illnesses.

Focusing on prevention by advocating a healthier lifestyle and regular physician visits can help eliminate some of the leading Medicare cost drivers. However, given the power and mission bestowed upon IPAB, limiting preventative care will undoubtedly be considered for the immediate cost savings and limited short-term impact. What does this mean for patients on the slippery slope toward diabetes, heart disease and hypertension to name a few? It means they will not be forewarned of these medical red flags and will not take the appropriate steps to avoid a preventable diagnosis. Alternatively, successful management of chronic illnesses such as coordinating insulin schedules for diabetics and regular blood pressure monitoring for hypertension patients would reduce hospitalizations and emergency room visits, keeping the cost down.

So, what needs to be done? First, the goal of reform should be not only to provide appropriate care, but also to reduce the number of Americans affected in the first place. Rather than simply cutting payments to providers and increasing cost sharing to Medicare beneficiaries, future recommendations should focus on reducing chronic disease prevalence and keeping chronically ill patients healthy.

Potentially preventable readmissions in the Medicare program over the next decade will cost nearly $250 Billion, costs that can be averted through evidence-based care coordination. Data from randomized trials show we can reduce the incidence of diabetes by 70 percent among overweight adults. We need to adopt these programs nationally, which will reduce weight and with it chronic disease and Medicare spending. These are just two of the common sense proposals that need to be included in future reforms.

Second, we need to better understand the needs of patients and tailor health management services to meet them in an efficient and thorough manner. The right plan should be built upon a foundation of consistent care and then personalized for each patient to ensure that each one is receiving only the tests and medicines that fit his or her treatment plan. By focusing on the patient's specific needs, we can reduce the stress on the patient and the overall cost of services.

Finally, striking this important balance between affordability and quality care can't come from one panel that shares the solitary motivation of cutting costs. It needs to be a joint effort among patients, providers and policymakers. While there is no question that decisions must be made to address rising health-care costs, we simply cannot accept any proposals that would cut the quality of that care.