Top Chronic Diseases Behind Payer Spending And How to Prevent Them
Chronic diseases are a source of high payer spending, but payers can implement preventive care strategies to lower their expenses and maintain positive patient outcomes.
Source: Getty Images / Xtelligent Healthcare Media
- The Centers for Disease Control and Prevention (CDC) estimates that 90 percent of national healthcare spending goes toward chronic disease management and mental healthcare, which means that strong mental health and chronic disease prevention strategies can help reduce payer spending.
The CDC has named the eight most expensive chronic diseases in the US. The good news for payers is that most of these can be prevented to some degree. By being aware of preventive care strategies for these eight chronic conditions, payers can actively reduce their healthcare spending and support positive patient outcomes.
Heart disease and stroke
According to the CDC, heart disease and stroke remain the most expensive chronic diseases for the healthcare system. It causes a third of all deaths in America on a yearly basis and costs the healthcare system $199 billion.
Eating healthy can play a big role in preventing heart disease and stroke, according to the American Heart Association. To reduce the risk of heart disease and stroke, payers can design benefits that incentivize members to eat a diet that is low in saturated fat, trans fat, and sodium and high in fruits, vegetables, and whole grains, among other foods.
However, not everyone has access to these options. For those with social determinants of health barriers, Humana has seen success in combining social and clinical approaches in order to support members through chronic disease management for heart diseases including coronary artery disease and congestive heart failure.
Cancer
READ MORE: Zero-Dollar Drug Copays Lowered Total Chronic Disease Spending
Cancers are consistently one of the most fatal diseases in the US. Over 1.6 million Americans are diagnosed with cancer, nearly four in ten of whom (37.5 percent) will die from it. The disease has been projected to cost the healthcare system around $174 billion in 2020, according to the CDC.
There are a wide variety of cancers and not all of them are preventable. However, the American Cancer Fund recommends chronic disease prevention strategies that emphasize early detection, such as cancer screenings.
More advanced methods such as precision medicine can also help detect a patient’s likelihood of getting certain cancers. For example, CVS Health established a precision medicine program for Aetna members as well as nonmembers to execute rapid diagnoses and identify the best preventive care and treatment options based on the patient’s genetic makeup.
Diabetes
Diabetes is also a major driver of healthcare spending. Between medical bills and reduced productivity, the disease cost the US around $327 billion in 2017. It is often a comorbidity for other serious conditions including heart disease.
According to the CDC, over 34.2 million Americans have diabetes and more than double that have prediabetes, which can lead to type 2 diabetes.
READ MORE: Five Gaps Block Patient Centered Care in Chronic Disease Management
Maintaining a healthy weight and a healthy lifestyle is critical in chronic disease prevention for diabetes. The American Diabetes Association suggests that potential diabetes patients measure their weight once a week or more often.
CVS Health’s update of the Transform Diabetes Care model emphasized chronic disease prevention methods. The preventive care module identified potentially prediabetic members and gave them tools to prevent their condition from deteriorating in that direction. CVS Health sent members a digital scale that recorded their weight each time they used it and provided access to MinuteClinic practitioners and experts for lifestyle coaching.
Obesity
Obesity is a chronic condition that affects many Americans both young and old, with one in three adults and one in five children classified as obese. As a result, obesity costs the healthcare system around $147 billion per year.
Chronic disease prevention strategies for obesity may address physical activity, diet, screen time, sleep patterns, and stress management, the Harvard T.H. Chan School of Public Health says.
Again, however, healthy foods are not readily accessible to all members. Thus, the BCBS Institute and Health Care Services Corporation (HCSC) began a food delivery service for these types of preventive care. The program, foodQ, brought nutritious food to members in food deserts.
READ MORE: Strategies for Managing Chronic Conditions in Rural Areas
“With the alarming rates of obesity and diabetes in our country, we need a different approach to supporting healthy living, and this pilot program can help remove the barriers that keep people from accessing healthy, affordable and nutritious foods,” explained Trent Haywood, MD, who was president of the BCBS Institute at the time that this program started.
Arthritis
Arthritis is a debilitating disease and one of the most common chronic diseases in the US, affecting around a quarter of American adults. It has cost the healthcare system around $140 billion in a single year.
Being active is a key part of any chronic disease prevention strategy for arthritis, the CDC indicates.
To keep members healthy and support chronic disease prevention for conditions like arthritis, some payers offer online exercise classes through various platforms. Blue Cross Blue Shield Rhode Island, for example, transformed its in-person yoga classes into live online classes for free through Facebook Live. Registered yoga teachers lead the classes five mornings a week so that members can stay in shape even from afar.
Alzheimer’s disease
Alzheimer’s disease is among the most common causes of death in the US. According to a report released by the Alzheimer’s Association in 2017, the costs for this disease have been increasing such that in 2017 the cost was $259 billion and by 2050—unless something changes—the costs will be $1.1 trillion. At the time, around a fifth of Medicare spending went toward Alzheimer’s.
As of this article’s publication, there is no known way to prevent Alzheimer’s. However, the Alzheimer’s Association notes that cognitive decline and a history of depression can be linked. The organization recommends that at-risk individuals take care of their mental health to prevent Alzheimer’s.
“Almost half of all US adults will experience a mental illness in their lifetime, but only a fraction of these people actually gets the behavioral health help they need,” says Eva Borden, managing director of behavioral and medical solutions at Cigna.
Cigna provides virtual access to behavioral healthcare visits through its partnership with MDLIVE. Patients can indicate their mental health condition and receive a list of behavioral healthcare providers who can support them through their recovery. As an added benefit, virtual visits shield members from the stigma of getting behavioral healthcare services by not forcing patients to go outside of their own home to receive care.
Epilepsy
Epilepsy is a fairly common and sometimes fatal chronic disease. Out-of-pocket spending for patients with epilepsy can range from $10,200 to $47,900 per year. Among the growing institutionalized epileptic patient population, overall healthcare spending has been projected to increase from around $6.82 billion in 2017 to $11.75 billion in 2027, according to the American Health and Drug Benefits journal.
The World Health Organization says that a quarter of epilepsy cases can be prevented. Namely, the organization points to protecting children and adults from head injuries as the most important way to prevent epilepsy. Education for parents and adults about protecting their children and themselves from brain trauma can help with chronic disease prevention.
Tooth decay
Tooth decay, or cavities, are now recognized as one of the most common chronic diseases. A fifth of US children between six and eleven years of age and a quarter of all American adults have tooth decay that has gone untreated. Without treatment, tooth decay can lead to a variety of negative health effects.
Tooth decay costs Americans over $45 billion in lost productivity. But visiting a dentist regularly for a cleaning and oral examination can help reduce the risk of tooth decay.
Thus, preventive care for tooth decay may be easier now than ever. Nearly eight in ten patients (78 percent) are turning to teledental healthcare to solve tooth problems including cavities.
Payers can help by covering teledentistry services, as many have started to do.
