WASHINGTON, D.C. – With the cost of chronic diseases overwhelming family budgets and federal health care spending, Americans need better tools to manage their health, according to witnesses testifying before a Ways and Means Health Subcommittee hearing. Nearly 90 percent of the $4.1 trillion spent on health care in America each year is attributable to chronic disease. Addressing obesity, a risk factor for several chronic diseases, could save taxpayers up to $500 billion annually, and improve the nation’s physical and fiscal health. Witnesses pointed to the success of programs in various parts of Medicare – including innovative Medicare Advantage coverage options and value-based care delivery options – in improving patient health.
The Health Subcommittee hearing follows the Ways and Means Committee voting earlier this year to provide innovative medical treatments to help more Americans manage chronic disease. In June, the Ways and Means Committee advanced bipartisan legislation requiring Medicare to cover certain anti-obesity medications, multi-cancer early detection tests, innovative medical devices and pilot a medically-tailored meal program. This week, the House of Representatives unanimously approved H.R. 3800, the Chronic Disease Flexible Coverage Act which passed out of the Ways and Means Committee as well and provides private health insurers with the flexibility to cover preventive medication and treatments.
“We Mop Up the Floor While the Sink Overflows”: America Ignores the Root Causes of Chronic Diseases
A common focus of the hearing was how food could be better utilized as preventive medicine to address America’s chronic disease epidemic and its associated cost to individuals, families, and taxpayers. Witnesses discussed the importance of preventive medicine in addressing chronic diseases versus the prevailing approach of simply managing them after Americans have already become ill. As one witness told Health Subcommittee Chairman Vern Buchanan (FL-16), the status quo approach is similar to “mop[ping] up the floor while the sink overflows.”
Rep. Buchanan: “Dr. Hyman…we’re spending over a trillion dollars. We’re spending more money than we’ve ever spent, but we’re going in the wrong direction in terms of health care. When you look at 42 percent…obesity of adults, 20 percent with children. That’s wrong. That’s sad. We can do a lot better. What are your thoughts on it?”
Dr. Mark Hyman, Institute for Functional Health: “The science and the data are clear that we can solve this chronic disease epidemic by focusing on its root causes. I practice root cause medicine…What is the root cause? In America, we mop up the floor while the sink overflows. How do we turn off the faucet, so we deal with the root cause of the problem, which is the food that’s driving the chronic disease epidemic. I think there are a lot of levers that the government can pull…I think a deep understanding of food as medicine is very important.”
More Innovative Medicare Programs Can Be Part of Solving Chronic Diseases
Medicare Advantage has various programs and payment models specifically designed to prevent and treat chronic diseases. Recent data shows that nearly four million seniors are enrolled in plans that offer food and produce benefits. Additionally, Medicare Advantage Special Needs Plans (SNPs) offer specialized care for individuals with severe or debilitating chronic disease (C-SNPs). One study on SNPs found that C-SNP enrollees with diabetes were 38 percent less likely to be admitted to a hospital and 22 percent more likely to have a primary care visit. Primary care providers treating patients upstream is key to chronic disease management. A Medicare Advantage provider detailed to Rep. Adrian Smith (NE-03) specific innovative coverage options targeted to seniors with chronic conditions.
Rep. Smith: “Dr. Rinaldo, based on your experience with Medicare Advantage, how would you say plan design can better incentivize patients to build stronger relationships with their primary care providers?”
Dr. Francesca Rinaldo, Chief Clinical Innovation Officer, SCAN Health Plan: “In our benefit design, we often eliminate or reduce costs for preventive care services like primary care visits, especially those that are related to chronic condition management. For example, we have our chronic condition ‘special needs’ plans related to cardiovascular disease, diabetes and end-stage renal disease. Specifically, for our diabetic members, we provide services and benefits that include no-cost insulin and low-cost other drugs, no-cost diabetic supplies and no-cost diabetic self-management training. For our cardiovascular disease members in our ‘Heart First’ plan, we provide $0 cardiologist visits as well as low-cost cardiac and pulmonary rehabilitation, and we provide no-cost primary care visits for these patients as well.”
New Report: Obesity Costs Taxpayers an Additional $9.1 Trillion
Obesity is a risk factor for several chronic diseases, including but not limited to, cancer, diabetes, and heart disease. Republicans on the Joint Economic Committee, led by Ways and Means Committee member Rep. David Schweikert (AZ-01), recently issued a report calculating that obesity and its associated health expenses will cost the federal government an additional $9.1 trillion over the next 10 years. Diabetes, a chronic disease, already accounts for a sizable portion of Medicare spending. These costs to taxpayers highlight the need to prevent and effectively manage chronic diseases.
Rep. Schweikert: “I’m the senior Republican on the Joint Economic Committee…We did the math on obesity in America. We calculate that over the next 10 years, obesity in America may add an additional $9.1 trillion additional health care costs…A bunch of the people on the Left and the Right came to me and said, I can’t believe you were willing to say it, but it’s true. You have a country where we are about to have the fifth year in a row where prime age males are dying younger. The Milken Institute says 47 percent of all U.S. health care is tied to obesity, and in many ways, we also have data that in four years, more than half of America will actually be up against that number. Diabetes now is 33 percent of all U.S. health care spending, 31 percent within Medicare.”
“Once you get the test, how do we act on that?” Connecting Innovative Screening to Treatment
Expanding coverage and access to innovative testing for chronic diseases – like multi-cancer early detection screenings – is a major first step in addressing the prevalence of chronic disease by allowing patients and providers to begin treatments even earlier than ever before. However, in response to a question from Rep. Brian Fitzpatrick (PA-01), former Senator and physician Bill Frist highlighted how more can be done to bridge the gap between when a test result is received and care is provided – particularly for patients in rural communities.
Rep. Fitzpatrick: “I also want to highlight the importance of prevention services – specifically for cancer. Currently there are more than 1.7 million people who receive a cancer diagnosis every single year. Our committee has advanced legislation to increase Medicare access to multi-cancer early detection screenings. Many of us are on the Cancer Caucus which I co-chair. We’ve also introduced numerous pieces of legislation. Dr. Peters and Senator Frist – in your experiences, what other investments, aside from early screenings, should be made to prevent further cancer diagnoses, and get our arms around this terrible killer in America.”
Former Senator Bill Frist, M.D.: “…Once you get the test, how do we act on that? In terms of the companies that I work with in the field, there’s a huge gap between if you have a positive result or a negative result, what happens? How do you get to that facility, to that critical access hospital, to the local hospital, to the hospital two or three hours away. And that’s where an opportunity, that gap exists for things like telemedicine, patient navigation.”