Treating chronic diseases accounts for an astounding 90% of the annual $3.5 trillion tab for health care services in the United States, according to the Centers for Disease Control and Prevention.
That’s why innovative health care models focus on improving health care outcomes for patients with chronic diseases. Value-based care, for instance, pays doctors, hospitals and other providers based on the quality and cost-effectiveness of the health care services they deliver rather than the number.
Under a traditional fee-for-service approach, provider compensation is based on the volume of services they provide. This creates a financial incentive to rack up office visits, tests and procedures that can lead to disjointed and expensive patient care. Value-based care takes a different approach — prevention and measurable improvement.
Here are examples of how value-based care focuses on preventing and managing three common chronic conditions.
Heart Disease and Stroke
Together, heart disease and stroke cost about $199 billion annually to treat, according to the CDC, and they make up the leading cause of death in the United States.
To address this sobering reality, some providers rely on resources such as the Million Hearts Cardiovascular Disease Risk Reduction Model to identify people at risk of developing heart disease and intervene early. Half of the providers in the program — which began in January 2017 and runs through December 2021 — calculate risk scores for their Medicare patients. From there, they help those with high scores lower their risk for heart disease through lifestyle changes, medication and other interventions. The other half of providers in the program are assigned to the control group and focus on what they’ve always done: treating only those who have already been diagnosed with a heart issue.
The program highlights the potential for value in care — preventing diseases before they occur to achieve better health outcomes with less costly care.
Asthma, aside from being an uncomfortable and dangerous condition, costs the U.S. $80 billion annually.
During a three-year pilot program, the Nemours Children’s Health System deployed care teams of doctors, nurses, psychologists and case managers to help patients with asthma and their families better manage the disease. Nemours also worked beyond the walls of the institution to make life easier for asthma patients. Hiring community health workers, for instance, made it possible to help families identify and avoid asthma triggers at home and school.
Working with patients to find and target potential health threats empowers them to take an active role in managing their health. The results of the pilot underscore that fact: The program saw 60% fewer emergency room visits, 44% fewer hospital stays and more than $2,100 in cost savings per child.
The direct costs of treating diabetes is about $237 billion annually, according to the CDC. When left untreated, it leads to complications such as heart, kidney and eye disease.
To improve care for patients with this disease, in 2017 the Blue Cross Blue Shield Association partnered with an outside vendor, Onduo, to pilot a program in Arkansas, Georgia and South Carolina that provides health plan members with access to personalized diabetes management.
Onduo, a partnership between Verily Life Sciences, an Alphabet company, and Sanofi, a pharmaceutical manufacturer. Onduo’s program uses virtual assistance to help people manage their Type 2 diabetes with virtual assistance, including a phone app and wirelessly connected continuous glucose monitoring devices. Certified diabetes educators offer lifestyle coaching alongside physicians, who manage patients’ medications. The program emphasizes preventing complications from chronic diseases, such as diabetes, by handing patients what they need to improve their health.
Rather than just reacting to health scares, value-based care makes it easier for patients to proactively manage their chronic conditions and avoid developing new ones by addressing the root causes. Better health care outcomes at lower costs are possible, but they require fresh ways of approaching care grounded in value.