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Chronic Disease Management: Key to Reducing Healthcare Costs

By Dr. Sultan Rahaman
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Sometimes statistics on the prevalence of diseases are hard to believe. However as family physician in private practice, I know from direct experience that serious chronic diseases exist in epidemic proportions. Managing chronic diseases also consume a tremendous amount of my professional time. 

Chronic diseases take a deadly toll on lives. The Centers for Disease Control and Prevention (CDC) reports:  “7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year”.

Vast amounts of money is spent by Medicare, Medicaid, private insurance companies and out of patients’ pockets  for the treatment of chronic diseases. In terms of healthcare expenditures the top chronic diseases are heart disease (especially coronary artery disease and congestive heart failure), strokes, diabetes mellitus, chronic lung disease, cancer, mental illnesses (especially Alzheimer’s disease), chronic kidney disease. The costs are staggering. Peter Pitts, president of the Center for Medicine in the Public Interest says:

 “Of the $2.2 trillion America spends each year on health care, 75 percent of that money goes to fighting chronic diseases.”

Here are some examples of expenditure from the Triple Solution for a Healthier America:

•        Heart Disease and Stroke: $432 billion/year.

•        Diabetes Mellitus: $174 billion/year.

•        Lung Disease: $154 billion/year.

•        Alzheimer’s Disease: $148 billion/year.

What is worth noting is that many of these diseases are preventable.  Obesity is a huge underlying cause. The CDC reports: “Obesity increases the risk of developing conditions such as diabetes and heart disease. The rate of obesity in adults has doubled in the last 20 years. It has almost tripled in kids ages 2-11. It has more than tripled in children ages 12-19.” Lung cancer is the leading cause of cancer death, and cigarette smoking causes almost all cases.

Lifestyle changes such as improved diet and more physical exercise can reduce the prevalence of obesity, which would have a favorable impact on other diseases such as diabetes mellitus type 2 and heart disease. Likewise reducing cigarette smoking reduces the incidence of chronic lung disease and cancers. In addition to primary prevention, treating hypertension and diabetes mellitus early, optimally and long-term reduces complications, costs and mortality.

The new healthcare reform law (The Affordable Care Act) contains many features to improve quality outcomes and the cost of chronic diseases. Here are two key features.

1.     Encouraging Wellness and Prevention: Physician Wellness visits to encourage lifestyle changes, services for early cancer detection procedures such as mammograms and colonoscopies are now covered without copayments starting Jan 2011.

2    Development of Accountable Care Organizations: A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organization's payment is tied to achieving health care quality goals and outcomes that result in cost savings.

 In May 2009 Kenneth Thorpe, Ph.D., Executive Director of the Partnership to Fight Chronic Disease and Professor and Chair of the Department of Health Policy and Management at the Rollins School of Public Health at Emory University stated:

"Unless we can realign our health care incentives to encourage preventive care and better disease management, our current course of 'inaction' will soon cause irreparable damage to our nation's economic viability and the strength of our greatest national asset: the health and wellbeing of the American people"

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