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As chronic illnesses drive up healthcare spending, solutions focus on wellness, interventions

In Massachusetts alone, the number of people with three or more chronic diseases is expected to grow from 625,000 in 2015 to 1.7 million by 2030.

Jeff Lagasse, Associate Editor

Healthcare spending is on the rise, and one of the main factors contributing to this trend is the rise in prevalence of chronic disease, particularly obesity.

That effect seems obvious. After all, people with chronic diseases are going to utilize more healthcare resources and drive up spending. But what's striking is just how much of an effect this has. Using Massachusetts as a case study, the Partnership to Fight Chronic Disease found that the projected total cost of chronic disease in that state from 2016-2030 is $870 billion.

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Chronic diseases could cost Massachusetts $41.4 billion in medical costs and an extra $16.6 billion in lost employee productivity during that time. In all, 5 percent of residents in Massachusetts account for 50 percent of its healthcare spending.

Ken Thorpe, the Robert W. Woodruff professor and chair of the Department of Health Policy and Management in the Rollins School of Public Health at Emory University in Atlanta, sees obesity and its resultant health complications as the primary culprit. Obesity, he said, can increase healthcare spending by about 20 percent.

"What we've found from our research is that 86 percent of what we spend is on chronic illnesses," said Thorpe. "The persistent increase in chronic disease is a rising driver of healthcare costs, and looking at the most recent data that just came out, the share of adults that have risen to obese is about 40 percent."

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It's a persistent problem throughout the entire country, but particularly in the South, with high concentrations of obesity in a triangle that stretches from West Virginia down to Florida. And with obesity often comes diabetes, hypertension and pulmonary disease.

The problem of multiple chronic diseases is only growing. In Massachusetts alone, the number of people with three or more chronic diseases is expected to grow from 625,000 in 2015 to 1.7 million by 2030.

Obesity can be a product of lifestyle, marked by a poor diet and a lack of exercise. To curb this trend, Thorpe suggests a chronic disease prevention program modeled after a diabetes prevention program that has already shown results.

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"It's an intensive lifestyle intervention were you go to an 18-week class, and it gives you information on diet and nutrition and tools to change your behavior," said Thorpe. "You're geared up to do 150 minutes of physical activity a week. What we've found is among pre-diabetic, hypertensive adults, it reduced the prevalence of new diabetes by about 15 percent. It's a very important intervention."

The program is currently run primarily by YMCAs, but Thorpe said Medicare will start covering it next year, with Medicare Advantage plans likely to follow. Those interested can apply to the Centers for Disease Control and Prevention to start providing the program.

"There's going to be a big increase in demand from providers to offer the program," said Thorpe. "There's also interest in internet-based options for this. It's generating similar results, a similar reduction in diabetes incidents. It's something that scales up very easily."

Obesity is only one piece of the chronic disease puzzle, though. Behavioral disorders also play a role. Depression is the most prevalent, followed by anxiety disorders -- which in turn are associated with diabetes, heart disease, cardiovascular distress, hypertension and bad cholesterol. Half of Americans, said Thorpe, have at least one of those ailments. They're often seen in more rural areas, and they're increasing among all age groups.

Vermont offers an example of an inexpensive approach that's been working: community health teams, which have been embraced by all payers in the state.

"They use these teams to manage these chronically ill patients at home," said Thorpe. "What they've done is combine traditional healthcare -- managing medications, health literacy -- and integrated it with social services." With transportation services and nutritional counseling is thrown into the mix, it represents a more comprehensive approach to managing patients and saving the healthcare system money.

Thorpe said policy changes are the best way to enact approaches like this on a national level, adding that the Centers for Medicare and Medicaid Services can take the lead.

"CMS, if they wanted to, could move in this direction, just like they did with diabetes prevention," he said. "With innovations that have gone through the Centers for Medicare and Medicaid Innovation, CMS has the authority to adopt that intervention program-wide. It wasn't something they had to go back to Congress and get approval for."

Medical breakthroughs have already played a part in tamping down costs and saving lives. According to the Partnership, breakthroughs have prevented 3.1 million cases of chronic disease in Massachusetts alone, with $122 billion saved. Nationwide, those numbers are 169 million and $6 trillion, respectively.

Thorpe is hopeful that the policy situation will continue to improve.

"These are not Republican or Democratic issues," he said. "These are patient health issues."

Twitter: @JELagasse
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