The High Cost of Managing Chronic Illness in America

Strategies for Using Prevention to Reduce Chronic Illness Care

Chronic Illness

Perhaps no other cost is higher than trying to manage a chronic disease or illness that has life-long repercussions for insurance companies, employers, and plan members. Just a single employee with a chronic disease can cost in the hundreds of thousands of dollars in routine care. According to the Centers for Disease Control (CDC), chronic conditions such as heart disease, cancer, strokes, diabetes, and arthritis are responsible for 86 percent of the total cost of health care in America.

Additionally, chronic diseases cause 7 in 10 deaths each year in the United States, the number of children with chronic health needs has risen by 7 percent since the 1960s, and there are about 133 million Americans—nearly 1 in 2 adults—who now live with at least one chronic illness.

Strategies for Managing Chronic Health Conditions

Managing chronic health conditions is often left up to a team of healthcare providers, insurance carriers, and the individuals themselves. The approaches vary, but can include:

  • Second Opinions - Oftentimes, health care providers may order a diagnostic test or surgery to correct matters around a chronic condition, however, these can be expensive. Managed health care helps to control costs by requiring a second opinion from a qualified healthcare provider or specialist.
  • Nurse Advisors - Managed care plans often utilize a nurse telephone hotline so that plan members must call in to seek approval before obtaining certain types of emergency care services, which should be used sparingly. This is generally a feature of HMO type plans, but it can be also used for making sure a planned test is going to be needed under the current health care plan.
  • Utilization Review - Insurance companies often turn to an analysis of medical treatment to determine if a plan member is getting the necessary services to maintain good health. Utilization reviews take place periodically to make sure that members are actively taking medication, getting preventative care and annual health screenings. This can also include a requirement for plan members to obtain precertification before any emergency care treatments, planned surgeries, or tests take place.

    Preventative Care Helps Control Costs of Chronic Diseases

    Studies have shown that preventative care and screening can stop many chronic and terminal illnesses in their tracks. Yet, before the Affordable Care Act of 2010, too many Americans did not get the preventive care they need to stay healthy, avoid or delay the onset of disease, and reduce health care costs. Often because of cost, Americans used preventive services at about half the recommended rate.

    The ACA helps make prevention affordable and accessible for all Americans because it requires most health plans to cover recommended preventive services without cost-sharing.  In 2011 and 2012 alone, 71 million Americans with private health insurance gained access to preventive services with no cost sharing because of the law. Many more now take advantage of preventative care services to stay healthy. The ACA also makes certain recommended FREE preventive services for people on Medicare and Medicaid. Examples of preventative care include:

    • Mammograms and Cervical Cancer Screenings for Women
    • Testicular and Prostate Exams for Men
    • Colorectal Cancer Screenings for Men and Women
    • Vision, Dental and Hearing Tests for Children

    By preventing rather than reacting to health concerns, Americans can save money on medical costs and insurance companies so can pass the savings onto employers in the form of discounted group premium rates and other incentives.