In the United States, people 65 and over carry a disease burden far in excess ofmore than what could be achieved with effective lifestyle and therapeutic interventions. Proper management of common risk factors like obesity and diabetes could significantly reduce the high degree of suffering and costs associated with avoidable complications such as heart attack, heart failure, stroke, and kidney failure.
The facts surrounding healthcare for aging Americans are sobering. Consider:
- More than 10,000 people turn 65 in the United States every day. Given the myriad and advanced illnesses that many older adults cope with, the challenge for providers and payors in providing compassionate relief for these patients is daunting.
- Approximately 6 million people in the U.S. have cardiovascular disease. Nearly 50% of those people are older than 60. As our population ages, the resources needed to support these patients will be enormous.
- One in four physicians feel that lack of technology to accurately diagnose coronary artery disease (CAD) and peripheral artery disease (PAD) is a barrier to early and accurate diagnosis. Diagnostic delays result in avoidable suffering and costs.
- One in three healthcare leaders feel that a lack of standardization in diagnosing CAD/PAD is a barrier to accurate diagnosis.
Treating advanced disease of any kind is expensive and ultimately less effective than prevention or early intervention. We know that poorly managed chronic diseases like hypertension and diabetes are associated with, for example, heart failure and renal failure, and life-style changes coupled with proven diagnostic and therapeutic modalities can reduce the incidence and severity of these complications. Given these facts, how impactful could programs directed at these chronic diseases be in mitigating costs and human suffering? Extending the notion of prevention or preemption of complications by optimizing management to multiple disease states, could help in addressing societal goals around health equity and harnessing cost increases for our aging populations.
Moving Towards a Solution
How then can hospital administrators, providers, payors, and industry work with individual patients to deploy capabilities designed to improve clinical outcomes and medical costs? The answer is multitiered. We must:
- Address the variability in care associated with social circumstances, clinical inertia, and access/affordability
- Standardize protocols and outreach for screening high risk individuals
- Embrace personalized care with a focus on the individual characteristics and expectations of patients
- Target high-risk individuals with preventative preemptive care designed to halt disease progression and limit irreversible complications
Address care variability
Multiple factors influence the insidious variability in care delivered to populations. Social determinants require concrete and specific solutions, while excessive costs to patients need reform to limit out-of-pocket costs imposed by high premiums, deductibles, and coinsurance/copays. On the provider side, technological solutions that enhance decision making must be deployed, while incentives linking revenue to volume must be replaced by value-based payments that reward superior patient experience and clinical outcomes. A system designed to reward high-value services to patients across all ages would significantly impact the disease burden that the Centers for Medicare & Medicaid Services (CMS) encounters as patients become Medicare eligible.
Standardize screening of at-risk populations
Known modifiable risk factors are associated with significant morbidity, cost, and death. Obesity clearly leads to risk linked to hypertension, diabetes, and hyperlipidemia, which in turn leads to serious cardiovascular morbidity. Screening for these risks is critical, and yet Abbott’s Beyond Intervention research revealed that the significant variability in screening is substantially affected by knowledge deficits in provider and patient communities around prioritization, access, and available tools. Missed opportunities to introduce lifestyle and clinical modifications lead to avoidable disease and cost progression.
Retailers offer clients goods targeted to their specific needs and preferences. Healthcare does not. Without personalized consideration of patient needs, prudent advice will be ignored, trust will erode, and outcomes will deteriorate. Currently we don’t have a system that bridges a public health orientation to a level of personalization that considers the clinical, social, and financial factors impacting a patient. The volume and completeness of data needed to personalize care is available but is prodigious and effectively uninterpretable by individual physicians and care givers. We need analytic and artificial intelligence (AI) expertise to convert those data to personalized insights and interventions. This challenge underscores the opportunity for AI to play a transformative role in advancing personalized and precise care.
Target patients through pre-emptive care
The classic rubric of population health management focuses on preventative care at one end of the illness spectrum, and catastrophic case management at the other. Along that continuum is an opportunity to support high-risk patients who require interventions tied to the emergence of disease states that have developed as a result of inadequate management of modifiable risk factors. If left unchecked, these disease states will result in catastrophic events like stroke and heart or renal failure. The notion of preemptive care highlights the need to effectively use the therapeutic and diagnostic tools at our disposal to stop the progression of chronic disease to irreversible end stage consequences.