A better approach to preventing chronic conditions

More than 3 in 4 Americans live with a chronic health condition — many of them preventable.

A major reason this crisis continues is that our U.S. health care system focuses more on treatment than on prevention.

At Kaiser Permanente, we take a different approach.

We work to keep people healthy, not just treat them when they’re sick.

There are key steps policymakers can take to help more people stay healthy and reduce the cost of chronic conditions in our country.

Chronic conditions harm people, families, and our economy. About 1 in 4 deaths in this country every year are from heart disease or stroke — both tied to chronic conditions.

Some of the most costly and prevalent chronic conditions in the U.S. include: hypertension, high cholesterol, coronary heart disease, chronic obstructive pulmonary disease, asthma, chronic kidney disease, diabetes, and cancer.

Even when it is not fatal, a chronic condition affects a person’s daily life, work, and long-term well-being.

Chronic conditions are making us sick, and they are costing us. America spends $4.9 trillion on health care each year, and 90% of that goes to treating chronic conditions.

Our nation spends over $400 billion every year treating Type 2 diabetes alone. That’s about the same as the budget for the Department of Veterans Affairs. Yet, Type 2 diabetes is preventable.

That’s why prevention should be a top national priority.

At Kaiser Permanente we believe prevention comes first. We want to stop chronic conditions before they start. And when a person already has an ongoing condition, we work to keep it from getting worse.

We do this through our unique approach to value-based care.

Kaiser Permanente’s distinct brand of value-based care is:

A health care delivery and financing model that improves health outcomes and increases access to affordable care in the community through evidence-based care, a commitment to equity, simplicity, and aligned incentives across the system.

The evidence is clear: Prevention works.

Example: Preventing and managing Type 2 diabetes at Kaiser Permanente

• We screen all adult members. If we see signs of prediabetes, we check for risk factors that show the condition may be progressing.
  
  
• We offer programs that support healthy living. Members can join no- or low-cost programs for exercise and nutrition. They can also take diabetes education classes and receive ongoing coaching.
  
  
• We address social needs. Our care teams ask about food and housing needs because ongoing conditions are harder to manage without these basics. We also connect members to resources that support housing, healthy food, and other resources in the community.
  
  
• We match members who have diabetes to a trained care manager. Care managers help monitor blood sugar, manage medicine, and coordinate care with physicians, dietitians, and health educators.
  
  
• We use technology to support everyday care. Our Kaiser Permanente app provides reminders for medication and helps patients manage their care.

As a result, our members with diabetes are more likely to have their blood sugar under control compared to patients nationwide.

This value-based approach extends far beyond diabetes. That’s why our members are 33% less likely to die early due to heart disease and 20% less likely to die early from cancer than others in their communities.

By supporting this approach to value-based care policymakers can help all Americans lead healthier lives. Specific actions they take can include:

• Paying for the health outcomes we want. If we want health care systems to invest in prevention, we need to reward good health outcomes.
  
  
• Supporting patients’ social needs. A core part of prevention is attending to patients’ social needs, like housing and food security. We’ve empowered community health workers to help patients meet these needs. This has significantly reduced hospitalizations for our members by keeping people healthier.
  
  
• Ensuring health coverage remains accessible and affordable. People with health insurance are far more likely to receive regular medical care. Routine care includes preventive screenings and blood sugar checks that can enable early diabetes detection. As a result, people with insurance are 55% less likely to have undiagnosed prediabetes or diabetes than people without health insurance.
  
  
• Supporting collaboration between health systems and public health is critical. Partnership is key when we focus on preventive care and address social health needs. If we work together, we can reach the goal set by the AHIP task force: Reduce chronic disease prevalence by 10 percentage points by 2035.
  
  

We must accelerate the shift to value-based care to reduce chronic disease in our country. We can do this in part by supporting prevention and addressing the root causes of poor health. This includes tackling social needs like housing and food security with the same rigor we apply to physical health.

With the right support from our policy leaders, we can help ensure fewer Americans live with the burden of chronic conditions.