Refocusing on Health Care Opportunities That Can Make a Real Impact
By Kenneth Thorpe, Chairman, The Partnership to Fight Chronic Disease (original on Huffington Post)
Now that the campaign smoke has cleared, we can expect a refocusing of the nation’s arguments from the question of who will get elected to what will be done about hot-button issues like health care. Expect pitched debates to begin imminently on battlegrounds including, but certainly not limited to, Medicare reform, revisiting the Affordable Care Act, the Independent Payment Advisory Board and medical device taxes.
The fact is though, the more time policymakers spend wrangling over these issues on which there are clear, and not easily bridged partisan divides, the more we’re missing the fundamental steps that can and must be taken if we’re going to contain health care costs without compromising the quality or accessibility of care.
It begins with acknowledging what we don’t know about improving health care, and what we need to do to broaden our knowledge base. And it has to do with the more than 75 million Americans who have not one, but multiple chronic illnesses. Our health care system in this country is quite adept at treating people who have a single disease. We don’t have an effective set of best practices, or an essential foundation of research, to know how to take care of those who are coping with more than one condition.
We have the opportunity to improve this situation, and it should begin with the Patient-Centered Outcomes Research Institute (PCORI.org), the entity created by Congress to evaluate different prevention and treatment therapies and offer scientifically-supported evidence on how to provide patients with the most effective care.
PCORI is in the process of collecting public input to help establish its national research agenda. Here is, as one would expect, a great deal of competition among advocates for various health causes to attract PCORI’s attention and resources. A compelling case can be made that PCORI should establish, as one of its research priorities, how we can enhance care for the millions of people coping with multiple chronic conditions within a medical system geared almost entirely around single-illness care.
There is both a human and an economic need to build this research base. When tens of millions of Americans — including one of every 15 children — has multiple conditions ranging from diabetes to heart disease to depression, policymakers cannot ignore the societal toll. And it can’t go unnoticed that two of every three dollars we spend in the U.S. health care system is devoted to the 27 percent of Americans with multiple chronic conditions.
Yet, despite the number of people affected and costs involved, there is a notable lack of research on effectively preventing and managing multiple chronic conditions. This disconnect between a growing problem and the lack of evidence-based solutions leaves patients, their family caregivers and health care providers without sufficient information to make critical health care decisions.
The nation’s leading health care voices and decision-makers should be weighing in on this issue, instead of using all their energies fighting the same political battles that have no imminent resolution on the horizon. There is no shortage of issues that PCORI could decide to take on. Yet, it is difficult to envision a patient-centered research agenda that fails to focus on improving health care quality and effectiveness for those who require the most health services. Likewise, it is unfathomable that any health-focused entity would try to develop a strategy for constraining health care cost growth without attacking the major cost driver that is chronic disease.
Sometimes the most powerful solutions to the most complex problems are right in front of us. And given the sheer number of people who have multiple chronic diseases, it’s not an overstatement to say that key components in improving our health care system are standing right in front of us every day.
About the Author
Kenneth Thorpe, Ph.D., is Chairman of the Partnership to Fight Chronic Disease (PFCD) and a Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management in the Rollins School of Public Health at Emory University, Atlanta, Georgia. He also co-directs the Emory Center on Health Outcomes and Quality.
Dr. Thorpe was Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services from 1993 to 1995. In this capacity, he coordinated all financial estimates and program impacts of President Clinton’s health care reform proposals for the White House. He also directed the administration’s estimation efforts in dealing with Congressional health care reform proposals during the 103rd and 104th sessions of Congress. (full bio)