Insurance, healthy behavior are key to reducing cost of chronic disease

HOUSTON — Chronic disease is a modern plague: Nearly half of adults have either diabetes or pre-diabetes, one in three suffers from high blood pressure and more than two-thirds are overweight or obese. These conditions not only maim and kill; they cost the nation hundreds of billions of dollars.

Panelists at a forum sponsored here last week by USA TODAY and Cigna agreed that both access to health insurance coverage and healthy behaviors are key to bringing those costs down. The experts stressed that cost-control measures are especially needed in an era of health reform as the nation faces an aging population.

“There are so many determinants of health, but one of the really important ones is that everybody has access to health care, and in this country having health insurance is really the major avenue to having that access,” Katherine Hempstead, director of the insurance coverage team at the Robert Wood Johnson Foundation, said at the forum, called “Building Healthier Communities."

A study out Tuesday by Cigna underscores these costs and shows programs to control chronic disease can go a long way toward easing the financial burden.

Cigna’s study looked at 200,000 customers in employer-sponsored plans between 2012 and 2014 and found that people with chronic conditions caused by unhealthy weight, high blood pressure, high cholesterol and high blood sugar had much higher health care expenses. The total cost for a customer with no chronic conditions was $3,024 a year, with the customer paying an average of $2,204 out-of-pocket.  The total cost for someone with two or more chronic conditions was $11,940 a year, with the customer paying $3,500 out-of-pocket. Overall, chronic conditions contributed to nearly half of all medical expenses in 2013, the study said.

These costs can be reduced, however, if patients keep their chronic diseases in check, the study says. It cites a Cigna program that connects patients with chronic diseases like diabetes or asthma to “health advocates” who help them change unhealthy behaviors contributing to their conditions — which saved $324 to $396 a person in medical costs and drove inpatient hospital admissions down by at least 7%.

But not all patients have access to such programs — or even to health insurance. And their diseases may fester unchecked, driving up costs for everyone.

Hempstead noted that close to 9 million Americans have gained health insurance since 2013, many through Medicaid and the new insurance exchanges made available under the Affordable Care Act. But she also pointed out that many states, including Texas, haven't expanded Medicaid to the poorest of the poor.

Insurance, healthy behavior are key to reducing cost of chronic disease

A new study released by RWJF found 73% of 831 respondents considered having health insurance very important, while 23% considered it somewhat important.

Nearly half of the population is insured through employers, which have been trying to improve the health of their workforces through wellness programs designed to prevent and control chronic disease — and keep costs down. Gretchen Young, senior vice president for health policy at the ERISA Industry Committee, which represents America’s largest employers, gave the example of a program that encourages employees to get together and walk around the block but penalizes those who don’t with higher premiums.

“Interestingly, (experts) found that penalties are much more effective than rewards,” she said. “You’ll do a lot more to avoid 10 dollars than you will to get 10.”

Another way businesses control health care costs, Young said, is to offer more high-deductible health plans coupled with health savings accounts, which require employees to pay more out-of-pocket. A Mercer study showed that 2014 saw the largest one-year increase in enrollment in high deductible plans, from 18% to 23% of all covered employees. Meanwhile, the size of the average deductible more than doubled in eight years, from $584 to $1,217 for individual coverage.

“The point is…if employees have skin in the game, then they will make better medical choices,” such as choosing generic medicines when possible, Young said, adding that there’s also a fear that some may delay care too long.

Cigna CEO David Cordani said workplaces can be just as effective as geographically based communities at encouraging healthy behavior, because they too have their own culture, peer pressure, and the ability to communicate with many people at once.

Jose Pagan, director of the New York Academy of Medicine’s Center for Health Innovation, said insurance is only part of the solution to controlling chronic disease. “It’s also about behavioral change,” he said. “It’s about using the resources of the community effectively to improve…health.”

Pagan said it’s also important for employers and health-oriented community organizations to have a neutral place, like the academy where he works, to gather and share ideas. One inspiring idea, he said, is the YMCA’s diabetes prevention program, which provides long-term lifestyle coaching to help people stave off diabetes by increasing exercise, eating healthier and losing weight.

Preventing chronic disease, he said, is “a way of taking a dollar and making it last longer when it comes to improving health.”