The true cost of chronic disease and why we need to act now

According to the Centers for Disease Control and Prevention (CDC), almost half of adult Americans, 133 million to be exact, suffer from a chronic disease [1]. Treating people with chronic diseases accounts for 86% of the US’s total healthcare costs, and chronic disease is responsible for 7 of 10 deaths in the US each year [1]. Chronic diseases have become the main cause of lower work productivity, absences from the workplace, and the markedly dropping quality of Americans’ lives over the past 50 years.

Before the Affordable Care Act, the healthcare system was spending $383,000 per patient [1]. As chronic disease continues to claim more casualties, the Act has resulted in little improvement because the cost of caring for the chronically ill continues to rise and insurance premiums continue to inflate all while insurers, in fact, begin to withdraw from the Affordable Care Act altogether [2]. Even more devastating than the monetary and lifestyle damage is the revelation that:

“Our children are the first generation in decades predicted to have a reduced lifespan and reduced health due to obesity and chronic disease” [2]

It is safe to say that the continuous sprawl of chronic disease isn’t just becoming a crisis; it is a crisis. It is a crisis for people currently diagnosed with chronic illness, it is a crisis to the healthcare system, and, even if they don’t know it yet, it is a crisis to the next generation who will not only suffer from chronic disease but will have to deal with the exponential growth of the economic catastrophe of overall declining health and, as a result, a financially burdened healthcare system. Something has to change. But what?

The greatest increase in chronic illness and disability over the last thirty years has come from the shift in people’s everyday lifestyle—poor diet, inactivity, smoking and excessive alcohol consumption. This means that many of the risk factors contributing to chronic illnesses that plague the US, such as diabetes and cardiovascular (CVD) disease, are preventable. In 2014, the United States Preventive Services Task Force recommended that overweight adults who are at risk for CVD be prescribed “intensive behavioral counseling interventions to promote a lifestyle shift that would include a healthful diet and physical activity” [3]. The challenge here is how to put this recommendation into action and actually deliver these preventative strategies in a cost-effective fashion.

In their June 2016 study Chronic Disease is Healthcare’s Rising-Risk, Felipe Lobelo, Phil Trotter, and Ashley John Heather discussed the “newly developed ability to sort a defined population into clearly labeled buckets – (well; low-risk; rising-risk; high-risk)” and how this is a foundational step for developing the change in healthcare’s framework that is necessary to mitigate the continually rising cost of chronic disease [4]. In particular, Lobelo et al. pointed out what they call “the care gap” within the rising risk population. This gap generally represents 20-30% of the population and can account for a higher total healthcare expenditure [4]. This population requires intervention care; they aren’t sick enough for admittance to hospital but they are beyond preventative care. This is where advances in medical technology can step in. There is great potential for wearable clinical grade technology that can be trusted and used by physicians, that can offer relevant feedback to the patient, and that can facilitate distance communication between physician and patient in a way that offers consistent and constant care to this population of patients.

Preventative medicine and strategies are quickly becoming the new goal in healthcare. Prevention, as opposed to reaction, can create a financially sustainable healthcare system under the new Affordable Care Act. A 2011 study showed that for each 10% increase in local public health spending, deaths from cardiovascular disease dropped by 3.2% [5]. This represents increased spending of $312,274 at the local health services level but, by contrast, to achieve the same reduction in CVD mortality through clinical care interventions would require over $5.5 million (that’s more than 27 times the public health investment) [5]. Indeed, community-based disease prevention programs could yield net savings of almost $18 B annually in US healthcare costs alone—not accounting for absenteeism and lost productivity—and so preventative care actually offers a potentially high return on investment for the healthcare system. Not only is prevention a good strategy financially but it is a movement that is both financially and holistically enticing to the healthcare system, healthcare providers, and patients because, let’s be honest, they simply want to avoid chronic illness altogether.

This brings us to the cost to the patient that underlies a chronic illness diagnosis. Despite Medicare in the US, the patient must take on a significant financial burden even if they are otherwise insured. For example, patients with diabetes often have out-of-pocket expenses of upwards of $1500 per month [6]. To compound the cost, those who suffer from chronic illnesses often find themselves too sick or unable to work and they enter into a vicious cycle of balancing cost with health; the pressure to change their lifestyle; and their everyday family and social life.

The increase in chronic disease diagnoses has the healthcare system bearing witness to a paradigm shift as individuals strive for normalcy by avoiding hospital care in favor of home healthcare and preventative options. People want to take an active role in managing their own health and be a part of the conversation. They want support and daily reinforcement that will help them prevent, manage, and treat chronic diseases in the comfort of their own homes. This desire has led to the development and introduction of portable and medical wearables. Mobile, or remote, medical grade devices can empower patients by giving them the tools they need to:

1. Understand and engage with their own health.
2. Adhere to their lifestyle change challenges by offering them constant relevant feedback.
3. Transform their previous subordinate relationship with their physician to a partnership that is engaged in working towards the same health goals.

So how do we go about encouraging preventative care? Well, patients bring those medical-grade devices into the home before they become another chronic disease statistic; in other words, before they become long-term patients. Since wearable fitness devices, such as the FitBit, began to appear on the market, it has become apparent that young people, healthy or not, want to become involved in their health; they want to build a healthy future for themselves, their community, and their own children. Getting people to participate in preventative health strategies before they become chronic disease patients will not only help to unburden the healthcare system, but in their proactivity and in the data that their use of medical wearables will provide, today’s concerned parents and grandparents can help to ensure the wellness of future generations.