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The chronic cost of chronic diseases
10/18/2007
By Ranch Kimball, The Boston Globe CHRONIC HEALTH conditions such as cancer, mental illness, heart disease, stroke, and diabetes extract a terrible human cost. According to figures released yesterday by the Milken Institute, Massachusetts has one of the highest rates nationwide for chronic illness. While the state's healthcare system is the best worldwide in helping acutely sick people, it is poorly organized to prevent chronic disease or to intervene early enough to prevent complications. Chronic disease requires multiple healthcare interactions every year to ensure small but steady advances that can prolong life. The impact of chronic illness takes a toll on everyone it touches: on a personal level, and on an economic level as the hidden and rising costs to treat chronic diseases strap organizations that must balance healthcare costs against other funding priorities. The unrelenting growth of chronic disease not only threatens the health and well-being of citizens but also the Massachusetts economy. All sectors of the Commonwealth, from health providers and payers, to government, businesses, and individuals must shift the focus of healthcare to preventing chronic illnesses and related complications. Only then can we truly improve quality of life and reduce the staggering economic cost. Consider these facts: More than half of all Americans have at least one chronic illness, and despite advances in treatment and management, the rates have risen significantly. The Milken study pegs the total cost of these diseases on the national economy at $1.3 trillion annually for treatment and lost productivity, including $34 billion in Massachusetts. A recent study by the New England Healthcare Institute indicates that while Massachusetts has made progress in reducing the impact of major diseases over the past 10 years, rising chronic disease rates could offset that progress. Obesity, directly linked to many chronic illnesses including diabetes, is increasing among older workers and minority workers who will make up more of the state's workforce in the years ahead. Statistics on diabetes are more daunting: More than 6 percent of Massachusetts residents had diabetes in 2005, a 39 percent increase over 1996, according to the NEHI study. Three in five people with diabetes have at least one complication; one in three has two complications; and one in 13 has five complications, which can range from heart attack and stroke to blindness and kidney failure. Fifty percent of people with Type 2 diabetes have complications by the time they are diagnosed with the disease. Diabetes costs the United States at least $132 billion a year - or one of every 10 healthcare dollars. These numbers are not sustainable. Most important, by shifting our focus to disease prevention and management, these numbers are largely avoidable. To illustrate the impact, look no further than patients with diabetes. With a family history of diabetes and overweight since his teens, "Roberto" is an electrician who didn't see his physician regularly. At age 41, he had a heart attack. While at the hospital, he was diagnosed with diabetes, high blood pressure, and elevated fats in the blood, and was referred to Joslin. Despite the excellent care he receives, he faces a costly lifelong struggle with these chronic diseases. "Barbara," who has lived for more than 50 years with diabetes, with minimum complications, is another poignant example. She visits her doctors regularly and follows recommended treatment plans, including maintaining a healthy body weight, exercising regularly, and keeping important health measures in check. This model of care demands a proactive approach to preventative patient health, and it works, but it's not built into the Massachusetts healthcare system - roughly 40 cents for every dollar Joslin spends on patient care is not reimbursed by insurance. At Joslin, our team-based model of patient care focuses on prevention and treatment. We aggressively screen for complications early and actively treat to prevent them, which lowers our morbidity and rates of diabetes-related blindness, kidney disease, cardiovascular disease, and amputations. Our model is proof that with aggressive focus on prevention and management, complications of diabetes can be prevented or reversed. To help ensure all residents with diabetes reap these benefits, we and others brought our best practices to the Department of Public Health's Diabetes Prevention and Control Program, which will issue updated statewide diabetes clinical care guidelines this week. The state's healthcare community saw success when we applied ourselves collectively to issues such as tobacco use. More recently, the 2006 health insurance reforms showcase what we can do together. Reducing chronic disease must be our next collective priority. Much more needs to be done about the "secret" of chronic illness as the driver behind the rising cost of healthcare and the burden it places on our citizens and on our economy. No one likes secrets - so let's work together to bring out in the open the impact of chronic disease and the importance of prevention. Just think of what America and Massachusetts could do with $1.3 trillion in newly found savings. Ranch Kimball is president and chief executive of Boston-based Joslin Diabetes Center and former Massachusetts secretary of economic development under Governor Mitt Romney.
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