Chronic diseases are health conditions that persist over long periods of time. The Center for Disease Controls and Protection (CDC) designates a condition as being chronic if it lasts for longer than one year. Examples of chronic disease include diabetes, heart disease, and Lyme disease.
Chronic diseases “are among the most prevalent and costly health conditions in the United States” (1). Approximately 45% of all Americans suffer from a chronic disease, while a quarter of all adults experience more than one chronic condition. The highest prevalence of chronic conditions occurs in the mid-southeastern region of the US, while the lowest prevalence occurs in the Pacific Northwest (2). These differences are accounted for in large part by income, education, access to healthcare, and other demographic factors. Even though chronic disease is more prevelant in adults, it can occur in children as well. Upwards of 8% of US children experience chronic conditions, driven mostly by obesity, mental health issues, and asthma (ibid).
The toll these diseases take on health outcomes is immense. Chronic diseases are “the leading causes of death and disability in the United States” (3), and the NCBI reports that “more than two thirds of all deaths are caused by one or more of these five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes” (1). This means that chronic diseases are killing almost 2 million US adults each year, and this problem is expected to get worse as previous generations of Americans continue to age. By 2060, the number of adults in the US over age 65 is expected to be nearly 100 million.
The US has a chronic conditions crisis. Interestingly, the severity of this crisis is unique to the US when compared with other high income countries. US adults are the most obese of any high income country, and consequently have the highest rates of diabetes. US adults also have uncommonly high rates of heart disease when compared with European adults. In general, when compared to other OECD countries, the US has the highest chronic disease burden by a large margin - 28% of US adults have chronic conditions, compared to the OECD average of 17.5% (4). This translates into disparate life expectancies among these countries - “since 1980, the United States has had the first or second lowest probability of surviving to age 50 among the 17 peer countries” (5).
These problems did not arise overnight. Throughout the 20th century, as infectious diseases became easier to treat, chronic disease incidence rose to become the leading cause of death in the US. This pattern continued well into the 21st century - in 1996, only 8% of US adults had 5 or more chronic conditions; as of 2015, that number had jumped up to 18% (6). Between the years of 2003 and 2015 alone, there was a 14.1% increase in rates of hypertension (ibid). That averages out to an increase of 1.2% per year during that same time frame. Right now, it is estimated that the number of individuals with chronic conditions will increase by 5 to 7 million people each year (2).
Why is the US facing this crisis? According to the CDC, these diseases are based largely on four risk factors - tobacco use, alcohol use, level of physician activity, and diet (3). Some of the rise in chronic conditions is accounted for by an aging population. However, the rest is accounted for by lifestyle changes that relate to these risk factors. Although tobacco and alcohol use in the US has decreased over time, the average adult has become more sedentary. This, coupled with poor dietary choices, has led to higher rates of obesity, which come with a whole slew of chronic health complications. Between 1960 and 2016, obesity among US adults rose by over 25% (7).
These chronic conditions come with a high price tag - chronic disease accounts for roughly $3.8 trillion in annual costs in the US alone (8). That is roughly one fifth of the entire annual US GDP. This $3.8 trillion includes direct costs (surgeries, medications, etc.) as well as indirect costs (losses in productivity). Annual average healthcare costs for someone with chronic conditions are $6,032, “approximately 5 times that of a person without a chronic disease” (2). The most expensive chronic disease in the US is diabetes, which alone accounts for nearly $200 billion in direct healthcare costs annually (9).
Such daunting numbers beg the question, “what can we do?” As healthcare experts consider solutions, many have turned their attention towards preventative care. Preventative care addresses conditions before they develop via screenings, tests, and education about these diseases. In the current Fee For Service (FFS) model of healthcare, providers are reimbursed based on the quantity of services they administer. This means that preventative care is given little attention and patients are generally treated after they have become ill. By comparison, in the Value Based Care (VBC) model of healthcare providers are reimbursed based on health outcomes and quality measures. Consequently, providers in VBC face far greater incentives to engage in preventative care and address chronic conditions before they develop.
The advantages VBC has in preventing chronic illness has been a contributing factor in the shift away from the FFS model. Under the direction of the Centers for Medicare and Medicaid Services (CMS), collaborative VBC organizations such as Accountable Care Organizations and Direct Contracting Entities have led the charge in this transition. However, these organizations cannot be successful if they do not balance their costs adequately. This means they must receive accurate reimbursements for their patient population, which can only be done through accurate risk adjustment. It is crucial, then, for these organizations to adopt tools that make the risk adjustment process easier for their providers. One such tool, Juxly Vault, gives providers a way to quickly and accurately risk adjust their patients. By making the risk adjustment process easier with a tool that sits directly in the EHR, providers are able to receive accurate reimbursements to cover the cost of care for their patients.
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Juxly is a FHIR-based SaaS healthcare technology company based in Springfield, Missouri. Founded in 2012 by Dr. Howard Follis, Juxly aims to bridge the payer-provider collaboration gap by hosting reliable patient data in a straightforward interface. For more information, visit juxly.com.
- Raghupathi, Wullianallur, and Viju Raghupathi. “An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach.” International Journal of Environmental Research and Public Health, MDPI, 1 Mar. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5876976/.
- Hayes, Tara O'Neill. “Chronic Disease in the United States: A Worsening Health and Economic Crisis.” AAF, American Action Forum, 10 Sept. 2020, www.americanactionforum.org/research/chronic-disease-in-the-united-states-a-worsening-health-and-economic-crisis/.
- “About Chronic Diseases.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 Apr. 2021, www.cdc.gov/chronicdisease/about/index.htm.
- Tikkanen, Roosa, and Melinda Abrams. “U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?” The Commonwealth Fund, The Commonwealth Fund, 30 Jan. 2020, www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019.
- National Research Council, and Institute of Medicine. U.S. Health in International Perspective: Shorter Lives, Poorer Health., U.S. National Library of Medicine, 2013, www.ncbi.nlm.nih.gov/books/NBK154469/.
- Angell, Marcia, et al. “REDUCING THE BURDEN OF CHRONIC DISEASE.” The Aspen Institute, The Aspen Institute Health Strategy Group, 2019, www.aspeninstitute.org/wp-content/uploads/2019/02/AHSG-Chronic-Disease-Report-2019.pdf.
- Holman, Halsted R. “The Relation of the Chronic Disease Epidemic to the Health Care Crisis.” NCBI, ACR Open Rheumatology, 19 Feb. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7077778/.
- Reed, Tina. “Report: U.S. Economic Burden of Chronic Diseases Tops $3.8 Trillion-and Expected to Double.” FierceHealthcare, Fierce Healthcare, 16 Apr. 2019, www.fiercehealthcare.com/hospitals-health-systems/fitch-rain#:~:text=The%20U.S.%20economic%20burden%20of,a%20unit%20of%20Fitch%20Group.
- Walters, Hugh, and Marlon Graf. “THE COSTS OF CHRONIC DISEASE IN THE U.S.” Milken Institute, Milken Institute, Aug. 2018, milkeninstitute.org/sites/default/files/reports-pdf/ChronicDiseases-HighRes-FINAL.pdf.