Maryland Health Care Reform Must Address Chronic Diseases

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Maryland Health Care Reform Must Address Chronic Diseases
April 8, 2009
By Gary E. Applebaum, MD
The Washington Examiner

Earlier this month, Maryland lawmakers outlined a $1.6-billion plan to overhaul the state's healthcare system. Their proposed reforms include a legal requirement that all citizens buy health insurance and new subsidies for private insurance coverage.

Expanding healthcare coverage is a laudable goal. But those without insurance lack it because of the cost. And unfortunately, these measures do nothing to address the main reason healthcare costs are exploding – the rise of chronic disease.

Unless legislators enact reforms that help folks better manage conditions like diabetes, heart disease, and mental disorders, healthcare expenses will continue to skyrocket, patients will suffer, and economic recovery will be delayed.

A study from the Milken Institute, an economic think tank, estimates that the seven most common chronic diseases cost the Maryland economy $25 billion every year in treatment costs and lost productivity. Nationally, these diseases cost $1.3 trillion annually.

Chronic diseases are the top cause of death and disability in the United States, afflicting more than half the population. With these staggering figures in mind, many key healthcare institutions -- from AARP to pharmaceutical companies -- have launched initiatives that aim to make chronic illnesses far less common.

Even if chronic diseases don't affect you personally, the tremendous costs associated with them certainly do. Whether it's higher insurance premiums, longer waiting times at hospitals, or higher taxes to pay for Medicare and Medicaid, chronic diseases affect us all.

Expanding insurance coverage alone will not solve this problem. Instead, we need a system that works to identify and prevent chronic diseases before they overtake a patient's life.

Treating a chronic disease early can save big money in the long term. Take diabetes. The Milken Institute estimates that diabetes costs the economy over $130 billion a year. In Maryland, where roughly 240,000 people suffer from diabetes, the disease's annual cost is more than $2 billion.

Prescribing diabetics the right drugs, however, can prevent a catastrophic event and reduce long-term treatment costs. According to a study in the journal Medical Care, every dollar spent on diabetes medication saves $7 in other medical costs.

There are some steps Maryland can take right now to combat chronic illness. First, Maryland needs to create a system where both patients and physicians are incentivized to prevent chronic illnesses before they develop.

In my work as a geriatric doctor, I have seen the benefits of getting seniors to take basic preventive steps like exercising regularly and eating healthy. These steps lead to a healthier --- and happier – patient population and a reduced rate of emergency medical services.

Moving closer to a healthcare model where patients are rewarded for living healthier lives and physicians are compensated based on outcomes rather than volume of service would go a long way toward reducing healthcare costs.

Second, we need to improve medical record keeping. Due to the way most doctors' offices keep their records, important information concerning a patient's health is often lost. This leads to improper diagnosis and excess costs.

Healthcare providers should switch over to electronic medical records. Doing so will help ensure against redundant or incompatible treatments and improve patient health.

I've witnessed the benefits of this switch first-hand. As the Chief Medical Officer of Erickson Retirement Communities, I led an effort to digitize 10,000 patient charts. Computerizing patient information enables us to access medical records quickly and utilize more effective treatments.

Knowing immediately which chronic diseases a patient suffers from gives doctors the information they need to provide quick treatment, which is imperative for reducing the economic strain of these diseases on the healthcare system.

The Maryland healthcare system should help us choose to live well, not simply take care of us when we do not. The healthcare reforms currently being considered by state legislators won't be very effective if chronic diseases are left unaddressed. Only by treating chronic diseases early and often can we right the ship, improve patient help and save us all a bundle.

Gary Applebaum, M.D., is a senior fellow at the Center for Medicine in the Public Interest. He is the former Executive Vice President and Chief Medical Officer of Erickson Retirement Communities.

© 2009 Center for Medicine in the Public Interest