Improve the Health of Individuals and Communities

One of the most pressing opportunities to reduce health care spending is to mitigate the need for high-cost interventions by preventing the onset of illness and injury. The U.S. has some of the highest rates of obesity, diabetes, kidney disease, liver disease, mental health conditions and multimorbidity in the developed world. Chronic disease management requires frequent — and often redundant — testing and imaging, medication titration, and episodic, and often very costly, acute interventions. In addition, medical and pharmaceutical advances allow many individuals to survive conditions that historically would have been fatal, often resulting in greater care needs over longer periods, including near the very end of life. While the root causes of illness and injury often are outside the health care ecosystem, providers, health plans, drug manufacturers and individuals play an important role in ensuring patients and communities achieve their best health.

Actions to improve overall health and affordability of care include:

• Increase access to primary care and prevention. Increase capacity for preventive services and other primary care, including maternal care and mental health, by investing in the workforce pipeline. Build new access points through innovative partnerships among providers, purchasers and communities; and broaden adoption of telehealth and AI tools to facilitate access.
• Improve transparency of pricing information. Improve access to reliable, upfront pricing information for services considered to be “shoppable;” simplify patient cost-sharing; and enhance cross-industry engagement in ensuring patients understand their benefit structure and available financial assistance across their care providers.
• Revise the tax code to protect patients from catastrophic costs. Explore changes to the tax code to protect individuals from catastrophic health care costs or bankruptcy due to illness or injury; options could include a “catastrophic health cost credit,” a permanent federal reinsurance pool for high-cost claims, modernizing premium tax credits or transforming health savings accounts.
• Modify requirements for high-deductible health plans. Reduce patients’ financial barriers to care by means-testing enrollment in high-deductible health plans to ensure that high copays and deductibles do not deter accessing care.
• Engage individuals in their health and health care. Support the use of “wearables,” EHR-integrated engagement platforms, AI chatbots, analytics and other new technologies to engage patients through messages, adherence prompts and lifestyle tips at the right time and via the right medium based on patient condition and risk; create incentives for individuals to maintain good health.