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Whereas all healthcare providers play a part in addressing chronic disease, primary care focuses ...
[+] mainly on preventing and managing these serious health issues. In the months leading up to the 2024 presidential election, Americans voiced concerns over the unaffordability of healthcare. In a Kaiser Family Foundation survey , voters said they worried most about the cost of medical care—more than groceries, gas, rent or any other expense.
With tens of millions of U.S. patients and thousands of employers struggling to afford rising premiums and drug prices newly elected officials now face increasing pressure to address the medical spending crisis without compromising the nation’s health.
But what’s driving the relentless surge in healthcare spending, and how can we contain it? How Chronic Disease Created A Spending Frenzy While many factors contribute to rising medical costs, the biggest driver—by far—is the explosion in chronic disease . Long-term illnesses like diabetes, high blood pressure and heart failure now affect six in 10 American adults— double the proportion from just two decades ago. These ailments are the primary culprits behind heart attacks, strokes and kidney failure, and they are estimated to account for 70% to 90% of all healthcare spending.
Google’s Gmail Decision—Why You Need A New Email Address Don’t Hold Down The Ctrl Key—New Warning As Cyber Attacks Confirmed Trump’s Cabinet: Here’s Who Will Fill Key Roles—FCC’s Brendan Carr, Karoline Leavitt And More It doesn’t have to be this way. According to the CDC, better prevention and management of chronic disease could reduce life-threatening complications by 30-50%. Even with conservative estimates, cutting these events in half could save the United States $1.
5 trillion annually—more than a quarter of the nation’s total healthcare expenditures . Where Should We Begin? Whereas all healthcare providers play a part in addressing chronic disease, primary care focuses mainly on preventing and managing these serious health issues. Studies conclude that effective primary care reduces hospitalizations, improves patient health and extends life expectancy more than other specialties.
And yet, the U.S. allocates just 5 cents of every healthcare dollar to primary care.
The rest goes toward costly interventions, efforts to reverse medical problems that could have been avoided in the first place. At first glance, the easiest solution would be to increase primary care dollars. But here’s the surprising truth: multiple recent studies show that simply allocating more money to primary care fails to reduce overall healthcare costs or improve clinical outcomes .
Contrary to what we might assume, communities with higher primary care spending report only modest gains in patient satisfaction and no significant reduction in total costs, emergency visits or hospitalizations. The reason? Most primary care providers still operate in a fee-for-service system that rewards them for treating medical problems, not preventing them. Seeing a patient twice as often after a heart attack, for instance, does little to improve health outcomes or save lives.
True impact comes from managing blood lipids, glucose and blood pressure long before an acute event occurs. A New Model: Enhanced Primary Care To combat healthcare’s rising costs, we need a new plan—one that ensures additional funding for primary care is used effectively. The following two-step approach to enhanced primary care enables doctors in both large healthcare systems and independent practices to more effectively manage chronic disease and lower medical spending.
Step One: Reward Better Health Outcomes Nearly half of Americans with hypertension—a major risk factor for stroke—do not have their condition under control. Diabetes and prediabetes, affecting one in three Americans, are managed even less effectively. These numbers reveal a critical failure in U.
S. healthcare: poor management of chronic diseases. Enhanced primary care aims to address this by preventing these medical conditions and rewarding improvements in specific clinical measures.
This plan’s financial approach builds on the success of the Medicare Shared Savings Program, which incentivizes large healthcare groups—known as accountable care organizations (ACOs)—to achieve superior clinical outcomes at a lower cost. Last year alone, ACOs saved Medicare $1.8 billion while achieving better patient outcomes than doctors in traditional Medicare programs.
Patients enrolled in these MSSPs experienced improved diabetes and blood pressure control, fewer emergency room visits and reduced hospital readmissions. These results demonstrate that well-designed incentives can effectively drive meaningful improvements in healthcare performance. Applying the ACO model, universally, would require a large number of doctors to form a group, appoint skilled leaders and accept the financial risk that their income would decrease if costs increase.
For small or solo practices without substantial financial reserves, this risk is prohibitive. Here’s how it would work: Step Two: Turn Potential Into Practice With a sound financial plan in place, the next step is to help clinicians successfully implement it. Today’s technologies can help physicians more effectively manage chronic diseases than ever before.
Patients who choose to participate in the program will receive wearable monitors connected to generative AI tools. These devices will allow patients to track their health in real time and receive immediate feedback on managing their conditions. They will know, for instance, when a medication adjustment is needed.
Free educational programs would also help patients learn to use these tools and make lifestyle changes—such as improving diet, exercise, and stress management—that can significantly impact their health. For clinicians, this approach will transform healthcare from episodic to continuous care. Instead of only assessing patients during office visits four or five times a year—leaving over 360 days with minimal oversight—doctors could continuously monitor their patients’ health using technology.
Consider this scenario: When a doctor prescribes blood pressure medication to a patient with hypertension, the patient’s wearable device would collect ongoing data while a GenAI tool uses that information to determine by the end of a month if the drug is having the intended effect. If not, the clinician would be notified and could alter the dosage or prescribe a different medication. Similarly, analysis of daily blood glucose levels would help physicians know when insulin doses need to be adjusted.
Generative AI tools would monitor the weight and degree of ankle swelling in patients with heart failure to detect early signs of trouble, allowing doctors to intervene sooner, preventing the need for hospitalization that otherwise would ensue. The Future Of Enhanced Primary Care The U.S.
healthcare system is at a crossroads. We can keep spending more and more to treat medical problems after they arise, or we can invest in a model of enhanced primary care that empowers doctors to prevent chronic diseases and their complications in the first place, improving patient health and lowering costs. If, over the next six years, this program simply cuts the rate of healthcare inflation in half, it would save the nation over $2 trillion compared to current predictions.
Preventing chronic diseases (and avoiding 30-50% of avoidable heart attacks, strokes, cancers and kidney failures) would bring about real, measurable improvements in people’s health and national financial stability—a two-part prescription for success. This program is structured so that, if it does not achieve the intended improvements, the government and private insurers would pay little. However, if the program succeeds, the benefits will be tremendous for patients, payers and primary care providers alike.
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