The Chronic Disease Management Act of 2018, which was introduced in the House of Representatives on February 8, 2018, is the latest legislation to address the growing concern over chronic diseases and preventative care.
“This bill amends the Internal Revenue Code, with respect to health savings accounts (HSAs), to allow the high deductible health plans required for an HSA to provide care for chronic conditions with no deductible. The bill covers care and prescription medicines related to the treatment of medically complex chronic conditions which: (1) are substantially disabling or life threatening, (2) have a high risk of hospitalization or other significant adverse health outcomes, and (3) require specialized delivery systems across domains of care.”
Chronic diseases account for a large portion of medical and pharmacy spend in the United States, with costs rising yearly. The Chronic Disease Management Act would permit High Deductible Health Plans (HDHPs) to provide chronic disease prevention and management, as defined by the 3 criterion in the bill, prior to a plan participant meeting a deductible.
High deductibles often prevent patients from seeking the proper care they need to improve their health. But improper care also often results in the worsening of symptoms, and may even lead to the development of a second or third chronic illness.
Also included in the proposed bill is prescription coverage for those with chronic diseases at no deductible. Medication adherence can be extremely effective in improving health outcomes. Many prescriptions used to treat chronic illness are classified under the specialty pharmacy tier and are often quite expensive. Such expenses serve as a financial deterrent to patients who desperately need access to these drugs in order to improve their health. More affordable access to prescriptions, as well as medication adherence, will pave the way for improved health outcomes and reduced hospital readmission rates/doctor visits.
Research has shown that patients with chronic conditions account for 81% of hospital admissions; 91% of all prescriptions filled; and 76% of all physician visits. Access to timely care and medications would greatly improve health outcomes and drive down health care costs for both patients and employers.
While this bill has just been introduced and will likely take some time to pass both the House and the Senate, employers can currently make good use of care management organizations, which strive to decrease costs and increase positive health outcomes by providing case management and preventive care services.