Health Care Reform

Providing affordable, patient-centered access to all three levels of prevention

Reforming our health care system…

Chronic conditions represent the highest cost of health care dollars with the greatest potential of preventability

Society today relates to chronic illness through a siloed filter. Treatments and reimbursements are disease-specific, implying there are no strategic commonalities. This exclusionary filter extends to relationships between policy, provider and disease-specific consumer organizations. In reality, there are macro issues that all of these organizations (and their constituencies) have in common. Few organizations are large enough to affect change at the macro level; legislation, regulation and business practice. Thus, until recently, each organization operated on its own, without the potential for a support network.

The California Chronic Care Coalition’s (CCCC) value lies in its members’ diverse perspectives of chronic illness, harnessing their commonalities to affect policy change, at the social and legislative levels including state and federal policy.

Providing affordable, patient-centered access to all three levels of prevention is cost-effective over the course of the disease or condition by reducing or eliminating unnecessary hospitalizations, improving medication management, surgery, physician visits, nursing home placement. When prevention is not affordable, patients will forego necessary testing, prescriptions, or medical visits and their medical conditions will ultimately worsen. Structural incentives and design of the current health care system are not well-suited for prevention and management of chronic conditions. We can do better.

The CCCC proposes restructuring health care systems to:

  1. Include in all benefit plan designs coverage for primary and preventive care services, including prescription drugs, combined with all levels that promote prevention for management of chronic conditions.
  2. Develop, with assistance of public/private and community partnerships, the promotion of wellness and chronic disease prevention, utilizing early intervention tools and management models incorporated throughout private and public health care systems.
  3. Promote a culture of health care productivity through the use of multi-disciplinary, primary care medical home models, medication therapy management, and patient-centered access to all three levels of prevention (primary, secondary, tertiary).
  4. Promotion of healthy lifestyles in workplaces, schools and communities by establishing a collaborative between business, health plans, faith-based, not-for-profit health organizations, consumer groups, education, including school health centers, government and other community entities to sustain changes in health behaviors.
  5. Include provisions to improve the quality and availability of health information technology (HIT) throughout the health care system.
  6. Ensure evaluation, education and coordination for the management of chronic conditions is included in all prevention and wellness programs.
  7. Take such other actions as may be necessary to ensure that all health plans, primary care providers and pharmacists are informed and incentivized to implement these recommendations.