Chronic conditions lead to large health care costs and loss of productivity.
Those with multiple chronic conditions make up 30% of Medicaid beneficiaries and 83% of spending.
Use of preventive services may increase with monetary and logistic support, such as providing transportation.
Chronic conditions are illnesses that last one year or more and require medical care or limit daily activities (Centers for Disease Control and Prevention (CDC) 2024a). Most chronic conditions are caused by smoking, excessive alcohol use, lack of exercise, and poor nutrition (CDC 2024a). The most common chronic conditions are obesity, depression, high blood pressure, and high cholesterol (Watson et al. 2022).
In the US, 1 in 3 deaths is due to heart disease or stroke (CDC 2024b). Heart disease and stroke cost the healthcare system $245 billion per year and leads to $168 billion in lost productivity each year. Nationwide, 38 million people have diabetes, and 98 million adults have pre-diabetes, leading to a combined $413 billion in losses from healthcare costs and lost productivity. About 20% of children and 42% of adults are obese, costing the healthcare system $173 billion per year.
In MO, 19% of adults smoke cigarettes, 32% and 35% are overweight and obese relatively, and 12% have diabetes (MO Department of Health and Senior Services 2020).
Prevention steps for chronic conditions include (CDC 2024c):
For the entire U.S., about 83% of Medicaid spending is on beneficiaries with multiple chronic conditions (Agency for Healthcare Research and Quality (AHRQ) 2014). Among adult Medicare beneficiaries, 7 in 10 are overweight or obese and 1 in 3 smoke tobacco (Ku et al. 2017). About 14.4 million (30%) Medicaid beneficiaries have a chronic illness (AHRQ 2014). Seniors and individuals with disabilities (including chronic conditions) make up 21% of Medicaid beneficiaries and 52% of Medicaid spending (Euhus and Chidambaram 2024, Figure 1).For all individuals, the U.S. spends $10,197 per capita on inpatient and outpatient care, long-term care, prescription drugs, and medical goods combined, and spends $742 per capita on preventive care (Wager et al. 2024).
Nationally, 94% of adult Medicaid beneficiaries have a usual place to get routine or preventative care (Ku et al. 2017). Nationally, there are over 700 Medicaid primary care physicians (PCPs) per 100,000 Medicaid beneficiaries (Fitzhugh Mullan Institute for Health Workforce Equity 2023). In MO, metro areas have 78 PCPs per 100,000 Missourians while non-metro areas have 48 PCPs per 100,000 Missourians (Kuhns 2021).
MO HealthNet’s Managed Care Plan provides preventive services such as smoking cessation or obesity services (Healthy Blue 2022). In the U.S., 38% of overweight or obese and 63% of smoking adult Medicaid beneficiaries receive counseling from their providers. (Ku et al. 2017).
Barriers to preventive care include: not having a primary care provider, living far from providers, lack of awareness of services, lack of time, and discrimination and lack of cultural awareness among providers (Office of Disease Prevention and Health Promotion n.a., Allen et al. 2017).
In 2011, the Centers for Medicare & Medicaid Services gave 10 states funding for five years to study preventive care incentive programs (Hoerger et al. 2017). Seven states found that monetary incentives increased participation, led to better health outcomes, or a decrease in Medicaid spending, while others found no effects. In states that saw no effects, these results were possibly due to lack of participants and issues with program implementation.
One review found that monetary incentives primarily lead to improved health outcomes and more frequent health monitoring (Haff et al. 2015). However, the structure of the monetary incentive also influences the likelihood of patient participation. Patients are more likely to participate if there is a deposit contract incentive, compared to getting a lump sum after meeting health goals. For a deposit contract incentive, patients put down their own money that is matched if they meet health goals or lost if they do not meet health goals.
Other incentives for preventive care are transportation, childcare, cell phones, farmers market vouchers, car seats, exercise equipment, tobacco cessation supplies, gym memberships, counseling, cookware, and weight scales (Medicaid and CHIP Payment and Access Commission 2016).
Figure 1. National Medicaid spending per beneficiary. National Medicaid spending per beneficiary from 2021 are shown in different categories. “ACA Expansion Adults” are those who qualified for Medicaid after expansion as allowed by the Affordable Care Act (ACA). Figure taken from Euhus and Chidambaram (2024).
References
Agency for Healthcare Research and Quality (2014) Designing and implementing Medicaid disease and care management programs. Accessed December 4, 2024. Link.
Allen EM, Call KT, Beebe TJ, McAlpine DD, Johnson PJ (2017) Barriers to care and healthcare utilization among the publicly insured. Med Care. 55(3): 207-214. https://pmc.ncbi.nlm.nih.gov/articles/PMC5309146/pdf/nihms807349.pdf.
Centers for Disease Control and Prevention (2024a). About Chronic Diseases. Accessed December 9, 2024. Link.
Centers for Disease Control and Prevention (2024b) Fast Facts: Health and Economic Costs of Chronic Conditions. Accessed November 19, 2024. https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html.
Centers for Disease Control and Prevention (2024c) Preventing Chronic Diseases: What You can Do Now. Accessed November 19, 2024. https://www.cdc.gov/chronic-disease/prevention/index.html.
Euhus R, Chidambaram P (2024) A look at variation in Medicaid spending per enrollee by group and across states. KFF. Link.
Fitzhugh Mullan Institute for Health Workforce Equity (2023) Medicaid primary care workforce. The George Washington University. https://www.gwhwi.org/medicaid-primary-care-workforce-tracker.html.
Haff N, Patel MS, Lim R, Zhu J, Troxel AB, Asch DA, Volpp KG (2015) The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis. American Journal of Health Promotion. 29(5): 314-323. Link.
Hoerger T, Boland E, Acquah JK, Alva M, Doto JK Farrell K, REead JG, Goodrich C, Perry R, Romaire M, Teixeira-Poit S, Treiman K,Witman A (2017) Medicaid Incentives for Prevention of Chronic Disease. RTI International. https://downloads.cms.gov/files/cmmi/mipcd-finalevalrpt.pdf.
Ku L, Paradise J, Thompson V (2017) Data Note: Medicaid’s Role in Providing Access to Preventative Care for Adults. KFF. Link.
Kuhns M (2021) Missouri Rural Health Care Access. Missouri Economy Indicators. 2(7). Link.
Medicaid and CHIP Payment and Access Commission (2016) The use of healthy behavior incentives in Medicaid. https://www.macpac.gov/wp-content/uploads/2016/08/The-Use-of-Healthy-Behavior-Incentives-in-Medicaid.pdf.
MO Department of Health and Senior Services (2020) Missouri Behavioral Risk Factor Surveillance System. https://health.mo.gov/data/brfss/2018-key-findings.pdf.
Office of Disease Prevention and Health Promotion (n.a.) Preventive Care. U.S. Department of Health and Human Services. Accessed December 5, 2024. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/preventive-care#cit4.
Wager E, Rakshit S, Cox C (2024) What drives health spending in the U.S. compared to other countries? Health System Tracker. Link.
Watson KB, Carlson SA, Loustalot F, Town M, Eke PI, Thomas CW, Greenlund KJ (2022). Chronic conditions among adults aged 18-34 years – United States 2019. Morbidity and Mortality Weekly Report. 71(30). https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7130a3-H.pdf.
