A vote for health

It’s an American presidential campaign, so you expect the grandiose posturing from candidates, the hollow rhetoric, and the political gamesmanship. You expect the discord and the shouting. 
The 2016 campaign has a surplus of that, with 
the volume turned all the way up.

Ken Thorpe has been working to make his message heard above the cacophony. He’s leading the effort to inform the voting public about the high cost of chronic disease in the U.S. and to make the candidates address the issue.

“The challenge is to get people away from the simple dichotomy of being for or against Obamacare. Oftentimes, the discussion doesn’t get any deeper than that,” says Thorpe, Robert W. Woodruff Professor and chair of health policy and management.

When the Patient Protection and Affordable Care Act became law, Thorpe was hoping it was just a first step. He pushed for Medicare and private plans to adopt better lifestyle and prevention programs and for more coordinated, patient-centered, collaborative care. But Congress didn’t seem interested in doing any additional work on health care beyond all the talk of repealing or not repealing.

Thorpe works on health policy issues through an organization he founded and runs, the Partnership to Fight Chronic Disease (PFCD). He launched PFCD just prior to the presidential election of 2008 because he knew health care reform was going to be a big issue. “We wanted to make sure the discussion about reform wasn’t just about health insurance but also about what’s really driving the increase in health care spending,” he says.

That would be the growing prevalence of chronic diseases. This election season, Thorpe and the partnership made sure the issue went coast to coast during the presidential primaries, producing and airing a 30-second TV ad throughout the debates.

“Our approach was different this election,” Thorpe says. “We did more advertising, and we really used social media 
to push the word out. And rather than primarily targeting policy makers, we took it to the public to try and pressure 
the candidates into addressing chronic disease.”

Thorpe and his team focused on a few key primary states: California, Florida, Iowa, Nevada, New Hampshire, and Wisconsin. The point was to educate the voting public and really challenge the candidates. “If they’re going to do health care reform, they can’t do it without addressing the growth of chronic disease,” says Thorpe. “These are not partisan issues. Keeping people healthy is something you expect both Republicans and Democrats to work on together.”

Besides the TV spots, Thorpe also wrote guest editorials for news sources like The Hill and The Huffington Post, and many of his PFCD colleagues at the state level have been publishing their two-cents’ worth in local and regional newspapers across the country.

“I think we’ve been effective in changing the dialogue so that people are focusing on the correct problem,” says Thorpe.

He thinks Hillary Clinton, the Democratic presidential nominee, gets it. “She’s demonstrated that she understands the issues of cost and outcomes, of rewarding quality care,” says Thorpe. “These things would be key parts of any reform proposal she puts together.”

He also thought that former Republican candidates John Kasich and Jeb Bush got it. However, Thorpe isn’t really sure what to expect from the candidate who got the Republican nod.

“Donald Trump has been less specific about health care, but as he goes forward in the campaign, he’ll be pushed on the issue and his thinking will evolve,” Thorpe says.

Either way, PFCD will continue making its case through the election, and there’s plenty to talk about. According to a recent PFCD study, 191 million people in the U.S. had at least one chronic disease in 2015, and 75 million had two or more. Chronic diseases are on pace to cost the U.S. $42 trillion between now and 2030—annually that comes to $2 trillion in medical costs and $794 billion in lost employee productivity. Between now and 2030, simple changes in our health care system—such as improvements in the prevention and treatment of chronic disease—could save 16 million lives, prevent 169 million cases 
of chronic disease, and save $6.3 trillion in health care costs.

It’s the price tag of chronic disease that resonates with policy makers. “It’s important to talk about how chronic disease impacts the economy because that’s what gets the attention of the media and ultimately, the people who want to lead us and who are developing their ideas about health care,” says Candace Dematteis, PFCD’s policy director. “Everyone talks about the expense of health care, but most are not looking at the drivers.”

When Thorpe and his partnership colleagues talk about solutions, they typically focus on preventive measures and proper management, much of it provided through a community-care approach with proven results.

“We’ve done some work at the state level, most notably in Vermont with the community health teams we put together,” says Thorpe. “Nurse practitioners, nurses, pharmacists, and social workers help patients and families execute health plans, working with primary care physicians. It’s a team-based approach that focuses on the patient rather than individual conditions.”

A statewide public-private initiative to transform care delivery was introduced in Vermont in 2008. Since then, the state’s growth in health care costs have slowed.

“Community-based programs implemented in relatively low-cost settings have been a success,” says associate professor Jason Hockenberry, one of Thorpe’s research collaborators in the health policy and management department. “They try to stave off development of chronic disease by identifying people who are at higher risk and trying to change their behavior. It’s about targeted prevention, and it’s about management.”

This approach seems pretty simple. A web-based central health registry captures changes in patients’ data, perhaps a marked increase in blood sugar. Then a program, probably including diet and exercise, is prescribed and implemented at the community level, maybe through the local YMCA or community clinic.

The community health team paradigm pioneered in Vermont and copied by other states may also fit the rest of the world. Toward that end, Thorpe has extended PFCD’s mission to India, where other Rollins researchers, including Mohammed K. Ali, associate professor of global health and epidemiology, have long been engaged in studies of diabetes.

India is one of the world’s fastest-growing nations, and its burden of chronic disease is particularly heavy. People in India develop chronic conditions at a significantly earlier age than in 
the U.S., so they have to deal with them longer.

In India as in the U.S., the aim is for a multi-pronged approach supported, at least in part, through enlightened government largesse. It’s a smart investment, the ounce of prevention. “It’s about governments buying into the idea that health and chronic disease are important issues,” Ali says. “Health in general represents an outflow of cash. You’ve got to invest in it, and the long-term investment in a population’s health is in a nation’s own best interest.”

That’s what Thorpe has been trying to impress upon the people who want to lead the U.S. government. Good health is a smart investment. And as the U.S. transitions toward a historic new presidential administration, Thorpe will stay on message.

“We’re not finished reforming health care in this country,” he says. “This is the next stage of the process. It’s health care reform, version two.”