Senators Seek to Lower Cost of Chronic Disease Management

Senators John Thune (R-SD) and Tom Carper (D-DE), and Representatives Diane Black (R-TN) and Earl Blumenauer (D-OR) recently introduced the Chronic Disease Management Act of 2018.

The bipartisan bill would amend the IRS Section 223 (c)(2)(C) to include coverage of chronic disease prevention and treatment. This would help Americans with chronic diseases to receive quality care at a lower cost, according to a press release from the University of Michigan Center for Value-Based Insurance Design.

It is well-known that chronic diseases account for a majority of health care spending in America, with some individuals spending a significant portion of their income on prescription drugs. Many studies have shown that patients with high out-of-pocket costs may be more likely to abandon their prescriptions at the pharmacy, which may put a patient with a chronic condition at risk of complications and unnecessary health spending.

Related video: Explain the Importance of Chronic Disease Management

Having a chronic disease can have a significant impact on quality of life if not managed properly and may result in high medical spending, according to the bill. In the press release, the lawmakers said that implementing value-based contracting may help lower the cost of chronic disease management.

The bill states: “Allowing health savings account-eligible high-deductible health plans to cover chronic disease prevention and treatment on a pre-deductible basis promotes the concept of Value-Based Insurance Design, which is an effective tool to improve the quality and reduce the cost of care for Americans with chronic diseases, with improved outcomes via increased medication adherence, reduced complications, and decreased emergency department visits.”

The bill amends the IRS section that grants safe harbor flexibility in defining the scope of preventative care. However, preventive care for chronic diseases was not previously included in this code, according to the release.

By amending the code, the IRS would allow high deductible plans that are eligible for a health savings account to cover treatment for the management of chronic diseases before the deductible is met.

Patients will be eligible if they have a disabling or life threatening complex chronic condition, have a high risk of hospitalization or other negative outcomes, and require specialized delivery across domains of care, according to the bill.

The bill is innovative as it will help develop and implement a high-value health plan that will offset any costs from non-adherence, enhance patient outcomes, reduce premium costs, and decrease overall health care costs for patients with chronic diseases, according to the release.

Millions of Americans with chronic illnesses may be able to receive better quality care at a lower cost if the bill is passed.