COVID-19 and Chronic Disease Management

COVID-19 has changed everything.  It is an experience we won’t soon forget, and a defining moment in our history.

Perhaps one of the saddest elements of this pandemic is how disproportionately it affects different communities.  The African-American community in the US is a prime example.

In Louisiana, African-Americans make up 32% of the State’s population and 70% of the COVID-19 deaths.  In Illinois, they make up 15% of the population and 42% of the deaths.  In Michigan, 14% / 41%.  It is staggering and highlights significant disparities in health among communities and our health system.

The Corona virus strikes the hardest when people have underlying health conditions – most notably, hypertension, diabetes and obesity – and, tragically, these conditions are more prevalent in the US African-American community.

To better understand some of the causes of disparity, let’s first start with a couple of simple definitions.

Acute care refers to the care of individuals needing immediate medical attention for serious illness or injury.  The devastating pneumonia caused by COVID-19 is a perfect example, and what dominates our headlines today.

On the other hand, chronic care refers to the care of individuals with long-term illnesses over protracted periods of time.  From onset these conditions often last for the remainder of the patients’ lives – heart failure, hypertension and diabetes are prime examples.

In the case of COVID-19, the acuteness (severity) of the disease is largely driven by age and chronic underlying conditions.

Now, consider how acute and chronic care differ in method of treatment.

With acute care, because of its immediate nature, the primary care setting is in the hospital or urgent care facility.  With chronic care, the primary setting for care is the home.  You take your insulin or your high-blood pressure medication at home.  With acute care, the physician is the focal point for directing treatment.  With chronic care, it’s the patient or the patient’s care partners (family member, visiting nurse, etc).  Whether a patient takes their medicine, when they take it, etc is largely up to the patient or their care partners.

The US health care system is also set up differently for acute care vs. chronic care.  In general, for acute care, hospitals get reimbursed for the cost of the procedures they perform on the patient.  With chronic care, generally, patients get a subsidy to buy the drugs or the devices to manage their disease.  That is, if they have health insurance and/or can afford to pay at all.

Let’s take a look at some additional statistics.   In 2017, the United States spent about $3.5 trillion on healthcare.  Forget, for a second, that this is more than 2x other developed nations and let’s look at the breakdown of the spend.  According to the CDC, 90% of the $3.5 trillion expenditure is spent on people with chronic and mental health conditions.  90%!

However, when you look at non-pharmaceutical innovation in healthcare, most of the R&D spending is tied to the treatment of acute issues.  The reasons for this are complicated – from history, to the reimbursement model, to profitability.

Tragically, COVID-19 has highlighted real underlying issues in our health system.  Beyond the very real issues of coverage and affordability, the virus is highlighting the need to pay much more attention to chronic disease management.  This just can’t be about finding the next best drug for hypertension or diabetes, or the next fad diet to try to treat obesity – that is, not if we want to make a meaningful difference.

This virus has shown that the severity of an acute condition is tied directly to how effective we are at managing a chronic condition. Because of this, the need for a different approach to chronic disease management has never been more obvious or urgent.  Obviously, a greater focus on prevention is needed.  However, there are millions that have these conditions right now, who are struggling to keep their condition(s) in control and who need help achieving the right outcomes.  These are the individuals we need to prioritize.  For starters, we need companies in the medical device industry to focus more of their mindshare and their R&D dollars on chronic care solutions – solutions that address both outcomes and cost.  This includes not only a focus on device technology, but also more focus on remote management and AI informed algorithms.  We also need the government and commercial payers to re-think the current payment model for chronic care in a way that prioritizes outcomes above all else. 

We are sadly learning that the novel Corona virus discriminates.  It preys on those with chronic disease.  This should be a national wake-up call.  At an absolute minimum, hopefully it will spark government and industry to take leadership roles in how to define a new way forward with respect to our approach towards chronic disease management.

Over the next few months, I will be focusing a series of articles on chronic care.  I will outline some key elements of chronic care – from the burdens associated with chronic diseases, to how industry may be able to think about solutions to better support those with chronic diseases.

COVID-19 has given us countless inspirational examples of those stepping up in the face of incredible challenges brought by this virus.  It is also shinning a bright light on chronic disease and the relative dysfunction of our health system to meet the needs of various communities.  Unfortunately, these dysfunctions and systemic challenges won’t end with a vaccine.