What ails us most? Addressing the quality of life and the impact of healthcare

The healthcare needs of Americans are vast and complex.  The ultimate goal of any healthcare system is to create the conditions necessary for a population to not only maximize total lifespan, but enjoy as much of that time in a healthy state, free of the burdens of chronic disease and symptoms associated with acute conditions and injuries.  Along with improving healthcare outcomes, the Triple Aim also emphasizes improving the experience of the patient, as well as reducing the total cost of care.

Chronic diseases such as heart disease and cancer continue to be responsible for the majority of deaths in the United States and elsewhere throughout the world.  The Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) estimates that cardiovascular disease and neoplasms account for 57 percent of total deaths in the U.S. and 47 percent worldwide.  Ongoing efforts to address risk factors for heart disease, such as identifying and treating hypertension, hyperlipidemia, and hyperglycemia, as well as the behavioral risk factors associated with cancer, which include tobacco and alcohol use, are absolutely critical to increase the life expectancy of a population.

However, increasing life expectancy is only one measure of improved population health.  Equally, if not more important, is maximizing the quality of life of a population and reducing the average number of years lived with a disability (YLD).  This is where all aspects of the Triple Aim are addressed, since patients typically engage with the healthcare system to address “quality of life” vs. “quantity of life” concerns. 

While cardiovascular disease and cancer account for 52 percent of years of life lost (YLL) in the U.S., it only accounts for 7 percent of years of life with disability (YLD) according to IHME GBD estimates.  The conditions that account for the majority of years of life with disability are musculoskeletal (23.4 percent) and behavioral (21.2 percent).  Most of this is attributable to depression, anxiety, back pain and neck pain.  From this perspective, the current opioid crisis that the U.S. is experiencing is not a surprise.

Musculoskeletal and behavioral conditions affect people of all ages and have a significant impact on quality of life, as well as the high cost of lost productivity in the workplace.  The cost to treat these conditions is high.  According to a May 2016 Health Affairs article, mental disorders are the single most costly condition in the U.S., costing $201 billion when institutionalized populations are included.

Many musculoskeletal conditions like back and neck pain, if not chronic, are at least intermittent, and remain lifelong issues for patients.  These conditions are most effectively treated at the primary care level, often including chiropractic treatment and physical therapy, since specialist involvement can lead to more invasive procedures with greater risks and higher costs, but not always better outcomes.  However, chronic pain patients often receive uncoordinated care that can lead to unnecessary imaging, long-term opioid use, and repeated treatments that do not lead to positive outcomes.

Behavioral health conditions, such as depression, anxiety and substance abuse, are also lifelong issues that often go undiagnosed and not treated or undertreated.  Pharmacologic treatment prescribed by primary care physicians needs ongoing management, including referrals and follow-up for counseling and other types of outpatient treatment.  Coordination of care is a critical component of behavioral health treatment given its co-occurrence with other conditions and prolonged treatment regimen.

Chronic pain and behavioral health issues often accompany many other medical conditions such as heart disease, cancer and diabetes, as the patient attempts to deal with the physical and psychological impact of a chronic disease.  The Triple Aim cannot be realized without addressing the musculoskeletal and behavioral health conditions that account for the nearly half of disability years among Americans and co-exist with many conditions that are routinely treated by primary care.

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.