5-point call goes out for action against ‘one of the most urgent and complex socioeconomic challenges of our time’

U.S. healthcare is in the throes of an affordability crisis. The good news is that healthcare leaders have all the evidence, tools and expertise needed to keep the predicament from becoming a plight. Can they marshal the will to wield those weapons toward that end? 

The leadership of the American Heart Association is asking the question, in its own words, as a call to arms. 

Given the scope of the challenge, the cost of inaction is high—and it may be measured “not just in dollars but in delayed or foregone care, diminished well-being and preventable loss of life,” 12 AHA representatives write in a paper published by Circulation April 29. “Meaningful change will require bold leadership and coordinated action to fundamentally rethink how we pay for, prioritize and deliver care.”

The authors believe the future of healthcare as a whole depends on how effectively stakeholders work to build a care delivery system that is no less economically sustainable than it is clinically effective.  

The article’s lead author is Dhruv Kazi, MD, MSc, and its co-authors include AHA president Stacey Rosen, MD. 

Presented as an AHA “presidential advisory,” the piece synthesizes input from providers, payers, employers, healthcare leaders, public health experts and, not least, patients. 

The authors flesh out a general framework for addressing the unaffordability crisis in all its dimensions. 

Along the way they offer guidance for pursuing five specific imperatives. Here are excerpts from those five sections.  
 

1. Ensure access to high-quality healthcare without financial hardship for every person living in the United States. 

Affordability must account for both direct healthcare costs (premiums, deductibles, copays) and indirect, nonmedical costs (transportation, childcare, time off work, lost wages). 

“The AHA is committed to policies that fairly address rising insurance premiums—including maintaining support for enhanced premium tax credits in the ACA marketplace—as well as patient out-of-pocket costs among those with insurance,” the authors write. 

2. Minimize cost-sharing for high-value services. 

Cost-sharing reduces the use of both high- and low-value services, leading to lower use of evidence-based clinic, laboratory and prescription drugs, higher rates of emergency department visits, more frequent avoidable hospitalizations and worse health outcomes.

“Evidence shows that even minimal cost sharing can reduce the uptake of statins, an inexpensive, evidence-based and cost-effective intervention for preventing cardiovascular disease.”

3. Create shared accountability across the healthcare system.

Policymakers at both the federal and state levels must work collaboratively with stakeholders to realign incentives and to reorient payment models away from volume and toward value, guided by rigorous evaluations of quality and outcomes.

“We recognize that, in a system as large and complex as the U.S. healthcare system, any change to one component inevitably affects others,” Kazi and co-authors remark. “Shared responsibility therefore requires that all stakeholders embrace necessary tradeoffs in pursuit of a common goal: high-quality, affordable care for everyone.” 

4. Invest in the workforce, infrastructure and data systems needed to support progress.

Coordinated investments in people, physical infrastructure and data systems are urgently needed to support the delivery of high-quality, affordable healthcare. 

“To meet the demands of a growing and aging population, a long-term workforce strategy is essential,” the authors state. “We must reform how we train and retain physicians, advanced practice professionals and nurses, with the goal of addressing shortages in specialties like cardiovascular and brain health.”

5. Address the social and structural factors that make care less affordable for many communities. 

Evidence linking social drivers of health to both health outcomes and costs underscores the need to better connect medical care with social services in ways that address the root causes of poor health. 

“Integrated care models that incorporate social needs screening and linkage to community services are critical to aligning healthcare delivery and public health,” Kazi et al. maintain. “At the same time, we should continue to pilot and evaluate alternative approaches such as the Food Is Medicine program to identify cost-effective strategies to prevent, diagnose and manage disease.”

Kazi and colleagues conclude that overturning widespread unaffordability in U.S. healthcare will “require give-and-take among all major stakeholders in service of a system that works better for everyone.”

The paper is posted in full for free.