Introduced on June 24, Bill S. 1948 would amend the Internal Revenue Code of 1986, section 223(c)(2) also known as the Chronic Disease Management Act of 2018. When amended this Act could be the legislative equivalent of a safety net for high-value care.

And it can't come soon enough, given the far-reaching impact chronic health conditions such as diabetes and cardiovascular disease are having on employers who pay a significant share of the costs for their employees and family members with these conditions. The bill addresses chronic conditions that substantially disable or threaten life; are a high risk of hospitalization or significant impact to health and require specialized treatment across all aspects of care.

Over the past 20 years, the health care community has identified several activities that can either prevent chronic health care conditions and/or curtail the long-term effects. High-value care should be encouraged as it leads to improved health care quality, clinical improvement and reduced costs. Unfortunately, these services are often underutilized.

There are several reasons why high-value interventions are underused including system, provider and employee-focused barriers. One of the barriers is plan design and the rules associated with high-deductible health plans. Today, a significant number of employers have chosen to use high-deductible plan designs as part of their benefits offering as a cost containment strategy and to engage employees in their own care.

One of the challenges associated with a high-deductible plan is that employees tend to forgo medical care altogether due to the financial costs. Under the present system, an employee self-funds high value care including activities that reduce or improve chronic medical conditions until which time they reach their deductible (which is often $2,000 or more).

This amendment would allow for chronic disease prevention services as well as certain services associated with chronic condition care to be funded prior to a health care consumer meeting their deductible. There would be certain limitations to the coverage of these activities, but these limitations have not been specified. The “safe harbor” that is offered by S. 1948 would include both medication as well as behavioral and other diagnostic and treatment activities.

Impact on employers

Employers have been offering support to their employees through chronic care management programs since the late 1980s and many are frustrated with the lack of employee engagement in managing their health. Although there are several reasons for low engagement, one area that employers can directly impact is the plan designs they put in place. The amendment to the Chronic Disease Management Act of 2018 should positively impact both the employer and the employee. By removing plan design financial barriers, employers should see an increase in the utilization of high value care. Over time this will result in clinical improvement of their employees and the employer will reap the benefits of the associated financial savings.

In addition to supporting passage of the bill, employers should act to:

Work with their health and welfare vendor partners to identify the chronic conditions and interventions that will be targeted
Engage with their health and welfare vendor partners to create a cross-functional communication strategy so that employees and their families understand the impact of the Chronic Disease Management Act of 2018

Value has become a cornerstone of improving the United States health care system. High-value care focused on prevention and treatment of chronic medical conditions should be a priority of employers, providers and employees. Amendment S. 1948 is an action that clearly can help to address the financial barriers to employees receiving these interventions. As health care purchasers, this is legislation we should stand behind.

Jan Berger, MD, MJ, is medical director for the Midwest Business Group on Health.

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Legislative changes for chronic conditions: What employers need to know

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