Steps forward in 2022

We can take solace in the fact, however, that elected government officials, policy makers and employers are starting to understand that health care is broader than just providing access to reactive sick care. As we start to emerge, somewhat, from the dark COVID cloud, there were some rays of sunshine in terms of progress that health care made in 2022.

Despite political blame games regarding the origin, speed of recognition and clarity of advice for COVID-19, Congress acted in a bipartisan manner to provide funding for research and vaccines – and oddly enough spent little energy arguing about whether people deserved health care or not. The Inflation Reduction Act of 2022, signed into law by President Joe Biden in August, has elements of reallocating available dollars among health categories, including: lowering future prescription drug prices to Medicare beneficiaries through price negotiation with manufacturers; capping out-of-pocket drug spending for beneficiaries in Medicare Part D at $2,000 annually; and extending for three years the enhanced Affordable Care Act subsidies that Congress passed last year as part of the American Rescue Plan Act.

In the second half of 2022, there was enough confidence in vaccination and control measures around COVID-19 to start thinking about a new normal in health care. Data affirmed that those who maintained overall better health and wellbeing fared far better than those with underlying conditions and less healthy lifestyles. But it also reminded us that sometimes, even very healthy people are overcome by novel diseases.

Sick care vs. proactive care

Most health systems around the world were designed in the post-World War II era for sick care; not to prevent the onset of disease, but instead to diagnose and treat illness. This "reactive" rather than proactive approach works well with acute diseases, which are short, easily diagnosed and treated with a cure.

But the rise in chronic illnesses points out the growing need for a proactive system. Chronic diseases are long-lasting and have compounding effects on individuals and society, not the least of which is economic. They are characterized by many risk factors and complex causes, and generally aren't cured completely. A study by the World Economic Forum found that the global economic impact of five leading diseases – cancer, diabetes, mental illness, heart disease, and respiratory disease could reach $47 trillion in U.S. dollars over a 20-year period. And a Global Burden of Disease Study showed urgent action is needed to address them, and in turn make countries more resilient to future pandemic threats.

In the areas of technology-supported quality and access, U.S. health care has made advancements such as electronic medical records (EMRs) and telehealth. Driving more value out of health care spending across the "cost, quality, and access" continuum, however, is a vital challenge to solve. Fortunately, there are ways to accomplish this that are already gaining traction.

How to move from sick care to proactive care in 2023

• A wider perspective in benefit plans. Medicare, Medicaid, military and commercial plans need to be looked at through the lenses of physical health, mental health, social health, financial health, and to the extent possible, individual purpose. These categories should start to show up more clearly in descriptions of benefits in addition to doctors visits, hospital visits, drugs, ER visits, etc.
• Better communication by employers. Employers, who by and large already have a belief system in total wellbeing, need to communicate the broader set of total health and wellbeing benefits more clearly and educate their employees on what is available.
• Cost focus by CMS. The Centers for Medicare & Medicaid Services (CMS) needs to take a step back and look at how less costly support for lifestyle and daily living (e.g., nutrition and reducing loneliness) can dramatically reduce the cost of traditional medical care.
• Combined data usage. Consumer permissions to combine non-health care data with health care data in the best interest of their health need to become commonplace when enrolling in health benefits.

In 2023, I think large employers will zoom out ahead of governmental approaches to health benefits. They will address total wellbeing while also emphasizing primary care connections to consumers through digital, virtual and physical means. Predictably, politicians will keep publicly attacking pharmaceutical companies and insurance companies as the cause of the economic challenges to health care. But they will work together in the background as private industry supports the innovation imperative.

Related: How employers are becoming more proactive with employee benefits

Decision-makers in both the health care industry and government need to get on the same wavelength more often and really work for the common good. Imagine a world in which the health care system actually works with people on improving their total health – a world where health care becomes proactive instead of reactive.

 Jeff Margolis, health care IT entrepreneur and innovator