Chronic Disease in California:

Implications for Individuals

and the State

Chronic diseases are the #1 cause of death and disability in

California
Almost 1 in 2 Californians have
at least one chronic condition.
One in four has two or more
conditions.

Seven of the top 10 causes of death are chronic diseases.

Chronic diseases cause 7

out of 10 deaths each year in
California.

People with chronic diseases account for 84% of healthcare

spending
During 2011, California spent more than $230 billion on healthcare-$193 billion
spent treating people with chronic diseases.
Of every dollar spent

84 cents was for treating

people with one or more
chronic medical condition.
In public programs, treatment of patients with chronic
diseases constitute an even higher portion of spending:

More than 96 cents in Medicare and 83 cents in Medicaid

The United States cannot effectively address escalating
health care costs without addressing the problem of
chronic diseases.
-- US Centers for Disease Control and Prevention

The greater the number of conditions, the higher the

spending

Healthcare spending is highly concentrated

Identifying and understanding hot spots in healthcare spending provides opportunities for
targeted interventions that improve health and lower costs.

Concentration of Medicaid Spending

100%

85%

90%

95%

68%

80%

54%

70%
60%
50%

25%

40%

50%

50%

30%

% Spending

25%

20%
10%

% Enrollees

1%

5%

10%

0%

5%

A mere 5 percent of Medicaid beneficiaries account for 54

percent of Medicaid spending. The top 1 percent account for
25 percent of total spending.
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The doubling of obesity between 1987 and today accounts

for nearly 30% of the rise in health care spending
Percent of U.S. Adults Who are Obese*

2013
WA

The percent
of children
and youth
who are
overweight
has tripled
since 1980.

MT
OR

ID

ME

ND

MN

VT

SD

WI
IA

NE

NV
CO

AZ

PA
IL

UT
CA

KS

OH

IN

WV
MO

OK
NM

KY

TX

VA
NC

TN
AR

SC
MS

AK

NY
MI

WY

AL

GA

LA

NH
MA
RI
CT
NJ
DE
MD
DC

If the
prevalence of
obesity was
the same
today as
1987, health
care
spending in
the US would
be 10 percent
lower per
person
about $200
billion less

FL

HI
GUAM

15%<20%

20%<25%

25%<30%

30%<35%

*BMI 30, or ~ 30 lbs overweight for 5 4 person Prevalence estimates reflect BRFSS methodological changes
started in 2011. These estimates should not be compared to prevalence estimates before 2011.

PR

35%

Economic losses from chronic diseases exceed treatment

costs in California

Chronic Disease Costs

Treatment Expenses
Economic Losses

22%

By 2023, reasonable
improvements in preventing and
managing chronic disease could
reduce future economic costs of
disease in California by

78%

The vast majority of cases of chronic diseases could be

better prevented or managed

The World Health Organization (WHO)

estimates that
At least 80% of all premature heart
disease, stroke, and type 2 diabetes,
and
More than 40% of all cancers
could be prevented by:
Avoiding tobacco
Eating healthy foods
Being physically active

Management of chronic disease could also

be significantly improved: Chronically ill
patients receive recommended preventive
care less than 60% of the time.

YET . . . adults in California

are overweight or
obese

60%

eat less
than 1 fruit
a day

30%

eat less
than 1
vegetable a
day

16%

smoke
cigarettes

13%
8

Healthcare coverage is important to people with chronic

diseases
People need affordable access to recommended
Preventive care to avoid disease onset;
Screenings to catch problems early;
Treatment to prevent disease progression; and
Ongoing management of chronic conditions to avoid costly complications.

Healthcare coverage is important to people with chronic

diseases
Managing Chronic Conditions Depends Upon

People need affordable

access to recommended

Preventive care to
avoid disease onset;
Screenings to catch
problems early;
Treatment to prevent
disease progression;
and
Ongoing
management of
chronic conditions to
avoid costly
complications.

Adopting
healthy
behaviors

Getting
regular lab
testing

Seeking
preventive
care

Taking
medicines as
prescribed

Obtaining
recommended
care

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But, access to insurance doesnt necessarily

mean access to care
Coverage Example from Lowest Premium Silver
Plan* on Covered CA Exchange
$507.06 a month premium (without a subsidy)
$2,000 deductible (n/a for all services)
Coverage example for person with wellcontrolled diabetes enrolled in plans
diabetes management program:
$507.06 x 12 = $6091.20 premium costs
$2,760 projected additional out-of-pocket
costs
= $8,851.20 in estimated total costs to
the consumer
Consumers need ready access to
information to make an informed choice.

51 year-old; zip code - 95814

Anthem Blue Cross Silver 70 PPO

11

But, access to insurance doesnt necessarily mean access

to care.
Important Questions for Consumers

Can I keep my doctor(s)?

Are my medicines covered?
What are my total costs, not just premiums?
Can I go to my local hospital?

12

But, access to insurance doesnt necessarily mean access

to care.
Important Questions for Policymakers

Do consumers have the information they need?

Is information easy to find and understandable?
Is coverage adequate?
Are costs to consumers reasonable?

13

Do consumers have the information they need?

Is information easy to find and understandable?

Important Questions for Consumers

Can I keep my doctor(s)?
Are my medicines covered?
What are my total costs, not just premiums?
Can I go to my local hospital?

14

Can I keep my doctors?

Age: 45
Income: $51,000
Zip: 95814
(Sacramento)

Easy-to-find links to
searchable provider lists
for each plan.

15

Are my medicines covered?

Age: 45
Zip: 95814
Income: $51,000

No easy way to find the list of covered

medicines for any plan.
Tab for Drugs >> out-of-pocket costs, but
no information about the actual medicines
covered.
Consumers have to dig through plan details
and multiple websites to find a list of
covered medicines.
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Do consumers have the information they need?

Is information easy to find and understandable?
Important Questions for Consumers
Can I keep my doctor(s)?
Are my medicines covered?

Covered California
Ready access to lists of in-network doctors
and hospitals.

Very challenging to find information on

What are my total costs, not just premiums?
covered medicines. Not consistently reported.
Can I go to my local hospital?

Helpful, general cost calculators for

consumers based on anticipated medical
needs and use.
Very difficult to estimate personal costs,
particularly with medicines.
Helpful information for special populations,
but HIV/AIDs was only disease-specific
special population.

17

Any Questions?