Global health systems are at a crossroads, facing exponential growth in healthcare costs that are far outpacing the growth rates in the GDP to support health system sustainability. Stretched budgets, coupled with aging populations and the rapidly growing prevalence of chronic illness, are collectively exerting strain on health systems that are already struggling to cope with demands for services.
Health systems have relied on well-established disease management pathways and evidence- based care approaches in an effort to manage care demands and standardize practices to improve quality and safety. Yet, the prevalence of chronic illness continues to grow; 60% of adults in the U.S. have a chronic illness and 40% have two or more chronic conditions (Centers for Disease Control and Prevention, 2019), accounting for $3.3 trillion in health system costs annually.
Chronic illness is now responsible for 75% of total health system costs in North America,
and evidence indicates that current care delivery models are not well constructed to effectively manage the growing demands chronic illness is placing on today’s healthcare systems (Milani, R. et al, 2017). Healthcare costs are expected to continue to grow as new therapies (e.g. genomics, personalized medicines) emerge and will place additional cost burden on health systems. Blue Cross Blue Shield Association has now reimbursed, for the first time in its history, new therapy for one patient in the amount of $2 million (Serota, 2019).
Current funding models and cost pressures will make such life-changing therapies unaffordable and inaccessible, until health systems can transform care delivery, and new business models are developed to support access to life-saving therapies — made available to all people and populations. The current reimbursement models and care pathways focused on disease management will continue to escalate, placing health systems in an impossible position as they continue to struggle to meet the demands for health services from populations they are mandated to serve (Marvasti, F. & Stafford, R, 2012).