Health Subcommittee Hearing on Modernizing Care Coordination to Prevent and Treat Chronic Disease

House Ways and Means Subcommittee on Health

2025-11-19

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Source: Congress.gov

Summary

The meeting addressed the pervasive issue of chronic illness in the United States, highlighting the substantial financial burden it places on the healthcare system and the critical need for more effective, preventive, and coordinated care strategies. Speakers emphasized that despite trillions spent annually, health outcomes are worsening, necessitating a shift from reactive to proactive healthcare models [ 00:17:15 ] .

Themes

The Crisis of Chronic Disease and its Costs

The U.S. faces a significant chronic disease epidemic, with a larger share of people suffering from these conditions compared to other nations [ 00:17:39 ] . Chronic diseases account for eight out of ten leading causes of death and affect all age groups, including a high percentage of children and young adults with obesity [ 00:17:47 ] . Healthcare costs nearly $5 trillion annually, with approximately 90% attributed to chronic diseases, yet the system often responds only after a crisis rather than preventing it [ 00:19:37 ] .

Healthcare Affordability and the Affordable Care Act

There was a strong debate regarding healthcare affordability, particularly concerning the Affordable Care Act (ACA) and its premium tax credits [ 00:22:28-00:22:33 ]

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. Many speakers underscored the importance of the ACA in protecting individuals with pre-existing conditions and making coverage accessible through marketplace plans . The impending expiration of enhanced premium tax credits is projected to significantly increase costs for millions of Americans, potentially leading to widespread loss of health coverage and catastrophic financial burdens for those with chronic illnesses . Concerns were also raised that Health Savings Accounts (HSAs) are not a suitable replacement for ACA protections, as they can serve as tax shelters and do not guarantee healthcare spending .

The Essential Role of Care Coordination and Value-Based Models

Care coordination was presented as essential for creating a healthier future, focusing on patient-centered, team-based approaches that are proactive rather than reactive . Integrated health systems like Novant Health and Summit Health detailed their success in reducing complications, emergency room visits, and hospital readmissions through ACOs and value-based programs . These models allow for investment in services like care management, community partnerships, social needs navigation, and predictive analytics, leading to better patient outcomes and cost savings . However, unstable reimbursement rates and misaligned incentives were cited as barriers to broader adoption of these effective models .

Pharmacists as Underutilized Healthcare Resources

Pharmacists, particularly in rural areas, are often the most accessible healthcare professionals and serve as a front door to the healthcare system [ 00:33:42 ]

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. They play a crucial role in medication management, screenings, and chronic disease monitoring, often seeing patients more frequently than other providers [ 00:34:20 ]

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. Legislation such as HR 3164, the Ensuring Community Access to Pharmacist Services Act (ECAPS), seeks to empower pharmacists by allowing Medicare reimbursement for services like testing and treating common conditions, which could reduce hospitalizations and stabilize community pharmacies facing closures [ 00:36:47 ]

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.

The Impact and Potential of Telehealth and Mobile Health

Telehealth and mobile health services were recognized as critical tools for improving access to care, especially in rural communities and for managing chronic diseases . These technologies facilitate care coordination, reduce wait times for specialty care, enable rapid diagnosis (e.g., telestroke), and support hospital-at-home programs . Speakers advocated for making pandemic-era telehealth flexibilities permanent to maintain and expand access, prevent complications, and avoid costly emergency visits .

Tone of the Meeting

The tone of the meeting was largely serious and concerned, reflecting the gravity of the chronic disease crisis and its financial implications [ 00:17:15 ] . While there was a bipartisan recognition of the challenges posed by chronic illnesses and the importance of care coordination, significant partisan tension emerged when discussing healthcare policy and funding, particularly concerning the Affordable Care Act and its premium tax credits [ 00:22:28-00:22:33 ]

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. This led to pointed criticisms and strong advocacy for differing approaches, creating a sense of urgency and sometimes frustration over policy stalemates .

Participants

Transcript

The hearing of the subcommittee will come to order.  Good afternoon, I want to thank our witnesses for being here today.  I know a lot of you traveled away, so we appreciate that.  Discussing important issues, I'm excited about reducing and preventing chronic illness.  Someone said, I'll get to that, but someone said we spent $5 trillion last year in terms of healthcare.   and we're getting worse results, so that's why we're glad to have you here and get your thoughts and ideas.  To combat the chronic diseases epidemic, I strongly believe we need to empower each other to work together to treat and manage patients.  The U.S. has a larger share of people with chronic diseases compared to other countries, more than twice as many Americans in terms of obesity.  In fact, chronic diseases make up about eight out of ten of the top causes of death.   in the United States.  This crisis spans all ages approximately.  When you look at it, even young children at 20 percent, adults at young men, women between 20 and 31 aren't even eligible to serve in the service because they're obese, 31 percent of them.  And then adults in the country, it depends on what you believe, is somewhere between 40 and 50 percent.   We spent $5 trillion a year.  I looked at it.  Someone said it was 4.9.  I looked at it today, and they said 4.5.  They said almost $5 trillion.  On healthcare costs, 90% from the chronic disease alone.  We must do more to help patients and taxpayers.  Too often, our healthcare system responds to health problems only after the crisis.   instead of preventing them in the first place.  That's my philosophy.  Let's not get the cancers and the heart disease and everything.  There's always a percentage that do, unfortunately, but there's a lot of them that shouldn't get it, and they do get it because they haven't done the preventative things ideally.
That's their choice.  I'm not telling anybody.  I just bring that up.  So I'm pleased to recognize the gentleman.   And my good friend from Texas, Mr. Doggett, for his opening statement.
Well, thank you very much, Mr. Chairman.  It's great for us to finally be back together after a long break.  And I appreciate your leadership on lifestyle medicine, on improving care coordination.  This is something that I certainly support.  I just wish that there was bipartisan coordination to come up with a solution   to prevent millions of Americans from losing their access to a family physician and vital medications.  About 60% of American adults have at least one chronic condition.  And I think of people like Walter, a constituent of mine, a small business owner down in Austin.  The Affordable Care Act has protected him from unjust coverage denials due to the fact that he has diabetes.   Many of our Republican colleagues appear to be afflicted with amnesia.  They have forgotten what life was like before the Affordable Care Act, not only for those people who rely on the marketplace, but for everyone when it came to denials for preexisting conditions, a term that was defined broadly to include everything from diabetes to surviving a domestic assault, to being a woman, to being of a certain age.   or any other excuse that an insurer might come up with.  Thanks to the protection for pre-existing conditions, Walter and his wife have been able to rely on marketplace plans to maintain his diabetes treatment and protect them from any other type of unforeseen emergency.  Next year, however, they will pay $700 per month more than they are paying this year for that coverage that is so important to them   because Republicans have taken away the tax credits that allow them to obtain coverage.  I agree with Republicans that we need better cost containment, but they have not acted on some of the remedies that would get us there, such as prescription drug price gouging and Medicare fraud proposals I've advanced.
And after failing more than 70 times,   to replace Obamacare with nothing care, I don't think they really have an alternative plan that begins to offer the kind of basic medical care, offer protection against a medical emergency, when 60% of our fellow Americans say they do not have the resources available to cover a $1,000 emergency.  After more than eight years, all we have from President Trump is what he calls concepts of a plan.   It's a secret plan, apparently.

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