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Why the U.S. Must Bridge Health and Health Care

Washington, DC – To confront the underlying challenge of poor population health in the U.S., leaders of the Bipartisan Policy Center’s Future of Health Care Initiative crafted a series of federal policy recommendations aimed at improving coverage of and access to primary care and preventive services—Bridging Health and Health Care.

The COVID-19 pandemic laid bare the impact of poor population health, with 63.5% of hospitalizations from the virus resulting from chronic conditions like obesity, hypertension, diabetes, and heart failure. Effective public health interventions would have resulted in fewer virus-related deaths and cases of serious illness, as well as fit into a larger strategy to help people live longer, healthier lives.

Bridging Health and Health Care focuses its recommendations on two key areas: improving access to and coverage and financing of non-medical and preventive services, and increasing capacity of the health care workforce to better support integration. Specific recommendations include:

  1. Authorizing the Health and Human Services (HHS) Secretary to expand Medicaid coverage of non-medical services that address social needs and community-based interventions,
  2. Requiring coverage of clinical preventive services without cost-sharing in Medicaid for the non-expansion population, and
  3. Directing the HHS secretary to provide CMS guidance to states on defining and reimbursing community health workers within their Medicaid programs.

The U.S. has built up an overburdened sick care system that takes a reactive approach to treating illness. Future of Health Care leaders believe that reorienting the health care system to build on prevention and primary care is long overdue. Not only will a prevention-oriented approach critically promote overall population health—it will reduce health care costs and improve health outcomes.

“Expanding access to preventive services in Medicaid would help reduce the risk of diseases, disabilities, and death,” said Tim Westmoreland, professor from practice at Georgetown University Law Center and the O’Neill Institute for National and Global Health Law. “Rather than caring for Americans only after they get sick, we should invest in the resources that will prevent illness.”

“Other high-income countries that spend more per GDP on social services and public health interventions experience better health outcomes compared to the U.S.,” said Gail Wilensky, co-chair of the Future of Health Care Task Force. “That is because investments in ‘sick care’ fail to address the underlying factors that lead to illness in the first place.”

The U.S. can improve population health and health outcomes by integrating social services with the health care system and addressing social determinants of health before they lead to or exacerbate chronic illness. This report recommends a multi-faceted approach that improves Medicaid-covered preventive and non-medical services and strengthens the primary care workforce through an independent evaluation of workforce shortages, greater use of telehealth and other technology, and higher reimbursement rates for select Medicaid services.

The report concludes: “BPC’s recommendations represent a bipartisan step toward bridging public health and health care, starting with the expansion of Medicaid coverage of services that enhance health and actions to bolster the workforce and empower providers to address social determinants of health. These proposals aim to increase access to services that prevent the onset of chronic conditions, stem disease progression and, therefore, lead to better health outcomes and drive down health care costs.”

Read the report