Congressional Briefing Examines Complex Patient Populations

Mary Mailloux, M.D., Aetna’s National Medical Director for Aetna Community Care and D-SNP, answers a question from the audience.

The Healthcare Leadership Council (HLC) hosted a briefing on Capitol Hill that addressed the needs of complex patient populations.  Featured panelists represented Adventist Health Systems, Aetna, and Novo Nordisk.    All three speakers presented research and recommendations on how to improve the health of individuals – many of whom have multiple complex illnesses – that represent just five percent of the patient population, but account for 50 percent of the nation’s healthcare spending.

Michael Griffin, Vice President of Advocacy and Public Policy for Adventist Health Systems, highlighted determinants of health — clinical care, patient behaviors, social economic factors, and environment.  He stated that socioeconomic factors have the largest impact on health in comparison to counseling, education, and clinical interventions which manage but do not address the root cause of a symptom.  Mr. Griffin listed access to care, behavioral health, and food security as the biggest challenges affecting health outcomes.

Mary Mailloux, M.D., Aetna’s National Medical Director of Aetna Community Care and Medicare D-SNP, introduced Aetna’s care management program that utilizes a community-based care team to ensure members overcome barriers to health. Social workers and community health educators are present to get to know individuals and assist them with complex needs.  Having people on the ground who can answer questions and address problems has shown to keep people healthier.

Gabriel Smolarz, M.D., Medical Director of Obesity for Novo Nordisk, explained that there is no medical specialty managing obesity.  Healthcare professionals are not taught how to treat obesity, and patients have limited treatment options. Obesity is a complex disease influenced by genetic, environmental, socio-economic and psychological factors.  He stated that direct medical costs tied to obesity are over 400 billion dollars per year, while indirect economic costs are nearly a trillion.