AHIP Outlines Nine Policies to Combat Chronic Conditions

The Scale of America’s Chronic Disease Crisis

Chronic conditions are making Americans sick — and the financial toll is staggering. The U.S. spends $4.9 trillion on healthcare annually, with 90% of that going toward chronic condition treatment. Moreover, the most prevalent contributors to chronic conditions include unhealthy eating, insufficient physical activity, low use of preventive screenings, medication non-adherence, and behavioral health factors such as tobacco and excessive alcohol use.

The CDC estimates that over three-quarters of American adults have at least one chronic condition, forcing healthcare leaders to strategize around system strain, quality of life, and costs. This reality demands urgent, coordinated policy action — and AHIP has stepped up with a clear roadmap.

What AHIP Recommends: An Overview

In a March report, AHIP — formerly America’s Health Insurance Plans — outlined approaches payers can take to address this challenge. The trade association suggested several areas of focus for insurers, including upstream prevention, benefits design, social determinants, medication adherence, and more.

To help confront these trends, AHIP convened a Task Force of Chief Medical Officers and public policy leaders from more than 30 health plans — representing about 200 million covered Americans — to identify evidence-based strategies to reduce chronic disease prevalence by at least 10 percent by 2035.

Even though health plans can voluntarily take steps toward better outcomes for those with chronic diseases, AHIP also laid out nine specific policy and regulatory recommendations for policymakers and regulators to act on.

Key Policy Recommendations by Category

Modernizing Wellness and MLR Regulations

AHIP advocated for updated regulations with employee wellness programs and more flexibility for states to incorporate wellness programs into the individual market. Currently, some administrative costs can serve as a benefit expense in the medical loss ratio, if they directly boost quality.

Furthermore, AHIP is pushing for HHS to broaden the definition of allowable costs in the numerator to incentivize chronic disease prevention strategies. This shift would reward health plans that invest proactively in prevention, rather than penalizing them for spending on programs that reduce long-term disease burden.

Expanding HSA and High-Deductible Plan Flexibilities

Greater flexibilities for health savings accounts and high-deductible plans could allow members greater access to chronic disease treatments. Removing barriers at the point of care encourages earlier intervention, which is far more cost-effective than treating advanced disease. Reforms here could meaningfully expand access for millions of Americans who currently delay treatment due to cost.

Strengthening Value-Based Care Models

CMS should continue rolling out and amplifying chronic disease-focused models to support value-based arrangements. Value-based care aligns financial incentives with health outcomes, motivating providers and plans alike to keep members healthier. Additionally, the roadmap emphasizes stronger prevention, earlier intervention, and more effective care management, supported by policy changes that facilitate progress.

Broadening Medicare and Medicaid Supplemental Benefits

CMS could broaden Medicare and Medicaid policies to allow members to embrace supplemental benefits and in-lieu-of-services for proven chronic condition resources and services. Supplemental benefits — such as transportation, home modification, and fitness programs — have demonstrated real-world impact on chronic disease management. Expanding access to these tools is a cost-effective strategy for reducing hospitalizations and emergency visits.

Prioritizing Nutrition and Food Access

Prioritizing food — by establishing nutrition program safe harbors and releasing best practices for Medicaid food interventions — is another of AHIP’s calls to action. Diet is among the most modifiable risk factors for chronic conditions such as diabetes, hypertension, and heart disease. Safe harbor protections would encourage health plans to invest in food-as-medicine programs without regulatory uncertainty.

Enhancing Data Interoperability and Telehealth

Wider data interoperability and permanent telehealth flexibilities can help with prevention coordination and care access. Telehealth has proven especially valuable for managing chronic conditions in rural and underserved communities. Meanwhile, seamless data sharing allows care teams to coordinate more effectively and intervene earlier when patients show warning signs.

Why These Policies Matter Now

Achieving a 10 percent reduction in chronic disease by 2035 will require continued collaboration among health plans, providers, employers, community organizations, and policymakers. Strengthening prevention, early detection, and coordinated care will improve health outcomes, make coverage more affordable, and support the long-term sustainability of the health care system.

Some of the most costly and prevalent chronic conditions in the U.S. include hypertension, high cholesterol, coronary heart disease, chronic obstructive pulmonary disease, asthma, chronic kidney disease, diabetes, and cancer. Together, these conditions affect tens of millions of Americans — and each one is increasingly manageable with early intervention and the right policy environment.

The Road Ahead for Health Plans

Health plans are not waiting for Washington to act. Health plans are voluntarily building on strategies across five categories designed to improve prevention, early detection, and chronic care management, including promoting healthy behaviors, early identification, behavioral health prevention, and integration in care.

Nevertheless, policy reform remains essential. Regulatory flexibility, modernized payment structures, and expanded benefits design give health plans the tools they need to truly move the needle on chronic disease. The nine recommendations AHIP outlined are not aspirational — they are actionable, evidence-based, and urgently needed.