AHIP Sets Ambitious Target to Reduce Chronic Disease: What the Evidence Says and Where Gaps Remain

Chronic diseases are one of the central issues in health care today. According to the CDC, 76% of American adults have at least 1 chronic condition, and over half have multiple.¹ Together, these conditions account for 90% of the country's $5.3 trillion in annual health care expenditures. Adolescents are now 15% to 20% more likely to have a chronic condition than they were in 2011, suggesting the pipeline of disease burden is expanding, not contracting.²

Against this backdrop, AHIP (formerly America’s Health Insurance Plans) released a March 2026 report titled Improving Chronic Disease Prevention and Management: Evidence-Informed Practices, Policy, and Partnerships. The report was developed by a task force of chief medical officers and policy leaders from more than 30 health plans collectively covering approximately 200 million Americans. It sets an aspirational target: reduce the current rate of chronic disease prevalence by at least 10% by 2035.

"Chronic disease is now the dominant driver of poor health outcomes and health care costs in the US, and without a different approach, that trajectory will only continue to accelerate," said LaShawn McIver, MD, MPH, chief health officer at AHIP, in an interview with The American Journal of Managed Care^® (AJMC^®).³ "The report really emphasizes that prevention, early identification, and coordinated care across clinical and community settings are critical."

McIver, a public health physician who previously served as director of the Office of Minority Health at CMS, was clear that neither the ambition nor the responsibility belongs to health plans alone. "There's no single stakeholder that can do this alone," she said. "Our progress will depend on alignment among plans, providers, employers, communities, and policymakers."

What Health Plans Bring to the Table

The report frames health plans as uniquely positioned actors due to their longitudinal visibility. Unlike providers who typically see patients episodically, health plans track members across conditions, care settings, and time. That vantage point allows them to identify gaps in care early, support data-driven outreach, and coordinate services that extend well beyond traditional clinical encounters.

"We operate at that intersection of care delivery, financing, and population health," McIver notes. "This perspective allows us to identify gaps early, support data-driven outreach, align incentives toward prevention, and coordinate services that extend beyond traditional clinical care."

The report outlines 5 domains for voluntary health plan action: enabling healthy behaviors and care management; behavioral health prevention and integration; diabetes prevention and physical activity; cardiovascular disease prevention and management; and cancer prevention and early detection. Many of these actions are tied to existing Health Effectiveness Data and Information Set measures, providing a framework for tracking whether goals are actually being met.

Where the Evidence Is Strongest and Where Scaling Remains the Challenge

Behavioral health integration with primary and specialty care has a robust evidence base that demonstrates that when implemented successfully, it improves medication adherence, reduces complications, and leads to better long-term chronic disease management. The report calls for expanding the number of practices offering integrated behavioral health and notes the comorbidity burden that makes this integration essential.

Yet scaling remains uneven. McIver cited workforce shortages, fragmented payment for behavioral health services, and regulatory barriers as persistent obstacles. "The next phase for this is really about aligning policy, technology, and financing so that integrated care becomes the norm and not the exception," she said.

Nutrition-based interventions represent another area where the evidence has matured considerably. The report spotlights medically tailored meals (MTM) as a particularly promising tool for people with complex chronic conditions. AmeriHealth Caritas District of Columbia's MTM program, for example, documented a 19% reduction in total annual costs among diabetes participants compared with a 99% increase in a matched control group. Additionally, they showed a 63% reduction in preventable hospital admissions. While these results are not causal, they do show that there is a significant positive correlation between MTM and positive outcomes experienced by participants.

"The evidence base for nutrition-based interventions has advanced significantly," McIver said. "What payers now need is clear guidance on targeting and value—specifically when these interventions work best, for whom, and under what conditions." The report calls for a nutrition program safe harbor to protect providers from patient inducement risks, as well as expanded health savings account (HSA) flexibility and higher Medicaid In Lieu of Services (ILOS) caps to make food benefits more broadly available.

The Workforce Gap: Community Health Workers

Community health workers occupy a prominent place in the report as trusted liaisons who can bridge clinical care and community-level social needs. The evidence supports their effectiveness when they are well integrated and well resourced. But as McIver acknowledged, the barriers are structural and multifaceted.

"To scale nationally, we need greater consistency in training standards, clear credentialing pathways, and long-term payment mechanisms," she said. "Policy makers can help by aligning definitions, supporting evidence development, and reducing administrative friction while allowing flexibility to reflect local needs."

The same workforce challenge applies to telehealth. The COVID-19 pandemic normalized telehealth use at a scale previously unimaginable, and the report supports making remaining temporary Medicare telehealth flexibilities permanent. McIver was direct about the stakes: "Rolling back telehealth access would disrupt care for many people managing chronic conditions, particularly those who rely on frequent touch points."

Health Equity: A Requirement, Not an Add-On

The report emphasizes that chronic disease does not burden all populations equally. Minority populations face disproportionately higher rates of chronic illness, driven by systemic inequities in access to preventive care, elevated exposure to social and environmental risk factors, and barriers to timely treatment. These disparities are structural, and they require intentional design to address them.

"Without that intentionality, well-intended interventions risk widening gaps rather than closing them," McIver cautioned. She called for data stratification and continuous monitoring of outcomes, with interventions tailored to differences in access, risk, and need alongside meaningful community engagement at the program design stage.

Looking Forward

The report also notes that voluntary health plan actions, however well designed, are insufficient on their own. Realizing the 10% goal requires regulatory modernization across multiple domains including revisions to employer wellness program rules, medical loss ratio definitions, HSA flexibility, Medicaid ILOS caps, data interoperability standards, and behavioral health payments.

When asked what single regulatory change would have the greatest immediate impact, McIver stated that she "would focus on modernizing our regulatory policies to support rewarding healthy behaviors. When coverage rules allow plans to intervene earlier and more consistently, prevention can become operational rather than aspirational."

References

1. Improving Chronic Disease Prevention and Management: Evidence-Informed Practices, Policy, and Partnerships. AHIP; March 23, 2026. Accessed April 21, 2026. https://www.ahip.org/resources/improving-chronic-disease-prevention-and-management

2. Forrest CB, Koenigsberg LJ, Harvey FE, Maltenfort MG, Halfon N. Trends in US children’s mortality, chronic conditions, obesity, functional status, and symptoms. JAMA. 2025;334(6):509-516. doi:10.1001/jama.2025.9855

3. Hohmann E, McIver L. How health plans are leading the fight against chronic disease. AJMC. April 20, 2026. Accessed April 21, 2026. https://www.ajmc.com/view/how-health-plans-are-leading-the-fight-against-chronic-disease-lashawn-mciver-md-mph