How Health Plans Are Leading the Fight Against Chronic Disease: LaShawn McIver, MD, MPH

Chronic disease is the dominant driver of poor health outcomes and unsustainable health care costs in the US, affecting three-quarters of American adults and accounting for nearly all of the country's $5.3 trillion in annual health spending.¹ In March 2026, AHIP (formerly America’s Health Insurance Plans) released a report titled Improving Chronic Disease Prevention and Management: Evidence-Informed Practices, Policy, and Partnerships that was developed by a task force of chief medical officers and policy leaders from more than 30 health plans covering approximately 200 million Americans. The report sets an aspirational goal of reducing chronic disease prevalence by at least 10% by 2035 and outlines both voluntary health plan actions and targeted government policy recommendations to get there. The American Journal of Managed Care^® (AJMC^®) spoke with LaShawn McIver, MD, MPH, chief health officer at AHIP and a public health physician with 2 decades of experience, about the motivations behind the report, the strategies it prioritizes, and what achieving that goal will actually take.

This transcript was lightly edited for clarity.

AJMC: What motivated this report, and what are the most important takeaways in your view?

McIver: 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. It now affects more than three-quarters of US adults and accounts for the overwhelming share of health care spending, making it one of the defining challenges for cost, quality, and sustainability in the American health care system.

Back in 2025, at the direction of our board of directors, we convened our chief medical officers and several policy leaders from more than 30 of our health plan members. Together they cover approximately 200 million Americans. This group focused on identifying practical, evidence-informed strategies to reduce that burden.

What stands out in the report is the shift to focusing upstream. In other words, how do we think about these issues rather than just focusing solely on disease management after diagnosis occurs. The report really emphasizes that prevention, early identification, and coordinated care across clinical and community settings are critical. There's no single stakeholder that can do this alone, and our progress will depend on alignment among plans, providers, employers, communities, and policy makers.

AJMC: The report sets a goal of reducing chronic disease prevalence by 10% by 2035. How confident are you in that target?

McIver: We acknowledge that a 10% reduction is ambitious, and we consider this an aspirational goal, but it is grounded in evidence and what we feel is a scalable infrastructure. We know already that there are many interventions proven to work: earlier screening, better behavioral health integration, improved medication adherence, nutrition support, and sustained lifestyle interventions. The challenge has been deploying them consistently and at the scale required to meet the magnitude of the problem.

Health plans engage individuals throughout every stage of the care continuum and over extended periods of time. When prevention is embedded in benefit design, care models, and member engagement—and reinforced year after year—the effects accumulate. This is not a short-term intervention. It's a decades-long strategy built on steady, measurable progress. We felt it was important to have something measurable over a period of time, so that we can hold ourselves accountable.

AJMC: The report frames health plans as having a unique vantage point across stakeholders. What specifically allows health plans to do what others cannot?

McIver: What we feel is unique about health plans is that we operate at that intersection of care delivery, financing, and population health, and we have longitudinal visibility across conditions, settings, and time. That's something that is not necessarily true for episodic care alone. 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.

Importantly, this isn't about plans acting independently. It's about using that system-level view to bring together other stakeholders including providers, employers, and community partners around shared outcomes.

AJMC: Behavioral health integration with primary and specialty care is highlighted as a key voluntary action. What does meaningful integration look like in practice, and how far is the industry from achieving it at scale?

McIver: When behavioral health is integrated, we see better adherence, fewer complications, and more sustainable chronic disease management. Meaningful integration treats behavioral health as a routine component of care rather than a downstream referral. When it's done successfully with standardized screening in primary care, shared care plans, warm handoffs between providers, and payment models that support team-based care, the evidence is clear that it improves adherence and chronic disease outcomes.

The challenge is that scaling it remains uneven, due to workforce shortages, continued fragmentation in behavioral health payment, and some regulatory issues that limit adoption. The next phase for this is really about aligning policy, technology, and financing so that integrated care becomes the norm and not the exception.

AJMC: The report classifies food insecurity and nutrition as health care issues rather than social issues. Can you speak to the evidence base for the food-as-medicine movement and what payers still need to see for broader adoption?

McIver: The evidence base for nutrition-based interventions has advanced significantly, particularly for medically tailored meals and targeted food benefits among people with complex conditions. There are several studies showing meaningful improvements in disease management and reductions in avoidable utilization for defined populations. What payers now need is clear guidance on targeting when these interventions work best, for whom, and under what conditions.

Regulatory clarity in this space, including the safe harbors we mentioned in the report, and standardized best practices are also going to be essential so that plans and providers can partner confidently while continuing to evaluate outcomes. Food security and access to appropriate medical nutrition are so key for people living with chronic diseases, which is why we wanted to focus on it in the report.

AJMC: Community health workers are described as a critical workforce lever. What needs to happen at the federal and state level to standardize training and credentialing in a way that actually scales these programs?

McIver: Community health workers have been shown to be most effective when they're integrated into care teams, supported by data, and sustained through reliable funding. To scale nationally, we need greater consistency in training standards, clear credentialing pathways, and long-term payment mechanisms. These have been major barriers for years.

Policy makers can help address some of these challenges by aligning definitions, supporting evidence development, and reducing administrative friction while still allowing flexibility to reflect local needs and community context. There is a great opportunity for the administration to make a meaningful difference here.

AJMC: What measures need to be embedded in this work to ensure improvements are equitable?

McIver: Chronic disease often has a disproportionate impact on minority populations, driven by long-standing inequities in access to preventive care, higher exposure to social and environmental risks, and barriers to timely, high-quality treatment. When we think about equitable improvement, this requires designing prevention and care strategies that work across populations, not just those with the fewest barriers.

That starts with data stratification, continuous monitoring of outcomes, and tailoring interventions to reflect differences in access, risk, and need. It also requires meaningful community engagement in program design. Without that intentionality, well-intended interventions risk widening gaps rather than closing them.

AJMC: What evidence exists that telehealth meaningfully reduces chronic disease burden, or is that case still being built?

McIver: Telehealth has expanded access and continuity, particularly for follow-up care, behavioral health, and chronic condition monitoring. When used appropriately, it supports adherence, allows for earlier intervention, and enables more consistent patient engagement. We already have demonstrated evidence of the effectiveness of telehealth during the COVID-19 era where it operated on a widespread scale. Now the goal is maintaining the flexibility that makes it work.

Rolling back telehealth access would disrupt care for many people managing chronic conditions, particularly those who rely on frequent touch points. There are so many different tools and ways to engage populations experiencing chronic disease that would benefit from our continued evolution in how we integrate telehealth into this work.

AJMC: If you could make one regulatory change tomorrow with the greatest impact on chronic disease prevention, what would it be?

McIver: If we were to start tomorrow, I would focus on the overarching goal of modernizing our regulatory policies to support rewarding healthy behaviors. Policy can remove barriers in such a profound way so that prevention happens well before a condition becomes harder and more expensive to manage. Greater flexibility in benefit design to support evidence-based prevention initiatives would have an immediate impact.

When coverage rules allow plans to intervene earlier and more consistently, prevention can become operational rather than aspirational. That would be my wish—if I could wave that wand and get number one started on our public policy recommendations, that's where I would start.

Reference

1. Improving Chronic Disease Prevention and Management: Evidence-Informed Practices, Policy, and Partnerships. AHIP; March 23, 2026. Accessed April 17, 2026. https://www.ahip.org/resources/improving-chronic-disease-prevention-and-management