America's Most Expensive Health Problem Is One We Don't Measure

The United States spends more on healthcare than any nation in the world, yet policymakers continue to struggle with a fundamental challenge: despite extraordinary investment, the overall health of the population is not improving at a pace commensurate with the resources being deployed. National health expenditures now exceed $5 trillion annually, with Medicare and Medicaid representing a substantial share of that spending. At the same time, chronic disease continues to drive an increasing percentage of healthcare utilization, disability, and long-term financial exposure across public and private healthcare programs.

Much of the national conversation surrounding healthcare costs focuses on payment models, pharmaceutical pricing, provider reimbursement, insurance design, or healthcare access. These discussions are important, but they often overlook a more fundamental issue. Healthcare spending is primarily measured through claims, encounters, prescriptions, admissions, and utilization metrics. While those measures provide valuable insight into how healthcare dollars are being spent, they provide considerably less insight into whether the underlying health of a population is improving.

The Measurement Gap

This distinction becomes particularly important when examining metabolic disease. Conditions such as Type 2 diabetes, cardiovascular disease, hypertension, chronic kidney disease, obesity, and many related disorders account for a significant portion of healthcare expenditures across Medicare, Medicaid, and commercial insurance programs. These conditions rarely develop suddenly. In most cases, they represent the culmination of metabolic deterioration that has occurred over many years. By the time the disease appears prominently in claims data, the underlying risk factors have often been progressing for a decade or longer.

The challenge for policymakers is that most healthcare measurement systems are designed to capture the consequences of poor health rather than the progression of health itself. Medicare can report utilization with extraordinary precision. Medicaid agencies can track expenditures across numerous categories of care. Health plans can identify high-cost claimants, pharmacy trend, inpatient utilization, and emergency room utilization. Yet there remains no broadly adopted longitudinal framework for measuring whether a defined population is becoming metabolically healthier over time.

A Framework for Measuring Health Over Time

The Community Metabolic Health Index (cMHI) was developed around that premise. Along with the individual Metabolic Health Index (MHI) and the Employer Metabolic Health Index (eMHI), the framework seeks to establish a longitudinal method for evaluating metabolic health across individuals, employer populations, and communities. The objective is not to replace existing healthcare measurement systems, but rather to complement them by addressing a question that existing systems were never specifically designed to answer: Is the population becoming healthier?

Before we can improve health and control costs, we must measure health over time. Understanding risk earlier allows resources to be allocated more effectively. Supporting interventions that improve health — not just manage disease — produces better outcomes. And improving population health ensures the long-term sustainability of Medicare, Medicaid, and the broader healthcare system.