Bringing health and healing to the chronically ill

By Josh Mendelsohn

A Daring Approach to Care
The Problem

Over 100 million Americans suffer from chronic illnesses

Nearly half the American population is suffering from an incurable or chronic disease. And by 2020, that number is projected to grow to a chilling 157 million, with 81 million suffering from multiple conditions.


of Americans suffer from a chronic or incurable illness


of hospital admissions are due to chronic ailments

7 out of 10

deaths in the U.S. are due to chronic diseases

The state of health in America is experiencing a concerning decline. Chronic diseases are among the most prevalent and costly health conditions in the United States. And they’re far more prevalent than most think: chronic conditions are physical or mental health issues that last more than a year and cause functional restrictions that require ongoing monitoring and treatment.

Generally incurable and ongoing, chronic diseases affect approximately 133 million Americans, representing more than 40% of the total population of this country. These health issues are ongoing, generally incurable illnesses or conditions, such as heart disease, asthma, cancer, and diabetes. These diseases are often preventable, and frequently manageable through early detection, improved diet, exercise, and treatment therapy. And the number of people with chronic conditions is rapidly increasing. In 2015, a study documented a shocking trend: despite advances in medical technology, middle-age white Americans are dying at younger ages for the first time in decades. Every year more than 1.7 million Americans die from a chronic, incurable disease.

The rise of chronic diseases are leaving healthcare payers with the challenge of covering care for patients with these expensive, long-term conditions. Chronic diseases account for the vast majority of health spending – in 2005, total spending on public and private health care amounted to nearly $2 trillion. People with chronic conditions are the most frequent users of health care in the U.S. They account for 81% of hospital admissions; 91% of all prescriptions filled; and 76% of all physician visits.

A 2007 study reported that chronic diseases including cancer, diabetes, stroke, heart disease, and pulmonary conditions have an impact $1.3 trillion annual impact on the economy. By the year 2023, this number is projected to increase to $4.2 trillion in treatment costs and lost economic output. Health care premiums have increased by 87% in the last twenty years, and the average costs for chronic patients is over $6,000 annually, which is five times higher than for those without a condition. The total cost of obesity alone to U.S. companies is estimated at $13 billion annually. This includes the impact costs, such as health insurance ($8 billion), sick leave ($2.4 billion), life insurance ($1.8 billion), and disability insurance ($1 billion) that are associated with obesity. Of that amount, more than 75% went toward treatment of chronic disease.

The disconnect is that many of these conditions could be dramatically reduced with the right care. Many chronic diseases could be prevented, delayed, or alleviated, through simple lifestyle changes. According to the New England Journal of Medicine, people with chronic conditions typically receive less than 60% of the recommended preventive measures prescribed. Compared with other developed nations, the U.S. ranks poorly on cost and outcomes. This is predominantly because of our inability to effectively manage chronic disease. A recent Milken analysis estimated that modest reductions in unhealthy behaviors could prevent or delay 40 million cases of chronic illness per year. If we learn how to effectively manage chronic conditions, thus avoiding hospitalizations and serious complications, the healthcare system can improve quality of life for patients and greatly reduce the ballooning cost burden we all share.

The Solution

Improving care outcomes for chronically ill patients

Collectively, Medicare and Medicaid spending has reached nearly $1.2 trillion, over a third of national health expenditures, and exceeding private health insurance spending by $2 billion.

Roster is on a mission to address these growing trends through an innovative approach to improving care outcomes for chronically ill patients through community-based engagement.


of medicaid patients account for 63% of total costs

One-on-one human contact has been shown to dramatically drive increased medical adherence.

As a country, the United States spends about as much on Medicaid as on Medicare. Most are aware of Medicare because it’s a program for seniors, while Medicaid is the less loved, more controversial stepchild. Most Medicaid consumers are economically disadvantaged, and far too often, children.

The overuse of U.S. emergency departments and hospital readmissions is responsible for $85 billion in unnecessary Medicaid spending. Medicaid enrollees use emergency rooms at roughly 4x the rate of privately insured patients. Within the medicaid population, 6% of patients account for 63% of total costs. These are individuals who have chronic illnesses and disabilities that make them quite ill, but will still live long lives. For years, these patients were lucrative for hospitals which were happy to welcome them into emergency rooms and into beds and expensive overnight stays. But that changed through a series of reforms at the Federal and State levels. Hospitals, for the first time since the creation of these health programs, have incentive to keep these patients out of emergency room and healthy.

Reducing costs is about getting patents healthier, and keeping them healthy. In many cases, this is simpler to achieve than most think. Modern medicine has made great advances, so often the struggle is in the simple act of ensuring patients are taking their medications daily. With regular medication adherence and preventative screening, these patients move from among the 6% that drive 60% of costs, to the bottom 50% that drive 8% of costs. The challenge is creating scalable ways to help keep these patients out of acute health struggles and therefore away from expensive hospital visits.

Roster is a new healthcare company taking a unique approach to improving care outcomes through community-based engagement. Roster turns community leaders into highly effective healthcare facilitators through the use of smart, mobile technology that ensures they ask the right questions and have access to immediately useful resources.

Roster works with hospital systems to ensure that patients who are most at risk for poor adherence, but most likely to be able to stay healthy with adherence, are visited one or twice weekly by a member of the Roster team. Roster team members are pillars of their communities: retired foremen, church lay leaders, rotary club presidents. This army of certified healthcare assistants check on neighbors who have enrolled in the Roster program through their hospital of record. This empowers a whole new level of community-driven care – Roster assistants have the advantage of walking the same streets, drinking the same coffee, and rooting for the same home team as the patients they care for. The human touch is as important as ever. And while Roster’s mobile technology ensures caregivers are asking the right questions and have access to useful resources, technology cannot replace the power of connection in the healing process.

Roster’s mission is ambitious and bold, but they have a powerful force working in their favor: it’s the right thing to do. And its connecting people back to their communities, neighbors, and cities, while also improving lives and improving health. Roster is currently piloting their program at one of the best hospitals in the country and will be launching in two additional states in 2019.