By Claude Pirtle, MD 

President, Heartland Whole Health Institute 

Across the heartland, communities are facing the same reality: chronic disease is reshaping lives, straining local and state economies and challenging health systems. But this moment also presents a significant opportunity to fundamentally shift the paradigm. When states work together, share insights, align incentives and invest in people, we can create a stronger, more sustainable model of long-term, whole-person care. 

At Heartland Whole Health Institute, we see collaboration and convening not as an aspiration, but as an essential strategy for changing the trajectory of health in the region. 

A Regional Challenge That Demands a Regional Response 

Across the heartland, chronic disease isn’t just common — it’s concentrated in communities facing the steepest barriers to care. These conditions drive the vast majority of health spending nationwide, with illnesses such as heart disease, diabetes, cancer and chronic obstructive pulmonary disease accounting for roughly 90% of annual health care costs, according to the CDC. 

In many heartland communities, these conditions cluster in ZIP codes marked by lower income, higher uninsured rates and longer travel to care, leaving patients to navigate barriers that lead to avoidable complications and economic strain. 

The result is a regional health picture that is both preventable and profoundly consequential. It’s why a siloed, state-by-state approach can’t solve what communities are experiencing on the ground. 

What Collaboration Makes Possible 

Throughout the region, we are beginning to see how coordinated action leads to measurable progress. The Heartland Health Caucus is one example of leaders coming together around shared priorities: building a stronger workforce, expanding access through telehealth and investing in prevention. Early momentum, such as the spread of Community Health Worker legislation across multiple states, underscores what becomes possible when policymakers work from a shared playbook informed by the needs of their communities. 

These efforts reflect a broader truth: collaboration accelerates change. When states align, they can scale what works, smooth variation and create a clearer path for providers, payers and patients. We must strengthen our ability to replicate and operationalize proven models from other states; not every effective solution needs to be net new or novel. 

What It Takes to Transform Chronic Disease Care 

A more coordinated and effective system requires four core shifts: 

1. A Payment Model That Rewards Health 

Value-based care models reward health outcomes over patient volume, making prevention and chronic disease management financially sustainable and helping shift the system away from reactive care. By tying reimbursement to meaningful measures such as blood pressure control and HbA1c improvement, value-based care makes it possible for providers to invest in the tools and touchpoints patients need most, including coordinated care teams, telehealth and accessible patient education. 

2. Technology That Extends Care Beyond the Clinic 

Telehealth and remote monitoring have proven their ability to drive adherence, improve control of chronic conditions and reduce avoidable complications. Sustaining these tools — supported by broadband expansion — helps ensure rural communities are not left behind. A JAMA study found that simple text message reminders approximately doubled the odds of medication adherence, illustrating how digital touchpoints can strengthen day-to-day management. Maintaining telehealth reimbursement, paired with continued broadband expansion, can bridge persistent gaps in specialty care and help patients stay connected to the support they need. 

3. A Workforce Built for Whole Person Care

Growing and supporting a diverse workforce — including Community Health Workers, care navigators, pharmacists, nurses and advanced practice providers — strengthens the care team and helps patients get the support they need, when, where they need it and how they would like to receive it. Consistent certification standards and reimbursement structures across states make this growth faster, more flexible and more sustainable. 

Community Health Workers, cross-state licensure and redesigned care teams are particularly powerful in meeting chronic care demand amid nationwide clinician shortages. Aligning these policies across the region expands access and ensures underserved and rural communities benefit first. 

Heartland Whole Health Institute has contributed to this progress by sharing research and convening leaders to inform licensure strategies across heartland states, helping build a more coordinated, whole-person workforce that can scale. 

4. Prevention That Reaches People Early 

By aligning incentives across Medicaid, Medicare, employers and health systems, states can promote trusted, evidence-based programs for diabetes, hypertension, obesity and cardiometabolic risk reduction. Prevention is not a cost center; it is an investment in the long-term vitality of communities and economies. 

Policy Opportunities

• Sustain telehealth flexibility and continued expansion of rural broadband.
• Standardize Community Health Workers certification and reimbursement across states.
• Create a heartland data collaborative to share insights and coordinate interventions.
• Modernize rural infrastructure to support team-based chronic care and telehealth-enabled delivery.
• Expand value-based payment models across heartland states to align incentives for prevention, telehealth and whole-person care. 

The Economic Case 

Chronic diseases burden both health care systems and economies. The Integrated Benefits Institute found that employees living with chronic conditions face an average annual productivity loss of $4,798 per person, driven by increased absenteeism and presenteeism. Without coordinated action, costs will continue to accelerate, with cardiovascular disease alone projected to approach $2 trillion by 2050, according to the American Heart Association. Chronic disease isn’t just a health crisis — it’s an economic one. 

Looking Ahead

Heartland Whole Health Institute is advancing this work by bringing partners together across the health ecosystem to strengthen prevention, improve chronic disease management and generate practical evidence that can guide decision-making across the region. In the years ahead, our focus will remain on building durable partnerships, supporting community- and clinically based interventions and translating insight into action. 

By prioritizing whole-person care and regional collaboration, we aim to help communities make measurable progress toward better health outcomes and a more sustainable system of care. 

A healthier heartland is within reach, and collaboration is how we get there.