Podcast Summary: Becker’s Healthcare Podcast

Episode: Strategies for Reducing the Total Cost of Care – Part 1

Date: March 4, 2026
Host: Sierra Garvin (Behringer Ingelheim)
Guest: Mandy Leonard (Cleveland Clinic)

Episode Overview

This episode inaugurates a four-part series focused on strategies to reduce the total cost of care in U.S. healthcare. Host Sierra Garvin is joined by Mandy Leonard, Senior Director of Drug Use Policy and Formulary Management at the Cleveland Clinic, to discuss the systemic, demographic, and disease-related drivers of high healthcare costs, with an emphasis on chronic conditions, wasteful spending, and rare diseases.

Key Discussion Points & Insights

U.S. Healthcare Spending Overview (02:47)

• U.S. Outpaces Other Nations in Healthcare Spending: Healthcare accounted for nearly 18% of GDP in 2023.
• Federal Government Expenditures: The federal government pays for nearly one-third of all healthcare spending.
• U.S. Health Metrics Lag: Despite high spending, the U.S. falls behind other countries in life expectancy, obesity rates, infant mortality, and diabetes hospital admissions.
  • Quote [03:03, Mandy Leonard]:
    “What's most unfortunate is, is that despite our larger expenditures, the US ranks behind other countries in key health metrics, such as life expectancy, obesity rates, infant mortality, and hospital admissions for diabetes.”

Drivers of High Healthcare Costs (03:38)

• Aging Population: By 2032, individuals 65+ will make up over 20% of the population.
• High Utilizer Impact: 5% of Americans are responsible for nearly half of all healthcare spending, predominantly older adults and those with chronic illnesses.
  • Quote [03:43, Mandy Leonard]:
    “Just 5% of the US population is responsible for nearly half of all healthcare spending.”

The Role of Chronic Conditions (04:28)

• Magnitude of Chronic Disease Costs: 90% of U.S. healthcare spending is tied to chronic and mental health conditions. 60% of adults have at least one chronic condition.
  • Quote [04:28, Mandy Leonard]:
    “About 90% of US healthcare spending involves chronic and mental health conditions, and about 60% of Americans have at least one chronic disease.”
• Hospitalizations and Prescriptions: Patients with chronic diseases drive the majority of hospitalizations and prescription fills.

Modifiable Risk Factors (05:01)

• Leading Risk Factors: High BMI, blood pressure, plasma glucose, poor diet, and smoking are major modifiable contributors.
• Older Adults at Risk: The majority of spending related to these factors involves patients 65 and older.
• Conditions Linked to Modifiable Risks: Musculoskeletal, respiratory, digestive, mental health, substance use, and neurological disorders.

Most Costly Chronic Conditions (05:50)

• Top Offenders: Cardiovascular diseases, cancer, diabetes, chronic kidney disease, and autoimmune diseases.
  • Quote [06:05, Mandy Leonard]:
    “Cardiovascular diseases are the leading cause of death and cost over $250 billion annually to treat... diabetes or prediabetes, resulting in the astounding annual cost of $413 billion.”

Multiple Chronic Conditions (MCCs) (06:36)

• Prevalence & Impact: Over 55% of Americans have multiple chronic conditions (MCCs).
• Worse Outcomes & Higher Costs: MCCs increase mortality, reduce quality of life, and elevate healthcare use.
• Most Costly MCC Combinations: Heart failure with cardiovascular disease ($30,000+ per patient annually), diabetes with depression/anxiety, cardiovascular disease with other chronic illnesses.
  • Quote [07:22, Mandy Leonard]:
    “The most expensive two way combination is heart failure and cardiovascular diseases, which is associated with annual medical costs of over $30,000 per patient.”

Rare Diseases (08:27)

• Definition & Prevalence: Affect fewer than 200,000 patients each, with a collective population of 25–30 million affected Americans.
• Economic Impact: Nearly $1 trillion annual burden (direct: $449B, indirect: $437B), including productivity and opportunity loss due to disability.
  • Quote [09:10, Mandy Leonard]:
    “The economic burden of rare diseases was estimated to be nearly $1 trillion... The economic burden created by the direct cost for rare diseases is $449 billion.”

Wasteful Healthcare Spending (09:43)

• Wasteful Spending Estimate: Approximately 25% of all healthcare expenditures are considered waste.
• Six Domains of Waste:
  1. Failure of care delivery (hospital-acquired conditions, lack of preventive care)
  2. Failure of care coordination (unnecessary admissions and complications)
  3. Over-treatment/low-value care (unnecessary tests, treatments)
  4. Pricing failure (medication and service overpricing)
  5. Fraud and abuse (including Medicare)
  6. Administrative complexity (billing inefficiencies, excessive reporting)
• Potential Savings: Addressing these domains could reduce total waste costs by about 25%.
  • Quote [10:17, Mandy Leonard]:
    “A review article published by JAMA in 2019 found that wasteful spending accounted for about 25% of all healthcare expenditures at that time.”

Memorable Moments & Quotes

• On Outspending for Worse Outcomes:
  “Despite our larger expenditures, the US ranks behind other countries in key health metrics.” (03:03, Mandy Leonard)
• On Chronic Disease Costs:
  “About 90% of US healthcare spending involves chronic and mental health conditions...” (04:28, Mandy Leonard)
• On High-Utilizer Impact:
  “Just 5% of the US population is responsible for nearly half of all healthcare spending.” (03:43, Mandy Leonard)
• On Waste in the System:
  “...Wasteful spending accounted for about 25% of all healthcare expenditures at that time.” (10:17, Mandy Leonard)
• On Complex, Costly Combinations:
  “The most expensive two way combination is heart failure and cardiovascular diseases, which is associated with annual medical costs of over $30,000 per patient.” (07:22, Mandy Leonard)

Important Timestamps

• 00:29 — Series and Episode Introduction by Sierra Garvin
• 02:47 — Overview of U.S. healthcare spending (Mandy Leonard)
• 03:38 — Key cost drivers: aging, high utilizers
• 04:28 — Impact of chronic and mental health conditions
• 05:01 — Modifiable risk factors and associated costs
• 05:50 — Most costly chronic diseases
• 06:36 — Multiple chronic conditions and their impact
• 07:12 — Most common and expensive MCC combinations
• 08:27 — The burden of rare diseases
• 09:43 — Wasteful spending and its domains
• 11:22 — Episode wrap-up and closing remarks

Closing Thoughts

This comprehensive episode frames the immense challenge ahead in reducing the total cost of healthcare in the U.S. Mandy Leonard highlights how demographic shifts, chronic conditions, rare diseases, and systemic inefficiencies all play integral roles in soaring expenditures. The episode sets the stage for subsequent discussions on value-based care and actionable solutions to bend the cost curve.

For further insights, tune into the next episode focused on value-based care and its role in cost reduction.