Many new care models in both the public and private sector focus on people with chronic diseases, particularly conditions like diabetes, congestive heart failure, and hypertension. The Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) pilot program serves veterans at risk of needing long term care for chronic conditions. Physician payment reform models for primary care, such as patient-centered medical homes (PCMH), promise the greatest benefits when serving patients with complex, chronic needs. And Special Needs Plans for Dual Eligibles (D-SNP), part of Medicare Advantage, include chronic conditions data among their quality measures.
Reformers have good reason to target patients with chronic conditions. Such patients account for huge portions of health costs and spending, and also present a big opportunity to improve quality and patient safety. The Centers for Medicare and Medicaid Services (CMS), for example, estimates Medicare beneficiaries with two or more chronic conditions accounted for 93 percent of Medicare spending in 2011, about $276 billion. Many of those beneficiaries are likely to be Medicare-Medicaid dual eligibles, who tend to have complex health conditions and severe mental and physical disabilities.
CMS Releases Dashboard to Track Beneficiaries with Multiple Chronic Diseases:
CMS has for several years recognized the potential to improve care for people with chronic conditions. CMS Acting Administrator Marilyn Tavenner recently announced another strong step toward that goal: a data dashboard tool to help researchers, physicians, public health professionals, and policymakers analyze services and needs for Medicare beneficiaries with multiple chronic conditions.
Electronic health records (EHR) and other health information technology (HIT) play an important role in managing care for people with chronic diseases. In this case, CMS’ cool new web-based dashboard will help manage data from the CMS Chronic Conditions Database. Armed with data, policymakers and providers can make better decisions about which treatments and preventive care reduce costs and improve quality.
Learn More on Chronic Disease Care:
Care and policies on chronic conditions are broad and complex. Those interested in learning more can dive into a number of excellent briefs and papers published in the journal Health Affairs. Abstracts from selected articles are below.
The U.S. chronic illness burden is increasing and is felt more strongly in minority and low-income populations: in 2005, 133 million Americans had at least one chronic condition. Prevention and management of chronic disease are best performed by multidisciplinary teams in primary care and public health. However, the future health care workforce is not projected to include an appropriate mix of personnel capable of staffing such teams. To prepare for the growing chronic disease burden, a larger interdisciplinary primary care workforce is needed, and payment for primary care should reward practices that incorporate multidisciplinary teams.
German Diabetes Management Programs Improve Quality Of Care And Curb Costs, By Stephanie Stock, Anna Drabik, Guido Büscher, Christian Graf, Walter Ullrich, Andreas Gerber, Karl W. Lauterbach, and Markus Lüngen.
This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from “classic” disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.
Medicare beneficiaries’ medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades. Twenty years ago, most spending growth was linked to intensive inpatient (hospital) services, chiefly for heart disease. Recently, much of the growth has been attributable to chronic conditions such as diabetes, arthritis, hypertension, and kidney disease. These conditions are chiefly treated not in hospitals but in outpatient settings and by patients at home with prescription drugs. Health reform must address changed health needs through evidence-based community prevention, care coordination, and support for patient self-management.
We examined the prevalence of self-reported chronic conditions and out-of-pocket spending using the 2005 Medical Expenditure Panel Survey (MEPS) and made comparisons to previously published MEPS data. Our study found that the prevalence of self-reported chronic conditions is increasing among not only the old-old but also people in midlife and earlier old age. The greatest growth occurred in the number of people affected by multiple chronic diseases, a group with sizable out-of-pocket spending. Policymakers should be aware that cost sharing at the point of care can disproportionately burden people with chronic conditions and discourage adherence to drugs that prevent disease progression.
Over the four decades since cost-effectiveness analysis was first applied to health and medicine, hundreds of studies have shown that prevention usually adds to medical costs instead of reducing them. Medications for hypertension and elevated cholesterol, diet and exercise to prevent diabetes, and screening and early treatment for cancer all add more to medical costs than they save. Careful choices about frequency, groups to target, and component costs can increase the likelihood that interventions will be highly cost-effective or even cost-saving.