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Costly Chronic Conditions

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2/5 of the population has one or more chronic conditions that, collectively, consumes 3/4 of all health care dollars.

For TB and HIV and "other chronic diseases, from diabetes to epilepsy to major mental illness and many cardiovascular diseases — and for many acute conditions, from trauma to obstructed labor (and most other conditions requiring surgical intervention), and most cancers. The development of new therapeutic agents has outpaced our investments in robust delivery platforms tailored to meet demand. Only by building health systems that provide high-quality care for all, especially the most vulnerable, can we catch up with the preventive, diagnostic, and therapeutic revolution. What we need now are revolutionary improvements in the delivery of prevention, diagnosis, and care."

"Five salient lessons can be derived from the history of tuberculosis control."

  • "First, drug resistance is here to stay, but the rate of its emergence can be slowed."
  • "Second, the development of robust delivery platforms will lead to improved clinical outcomes if what is being delivered is clinically effective."
  • "Third, care for patients who do not require inpatient care should shift from hospitals to clinics and community-based care."
  • "Fourth, therapeutic innovations need to be linked more rapidly to equitable delivery, which requires new financing mechanisms."
  • "Fifth, it is not clear that any disease is helpfully termed “untreatable.” This is true of drug-resistant tuberculosis, which serves as a benchmark for medicine today as it did 60 years ago. Just as one can insist overmuch on strict control of medications needed to treat an airborne threat, one can forget that patients and family members will always seek treatment, even for afflictions that experts deem untreatable among the poor. “Untreatable” often really means difficult or costly to treat, just as “resistant” sometimes means resistant to our best efforts to deliver care."

Farmer PE "Chronic Infectious Disease and the Future of Health Care Delivery" a N Eng J Med. article Dec. 19, 2013; 369:2424-2436

It is imperative to Understand and Address Multiple Chronic Conditions By 1) Fostering Health Care System Improvements, 2) Empowering Patients and Their Caretakers,  3) Equipping Practitioners, and 4) Enhancing Practical Patient-Centered Research

"First, more delivery and payment models will need to focus specifically on subsets of the multiple chronic conditions population that are at highest risk for poor outcomes and high costs.[ref. 6,7] Models that are shown to be effective and efficient should be widely disseminated and implemented.

Second, evidence-based community prevention and wellness programs currently reaching hundreds of thousands of individuals should be expanded further through partnerships with health care entities to reach tens of millions of individuals with multiple chronic conditions.

Third, the multiple chronic conditions population needs to be an area of focus for research on patient-centered outcomes to inform the development of future clinical practice guidelines, best practices, and quality measures.

The US Department of Health and Human Services (HHS) will continue to release data on chronic conditions so health leaders and innovators can better identify specific populations and geographic areas in which more coordinated and comprehensive approaches to prevention and treatment can be delivered to persons with multiple chronic conditions. Progress in these areas will be critical to improve the health status of individuals with multiple chronic conditions and to move toward a more effective and sustainable health care system."

Parekh AK, Kronick R, Tavenner M. "Optimizing Health for Persons With Multiple Chronic Conditions."  JAMA Network. Published online August 18, 2014. doi:10.1001/jama.2014.10181

See also

Pear R. "Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients. NY Times Aug. 16 2014

Press, MJ. "Instant Replay–A Quarterback's View of Care Coordination." N Engl J Med. Aug. 7, 2014; 371:489-491

Central Logic Patient Connect is a platform hospitals can use to "coordinate efforts with providers and optimize post-acute care. [This new] web-based technology .... operationalizes care coordination [by  providing] visibility to key data from inside and outside a hospital’s four walls. It uses in-depth information not available in any other system and sophisticated analytics to risk stratify patients, identify potential treatment failures, and predict readmission and frequent-use risk."