Chronic illnesses are ongoing conditions
that require adjustments by the affected person in addition to frequent interaction with the health care system.
Cynthia Napier Rosenberg, M.D., the senior
medical director at UPMC Health Plan, says
these chronic conditions are very costly to
treat. Complicating matters, about half the
people who have chronic illnesses also have
multiple conditions.
“If a chronic illness is not treated effectively, it can cause problems in many areas,”
Rosenberg says. “Because of these factors, it
is hardly surprising that chronic illnesses
account for three-quarters of our total national health care expenditures.”
Smart Business learned more from
Rosenberg about ways business owners can
handle the chronic care issue.
Why is this issue important to business owners and any purchaser of health insurance?
Anyone responsible for purchasing health
care in this country must understand how
important it is to find a way to effectively deal
with chronic care. Chronic illnesses can be
expensive to treat, but if they are not treated
correctly, they can become much more
expensive. While the direct cost of chronic illness in this country is more than $400 billion
a year, the indirect costs in terms of lost productivity has been estimated as more than
half of that amount per year.
A study by the Robert Wood Johnson
Foundation determined that large employers
can help to bring about changes in health
care that affect quality by creating incentive
for programs that have been shown to be
effective, such as the chronic care model.
What is the chronic care model?
Basically, the chronic care model is a
framework that can redesign the health care
system to better serve persons with chronic
conditions. It has six core elements:
- Health care organization and leadership:
The organizational environment that systematically supports and encourages chronic illness care through leadership and incentives. - Linkage to community resources: The
community can provide cost-effective access
to services such as nutrition counseling, peer-support groups and patient registries. - Support of patient self-management:
Individual and group interventions that
emphasize patient empowerment and self-management skills are effective in managing
many chronic conditions. - Coordinated delivery system design: This
is designed to coordinate actions of multiple
caregivers in the treatment of one patient. - Clinical decision support: Incorporating
evidence-based practice guidelines into registries, flow sheets and patient assessment
tools can change provider behavior. - Clinical information systems: With
access to adequate database software, health
care teams can use disease registries to deliver proactive care, implement reminder systems, and generate treatment plans and messages to facilitate patient self-care.
How effective is the chronic care model?
Studies have indicated that the chronic care
model can achieve better disease control,
higher patient satisfaction and better adherence to guidelines by redesigning delivery
systems to meet the needs of chronically ill
patients. For example, patients with acute
depression can receive significantly better
primary care treatment through a systematic
program of feedback to doctors on treatment recommendations, supplemented with follow-up and care management by telephone.
Similarly, patients with diabetes have been
shown to benefit with self-management support provided by the use of ‘mini-clinics’ of
teams of providers. Instead of receiving
uncoordinated care from a multitude of
providers in a variety of settings, patients
receive all of the care they need for their diabetes — including eye and foot care as well
as diabetic education — in one place.
What is the connection to the patient-centered medical home?
At the heart of the patient-centered medical
home — defined simply as physician-guided,
patient-centered care — is the chronic care
model. The chronic care model requires a
major rethinking of primary care practice.
In the patient-centered medical home concept, there is a partnership between the
physicians, the patients and their families.
That partnership is what makes it work. The
goal is a holistic, coordinated plan of care
that uses evidence-based medicine to produce better outcomes and lower costs.
Why can’t the current system deal with
chronic conditions effectively?
Although the current U.S. health care system is outstanding in treating acute medical
problems, it really is not designed to treat
chronic, long-term conditions that require the
time and expertise of many health care professionals. If you look at the current system,
you see providers who are very busy and frequently lack access to other health care team
members — such as diabetic educators and
care managers — which are critical to the
successful treatment of chronic diseases.
There is also the problem of coordination
of care and finding time for adequate follow-up. If a patient needs to change doctors,
important pieces of a patient’s health care
record are not always routinely transferred
from one care setting to another. Finally,
most patients and their families are inadequately trained to manage their illnesses. All
of these issues are addressed in the chronic
care model.
CYNTHIA NAPIER ROSENBERG, M.D., is the senior medical director of UPMC Health Plan. Reach her at [email protected] or
(412) 454-5906.
