Category Archives: Chronic disease management
New Study Points the Way to Better Care, Improved Outcomes and Lower Costs for Homeless People with Chronic Conditions
By Laura Sadowski, MD, MPH, and Romina Kee, MD, Robert Wood Johnson Foundation (RWJF) Clinical Scholar alumnae
Becoming homeless is distressing for anyone, and it is especially challenging for people with chronic health problems who need ongoing care.
The face of America’s homeless population is changing. When the job market collapsed a few years ago, millions of families were forced out of their homes. A 2009 national survey of organizations providing services to the homeless found that an estimated 10 to 19 percent had become homeless in the past year due to foreclosure. Nearly one percent of the U.S. population experiences homelessness each year.
Previous research on the health/medical, legal, housing and social services costs accrued by people who are homeless has focused on subsets of the population—those with mental illnesses, substance abuse problems, or the “chronic homeless” (those who have been without stable housing for 24 or more months). But they comprise a small portion of America’s homeless population. The chronic homeless, for instance, represent just 18 percent.
So how do we ensure that all homeless patients – regardless of their individual circumstances – get the care they need, while reducing costs?
In our study published in a special edition of Health Services Research: Bridging the Gap Between Research and Health Policy, we looked at a novel, broader sample: homeless adults with chronic conditions. Unlike previous studies, the majority of our study subjects were not mentally ill, substance abusers, HIV infected, veterans, or frequent users of the health care system.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Laura Brennaman, MSN, RN, CEN, a fellow at the RWJF Nursing and Health Policy Collaborative at the University of New Mexico.
As we enter 2012, my resolution and wish for the U.S. health care system is a fundamental and transformative shift from a focus on disease management to one of health promotion. As Americans and health professionals, we must recognize that even the most advanced and best interventions to remedy diseases do not improve the overall health status of our country. Only preventing epidemics of chronic problems like metabolic syndromes, heart disease, and lung disease that plague our population can have significant wellness and economic benefits.
The Affordable Care Act offers a mechanism to foster such a change in emphasis with the establishment of the National Council for Prevention, Health Promotion, and Public Health that intertwines the governance of 17 executive agencies. Leadership from diverse arenas such as transportation, trade, agriculture and labor concentrating on health promotion strategies from within and across domains provides opportunities to affect many of the determinants of poor health and transform them into positive scenarios to improve health status of all Americans.
Actualizing new health promotion strategies through shifting spending from direct care provision to prevention mechanisms of social programs like job training, housing supports, public transportation systems, and childcare services has greater potential to improve health outcomes for Americans than new technology or pharmaceuticals for disease management.
In this coming election year, the candidates for office will propose a bevy of ideas concerning health care. However, we must pay heed to all programs they propose to enhance or curtail through a lens of health outcomes. Proposals dealing with environment, energy and economic issues will affect our health as surely as any health care reform plan.
Hence, my resolution for our health care system is holistic and comprehensive consideration of the health impact of every policy. Through such integrated deliberation, we will achieve improvement in health outcomes and reductions in health disparities for all Americans.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Alexander Tsai, MD, PHD, RWJF Health & Society Scholar, Harvard University.
In the absence of addressing long-term drivers of population health in the U.S., changes in the health care delivery system may be within reach in the near term.
Management of care for chronic conditions remains notoriously poor, even among insured persons for whom out-of-pocket costs are not the primary barrier. Only one in two Americans with chronic conditions such as depression, diabetes and hypertension receives guideline-concordant care.
Poor chronic care management is often associated with systems-level failures such as lack of electronic data sharing among practitioners, or lack of care coordination for patients for multiple chronic conditions who struggle to adhere to complex medication regimens.
Further opportunities for cost containment are lost with regards to secondary prevention (e.g., readmissions for congestive heart failure), where better management could result in lower lifetime costs.
Reducing the costs for medical care in the United States without sacrificing health is among the highest priorities for the U.S. As our country continues to go through the demographic transition of becoming an aging society, we must consider ways to contain medical care costs and simultaneously increase healthy life expectancy.