Providing Care-Not Cure-for Patients with Chronic Conditions

The Foundation's goal of improving the way services are organized and delivered for people with chronic conditions has proven particularly elusive.

The realities are daunting: a disorganized array of actors deliver services that are driven more by financing rules than by the needs of chronically ill individuals. Moreover, because acute care is often covered by insurance, whereas more caring services such as homemakers' visits are not, the services offered to chronically ill people are skewed toward treating acute episodes of illness rather than coordinated approaches addressing a whole array of their needs. A logical approach to organizing services would be to start with the needs of people who have chronic conditions and then figure out how to meet those needs most effectively.

This chapter of the Anthology by Lisa Lopez, a freelance writer specializing in health care, analyzes the strategies and accomplishments of two significant investments by the Foundation to improve the way services for chronically ill people are organized and delivered. One of the programs—Chronic Care Initiatives in HMOs—attempts to improve the medical care of individuals with chronic illness enrolled in managed care. The second program—Building Health Systems for People with Chronic Illness —focuses on better approaches to coordinating both medical and supportive care services, such as assistance with activities of daily living.

Both national programs underscore the need to expand the services covered by insurance or health plans so that nonmedical, as well as medical interventions are covered. They emphasize, as well, the importance of coordinating the different providers needed by a person with complex chronic conditions.

Findings from these two programs have helped define a new generation of Foundation investments aimed at improving services for chronically ill people. Currently, the Foundation is beginning new national programs to improve the clinical management of the long-term medical needs of the chronically ill. Other national programs are being designed to increase the capacity of the long-term care system to meet the supportive needs of the chronically ill.