Chronic Care

Making the Case for Ongoing Care

Chronic conditions affect people of all ages and from all walks of life—a child with asthma, a co-worker with hypertension, an elderly relative with arthritis or Alzheimer’s disease.

As the numbers grow and grow, it is hard not to know someone whose life is in some way altered by a chronic condition. Unfortunately, over the past several decades, while our health care needs have evolved, often the health care system has not. It remains an amalgam of past efforts to treat infectious diseases and acute illnesses. It does not focus on today’s current and growing problem—increasing numbers of people with chronic conditions, especially those with multiple chronic conditions.

Chronic Care: Making the Case for Ongoing Care examines the impact of chronic conditions on individuals and their caregivers, as well as the inadequacies of the U.S. health care system to meet their needs. The data highlight the current problems encountered by people living with chronic health conditions. Most significantly, the author writes, “care provided in the current acute, episodic model is not meeting the needs of people with chronic conditions and often leads to poor outcomes for patients with chronic conditions.”

With 85 percent of the nation’s health care dollars spent on people with chronic conditions, “the challenge is to use these resources efficiently to provide people with access to high-quality care and appropriate services that maintain health and functioning in the face of disease progression and ensure that this care is coordinated across multiple providers and payers.”

Prevalence of chronic conditions:

  • The number of people with chronic conditions is rapidly rising. Between 2000 and 2030, the number of Americans with one or more chronic conditions will increase 37 percent, an increase of 46 million people.
  • Some 28 percent of Americans have two or more chronic conditions and they are responsible for two-thirds of health care spending.
  • In the Medicare program over two-thirds of the expenditures are for beneficiaries with five or more chronic conditions.

Impact of chronic conditions on the health care finance and delivery system:

  • People with chronic conditions are use over 75 percent of hospital days, office visits, home health care and prescription drugs.
  • People with chronic conditions are more likely to have preventable hospitalizations and other poor outcomes. Most people with chronic conditions have private insurance (54%). Others have Medicare or Medicare with supplemental insurance (20%), Medicaid (11%), or other insurance 6%). Some are uninsured (8%).

Impact of chronic conditions on individuals and their caregivers:

  • Poor coordination of care generally leads to unnecessary service utilization: hospitalizations, nursing home placements, and duplicate diagnostic tests.
  • People with serious chronic conditions are more likely to receive conflicting advice, have trouble accessing needed services, and receive prescriptions that adversely interact with one another.
  • People with chronic conditions spend much more on prescription drugs than people without chronic conditions.
  • People with chronic conditions rely on others not only for financial support but for personal assistance, as family and friends devote many hours per week to assisting people with long-term conditions.

Because the health care system is not designed to meet the needs of people with chronic conditions, their care is not coordinated, which leads to unnecessary service use. Individuals often receive conflicting advice from different providers, report difficulty accessing services and have difficulty paying out-of-pocket for health care. As a result, people with chronic conditions rely on others for financial support and personal assistance.

Solutions to the chronic care problem, the author writes, will come from broad-based reforms that involve incorporating people with multiple chronic conditions in medical research; rethinking how the health care financing system values and pays for the care received by people with chronic conditions; re-examining how we train health care providers; developing better connections between supportive and clinical care delivery systems; incorporating quality metrics for people with multiple chronic conditions; and encouraging and supporting patient self-management and family caregiving.