Coping with multiple chronic conditions

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Coping with multiple chronic conditions

Eighty-three percent of Medicare beneficiaries have at least one

chronic condition, such as congestive heart failure, Alzheimer's

disease or diabetes. Two-thirds of Medicare spending is incurred by the

9.5 million beneficiaries with five or more chronic conditions. These

percentages suggest that the Medicare program needs to address chronic

conditions rather than the acute, episodic illnesses that have been the

focus of the Medicare program since it began in 1966.

The Medicare Modernization Act of 2003 began the process of

transitioning Medicare into a chronic care program, but additional

changes are needed to complete this reorientation. " Significantly more

needs to be done if the millions of Medicare beneficiaries with

multiple chronic conditions are going to get the best possible care, "

said Gerard , PhD, a professor in the s Hopkins Bloomberg

School of Public Health's Department of Health Policy and Management.

He identified three steps that will further the transformation of the

Medicare program toward better care for Medicare beneficiaries with

multiple chronic conditions. 's article is published in the

July 21, 2005, issue of the New England Journal of Medicine.

The first step, according to , is to create an out-of-pocket

maximum. It would protect beneficiaries with multiple chronic

conditions from high out-of-pocket costs. Many private insurers already

have a similar provision. The second step is to pay physicians to

submit electronic medical records, which would reduce the number of

duplicate tests, adverse drug reactions and unnecessary

hospitalizations. Better care coordination among physicians is the

final step. Medicare beneficiaries with five or more chronic conditions

see an average of 13 different physicians per year. Quality of care

suffers when their doctors do not know what types of treatments and

tests the other physicians are prescribing. Paying one doctor to

coordinate the care for a patient could improve patient outcomes.

, also director of the s Hopkins Center for Hospital

Finance and Management, explained that because they ask the health

system to make fundamental changes, these reforms will be difficult to

implement. Active buy-in and participation by physicians are essential

for the Medicare program to save money and improve care for patients

with chronic conditions--and acceptance of these reforms by physicians

in initial program trials has been slow. For example, said,

paying doctors to complete electronic medical records would exceed $4

billion annually, but the cost would be far outweighed by the decrease

in duplicate tests and unnecessary hospitalizations if all physicians

complied and then relied on integrated electronic medical records.

" Nearly all of us have a relative with multiple chronic conditions. We

know the multiple problems they face. They want one physician to help

them coordinate all their care, ensuring proper treatment is being

given to each of their health concerns and that all the various

physicians are informed, " said .

http://www.eurekalert.org/pub_releases/2005-07/jhub-cwm071805.php