News & Commentary

Coordinated Care and Beyond: The Future of Chronic Care

July 21, 2017
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The Alliance for Health Policy recently held a half-day summit that examined ways to improve outcomes for patients with chronic conditions. While patients with chronic conditions represent a minority of patients overall, their care accounts for the majority of health care spending. The event, co-sponsored by Anthem, offered insights from providers, payers, and policy and patient advocacy experts on pressing issues in chronic care, including addressing the challenge of how to better serve and improve quality of life for patients with chronic conditions who are benefitting from today’s medical advancements.

Coordinated care is one possible solution to this challenge. Those with chronic conditions frequently see upwards of 10 disparate providers to treat and manage their conditions. Many also require a regimented medication and procedure schedule that may be difficult to comply with due to their physical health and limitations with travel and transportation. The result can be poorer health overall, often leading to the patient requiring emergency care – a situation which not only causes stress and suffering for patients and families, but also presents greater health risks and greater costs.

Health care programs that fully integrate a patient’s primary and specialist care providers with essential social supports through a vital care manager nurse or coordinator can simultaneously improve patients’ health and lower overall medical costs. This idea was discussed throughout the event as the best solution to managing chronic care and to preventing a further increase in their prevalence.

Additional key themes from the summit are highlighted below.

Future Trends in Chronic Care

The day’s first panel, “Future Trends in Chronic Care,” addressed the impacts of an aging population for our health care system. As Baby Boomers age, many of whom may have chronic conditions, it is likely to place an increased burden on Medicare. Potential policy considerations to address this issue include:

  • Policies must ensure improved access to primary care because primary care is essential both for maintaining health and for keeping costs low. 
  • Policies should support programs that connect people to social supports like meal delivery and non-urgent medical transportation to reduce catastrophic care incidents for people with chronic conditions.

Coverage and Chronic Care

The day’s second panel explored the intersection of chronic care and health insurance. Specifically, panelists discussed the roles of public and private health insurance in covering patients with one or more chronic conditions, and which benefits structures were most effective in preventing and managing chronic conditions.

In particular, this panel focused on reimbursement and the incentive systems that the health care system can employ to improve efficiency and to appropriately reward practitioners for taking on high risk patients. Panelists discussed how the “fee-for-service” model has in some cases resulted in high medical costs. To address this issue, potential solutions could include:

  • A system focused on rewarding outcomes, not services—a model known as value-based care.
  • A cost-sharing model that guarantees essential services like screenings and blood tests be basically free, while imposing a greater level of cost sharing for services that are not life-saving or compulsory.
  • A greater focus on social supports to lowering costs and allow value-based care to flourish.

The Future of Integrated Care for Complex Conditions: What’s Working, What’s Not?

The third panel of the Alliance for Health Policy’s summit discussed integrated care and analyzed successful delivery care models for people with chronic conditions and their families. An integrated health care approach aims to look at a patient’s health holistically across medical, specialty and behavioral health, as well as to consider social factors that drive health care outcomes.

Successful integrated care is contingent upon the free flow of patient information between members of that patient’s health care team. This means that all providers, payer representatives and case managers are on the same page about a patient’s care and treatment history. At the same time, this free flow of information and coordination for a patient’s care at once aids and depends on the strength of the non-medical community and social supports to which a patient has access. That is to say, if a nurse care manager calls a patient to remind her of an upcoming appointment, that effort is wasted if the patient is unable to procure transportation to the office. That is where social support and community programs like government funded non-urgent medical transportation can assist.  

The Alliance for Health Policy event provided valuable insight into how chronic care can be improved across health care and social systems. In addition to medical interventions, improving a person’s connections to his or her care team and larger community has a dramatic impact on outcomes. It is up to experts in the provider, payer, policy and patient advocate areas to determine how to support programs that will ensure better outcomes for patients with chronic conditions, eventually also leading to reduced costs for patients and society. 

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