Chronic Conditions in the U.S. Implications for Service Delivery and Financing

1
Chronic Conditions in the U.S.Implications for
Service Delivery and Financing

• Jane Horvath, M.H.S.A.
• Deputy Director
• Partnership for Solutions
• A Project of Johns Hopkins University and
• The Robert Wood Johnson Foundation

2
Chronic Conditions in the U.S.

• Chronic conditions are expected to last a year or
  more, limit what one can do and may require
  ongoing care.
• Chronic conditions are a significant and growing
  challenge.
• People with chronic conditions have significantly
  higher utilization and health care costs.
• Coordination of services for people with chronic
  conditions is lacking.
• There are opportunities for change.

3
The Number of People with Chronic Conditions is
Rapidly Increasing
Source Wu, Shin-Yi and Green, Anthony.
Projection of Chronic Illness Prevalence and Cost
Inflation. RAND Corporation, October 2000.
4
Almost Half of People with a Chronic Condition
have Multiple Chronic Conditions
Source Wu, Shin-Yi and Green, Anthony,
Projection of Chronic Illness Prevalence and Cost
Inflation. RAND Corporation, October 2000.
5
1/4 of Individuals with Chronic Illness also have
Activity Limitations
Both
Activity Limitation Only
Chronic Illness Only
30 Million
7 Million
90 million
n 127 Million

• Eighty-one percent of those with activity
  limitations also have a chronic condition.
• Although there are 37 million people with
  activity limitations living in the community,
  about 2.7 million adults are severely impaired
  and need assistance with three or more activities
  of daily living -- eating, dressing, getting in
  or out of a bed or a chair, or using the toilet
  (Feder, Komisar, and Niefeld, Long-Term Care In
  The United States An Overview, Health Affairs
  193, May 2000).

Source Medical Expenditure Panel Survey, 1998.
6
Most People with Chronic Conditions have Private
Health Insurance
Population of People with Chronic Conditions in
1998 n 120 million
. Source Medical Expenditure Panel Survey, 1998.
7
Health Care Spending for People with Chronic
Conditions Accounts for 78 of All Health Care
Spending
Source Medical Expenditure Panel Survey, 1998.
8
Health Care Spending Increases with the Number
of Chronic Conditions
Source Medical Expenditure Panel Survey, 1998.
9
People with Chronic Conditions are the Heaviest
Users of Medical Care
Source Medical Expenditure Panel Survey, 1998.
10
People with Multiple Chronic Conditions are Much
More Likely to be Hospitalized

Source Medical Expenditure Panel Survey, 1998.
11
More than Half of People with Serious Chronic
Conditions Have Three or More Different Physicians
Source Gallup Serious Chronic Illness Survey
2002.
12
People with Chronic Conditions Report Getting
Conflicting Advice
Source Chronic Illness and Caregiving, a survey
conducted by Harris Interactive, Inc., 2000.
13
Physicians Believe that Poor Care Coordination
Produces Bad Outcomes
Source National Public Engagement Campaign on
Chronic IllnessPhysician Survey, conducted by
Mathematica Policy Research, Inc., 2001.
14
Poor Care Coordination Leads to Unnecessary
Hospitalizations
Source Medicare Standard Analytic File, 1999.
15
How do we Improve the System?

• Benefits
• Medical necessity determinations and policies
• Disease Management
• Payments
• Clinical care case management fee
• Pharmacy coordinator
• Quality
• Care Coordination as a quality measure for health
  systems