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Jeannette is an 89 year old and has five medical conditions that have required long-term treatment ― diabetes, high blood pressure, heart failure, arthritis and depression. She is discouraged and anxious because she doesn’t have much energy and often can’t do what she’d like.  She works hard at maintaining independence at the basic activities of living – walking, eating, and toileting. She constantly juggles doctor visits and medications.  Jeanette feels overwhelmed with all of her medical issues and wishes one of her doctors would coordinate, prioritize, and streamline all of her visits, medicines, tests and instructions. She knows she needs more help in preparing nutritious meals, but doesn’t really know where to turn for assistance. Her son lives too far away to be helpful on a regular basis.   Jeannette’s neighbor looks in on her frequently and is beginning to worry as well as her family.

Sound familiar?  Jeannette (my mother) and those who care about her (me) are grappling with an increasingly common challenge ― the management of what many health experts refer to as “multiple chronic conditions.”  In fact, estimates suggest that about two-thirds of older adults live with two or more chronic conditions.  And the aging baby boomer population will only increase the magnitude of this challenge as they age.

The U.S. Department of Health and Human Services recently issued its new Strategic Framework on Multiple Chronic Conditions ― an innovative private-public sector collaboration to coordinate responses to a growing challenge.

Those individuals that have multiple chronic conditions account for 66 percent of the country’s health care budget. These numbers are even expected to rise as the number of older Americans increases. I hope you heard that – Two-thirds of all health care expenses in the U.S. are due to the treatment of multiple chronic conditions!

The current health care system is largely designed to treat one acute disease or condition at a time, but many Americans have more than one ― and often several ― chronic conditions. For example, just 9.3 percent of adults with diabetes have only diabetes, according to the Medical Expenditure Panel Survey from the Agency for Healthcare Research and Quality. As the number of chronic conditions one has increases, so do the risks of complications – including adverse drug events, unnecessary hospitalizations and confusion caused by conflicting medical treatments, therefore causing tremendous human pain, death and expense.

One theme that I have written about in previous articles is the unnecessary and expensive revolving door of re-hospitalizations of the 65+. It has been estimated that about 25 percent of hospital discharges end up back in the hospital within 30 days. The hospitals, rehab centers or nursing homes, and other medical or health services need to step up to the plate and be accountable. The Affordable Care Act will, in fact, mandate that hospitals be responsible for all re-admissions to hospitals within 30 days, regardless of diagnosis. They cannot continue the usual practice of finding another diagnosis and hence get paid all over again. This will force them and other health care providers in the community to work together and provide more coordinated quality care. This paradigm shift will reduce expenses and improve the quality of life for our frail elders, disabled, and those with multiple chronic conditions.

This new federal strategic framework which is coordinated by the U.S. Department of Health and Human Services involved input from agencies within the department, as well as multiple private sector stakeholders. This framework expects to reduce the risks of complications and improve the overall health status of individuals with multiple chronic conditions by fostering change within the system. This change will occur by providing more information and better tools to help health professionals and patients learn how to better coordinate and manage care. In addition, it will help facilitate research to improve oversight and care of multiple chronic conditions.

 The management of multiple chronic conditions has major cost implications for both the country and individuals. Increased spending on chronic diseases is a key factor driving the overall growth in spending in the Medicare program. And individuals with multiple chronic conditions also face increased out-of-pocket costs for their care, including higher costs for prescriptions and support services.

“Given the number of Medicare and Medicaid beneficiaries with multiple chronic conditions, focusing on the integration and coordination of care for this population is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said Centers for Medicare and Medicaid Services Administrator Donald Berwick, MD.

The Affordable Care Act, with its emphasis on prevention, provides the U.S. Department of Health and Human Services with exciting new opportunities to keep chronic conditions from occurring in the first place and to improve the quality of life for patients who have them. This is just another example of the progressive and positive results the Affordable Care Act provides. I maintain, as stated in previous articles, that the Health Reform Law will improve are broken health care system by reducing expenditures and by “adding life to years”.

Our Health Care System: How does it deal with Multiple Chronic Conditions? 

Jeannette is an 89 year old and has five medical conditions that have required long-term treatment ― diabetes, high blood pressure, heart failure, arthritis and depression.   She is discouraged and anxious because she doesn’t have much energy and often can’t do what she’d like.  She works hard at maintaining independence at the basic activities of living – walking, eating, and toileting. She constantly juggles doctor visits and medications.  Jeanette feels overwhelmed with all of her medical issues and wishes one of her doctors would coordinate, prioritize, and streamline all of her visits, medicines, tests and instructions. She knows she needs more help in preparing nutritious meals, but doesn’t really know where to turn for assistance. Her son lives too far away to be helpful on a regular basis.   Jeannette’s neighbor looks in on her frequently and is beginning to worry as well as her family.

Sound familiar?  Jeannette (my mother) and those who care about her (me) are grappling with an increasingly common challenge ― the management of what many health experts refer to as “multiple chronic conditions.”  In fact, estimates suggest that about two-thirds of older adults live with two or more chronic conditions.  And the aging baby boomer population will only increase the magnitude of this challenge as they age.

The U.S. Department of Health and Human Services recently issued its new Strategic Framework on Multiple Chronic Conditions ― an innovative private-public sector collaboration to coordinate responses to a growing challenge.

Those individuals that have multiple chronic conditions account for 66 percent of the country’s health care budget. These numbers are even expected to rise as the number of older Americans increases. I hope you heard that – Two-thirds of all health care expenses in the U.S. are due to the treatment of multiple chronic conditions!

The current health care system is largely designed to treat one acute disease or condition at a time, but many Americans have more than one ― and often several ― chronic conditions. For example, just 9.3 percent of adults with diabetes have only diabetes, according to the Medical Expenditure Panel Survey from the Agency for Healthcare Research and Quality. As the number of chronic conditions one has increases, so do the risks of complications – including adverse drug events, unnecessary hospitalizations and confusion caused by conflicting medical treatments, therefore causing tremendous human pain, death and expense.

One theme that I have written about in previous articles is the unnecessary and expensive revolving door of re-hospitalizations of the 65+. It has been estimated that about 25 percent of hospital discharges end up back in the hospital within 30 days. The hospitals, rehab centers or nursing homes, and other medical or health services need to step up to the plate and be accountable. The Affordable Care Act will, in fact, mandate that hospitals be responsible for all re-admissions to hospitals within 30 days, regardless of diagnosis. They cannot continue the usual practice of finding another diagnosis and hence get paid all over again. This will force them and other health care providers in the community to work together and provide more coordinated quality care. This paradigm shift will reduce expenses and improve the quality of life for our frail elders, disabled, and those with multiple chronic conditions.

This new federal strategic framework which is coordinated by the U.S. Department of Health and Human Services involved input from agencies within the department, as well as multiple private sector stakeholders. This framework expects to reduce the risks of complications and improve the overall health status of individuals with multiple chronic conditions by fostering change within the system. This change will occur by providing more information and better tools to help health professionals and patients learn how to better coordinate and manage care. In addition, it will help facilitate research to improve oversight and care of multiple chronic conditions.

 The management of multiple chronic conditions has major cost implications for both the country and individuals. Increased spending on chronic diseases is a key factor driving the overall growth in spending in the Medicare program. And individuals with multiple chronic conditions also face increased out-of-pocket costs for their care, including higher costs for prescriptions and support services.

“Given the number of Medicare and Medicaid beneficiaries with multiple chronic conditions, focusing on the integration and coordination of care for this population is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said Centers for Medicare and Medicaid Services Administrator Donald Berwick, MD.

The Affordable Care Act, with its emphasis on prevention, provides the U.S. Department of Health and Human Services with exciting new opportunities to keep chronic conditions from occurring in the first place and to improve the quality of life for patients who have them. This is just another example of the progressive and positive results the Affordable Care Act provides. I maintain, as stated in previous articles, that the Health Reform Law will improve are broken health care system by reducing expenditures and by “adding life to years”.

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