How important is chronic disease management? Here are some statistics and facts about chronic disease, provided by the Centers for Disease Control and Prevention (CDC):
- Six in 10 Americans live with at least one chronic disease.
- Four in 10 adults have two or more chronic diseases.
- Chronic diseases are the leading causes of death and disability in America.
- Nothing kills more Americans than two diseases classified by CDC as chronic: heart disease and stroke. More than 859,000 Americans die of these two chronic diseases annually — one-third of all U.S. deaths.
- Chronic diseases are a leading driver of healthcare costs.
Chronic disease management, when approached and executed effectively, can bring about substantial reductions in costs while improving outcomes and quality of life. Let's examine how critical components of chronic disease management, including those identified by HealthCare.gov as part of an integrated care approach to managing illness, help achieve these objectives.
Screenings should play a pivotal role in chronic disease management. As a ConsultGeri article notes, "Identification of chronic disease risk factors and early disease detection, through screening, may decrease the burden of chronic disease and protect and promote the health of older adults."
A Health Policy Institute (HPI) report notes, "Screening to identify people who have chronic conditions or are at risk of developing them can help prevent disease or lessen the severity of illness. Early detection and intervention can save money and lives."
Furthermore, Healthy People, a federal program administered by the U.S. Department of Health and Human Services, reports that clinical preventative services like screenings "… prevent cardiovascular disease alone could save tens of thousands of lives each year." Also, "Blood pressure screening and control is one of the most effective ways to prevent heart disease and stroke."
Unfortunately, as the HPI report later states, while screening test use has increased in the United States, not everyone who would benefit from such services receives them. This often includes people lacking health insurance or a typical source of healthcare, individuals with lower incomes and individuals living in rural areas. Improving screening test access would further drive down costs and mortality rates.
Checkups are effective in improving the control of chronic disease and reducing their likelihood.
A Milken Institute report includes recommendations for improving outcomes and reducing costs, one of which is a strategy focused on enhancing delivery of services and communication. "If providers were to routinely inform patients about their risks and how to better manage their health, it would pay off in better outcomes and lower expenditures. An emphasis on increasing the patient-centeredness of care delivery … can have a significant impact on both quality of care and quality of life."
Concerning heart disease, the Mayo Clinic advises patients, "Get regular medical checkups. Early detection and treatment can set the stage for a lifetime of better heart health. … If you have a recurring or chronic heart condition, regularly check in with your doctor to make sure you're properly managing your heart condition."
There are great opportunities to improve the value of checkups. A West report sharing the results of a patient and provider survey on chronic care reveals that, "Only 12% of patients with a chronic condition insist their healthcare provider is doing a good job of delivering information tailored to their specific needs and condition." Furthermore, "60% of patients feel they spend more time discussing their symptoms with healthcare providers than ways to manage their condition."
However, relying too heavily on checkups — and screenings — can lead to undesired results. The West report states that, "Patients are getting support from providers now, but that occurs mostly while they are sitting face to face in a physician's office. While office visits are important, chronic patients really want more provider support at home. … At least 70% of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease."
One mechanism that can provide the additional support patients are yearning for is telehealth/telemedicine. The use of applications such as videoconferencing, remote patient monitoring, and mobile health (i.e., mHealth) gives providers an effective and personalized way of communicating with patients between in-person checkups and screenings. As at least one case study shows, leveraging telehealth can deliver significant benefits to patients with chronic illnesses.
According to a news release from Frederick (Md.) Memorial Hospital, a telehealth pilot program launched in 2016 reduced hospital readmissions by 89% and emergency department visits by 49% for enrolled patients. The reductions achieved through the "Chronic Care Management Program" decreased the average cost of care for these patients by 52%.
Individual providers can positively impact chronic disease management, but more significant improvements will typically be the result of a collaborative effort between providers and organizations.
As a Seniorlink article discussing geriatric patients living with complex chronic conditions states, "Thanks to care coordination, providers benefit from seamless communication and access to patients' complete health history, which can reduce redundant medical tests and procedures; unnecessary emergency room visits; medication errors, such as multiple providers prescribing the same medication, or prescribing contraindicated medications; and preventable hospital admissions and readmissions. Reducing errors and unnecessary procedures, tests, and admissions, patients benefit from safer and more efficient healthcare delivery, as well as lower costs — and improved health outcomes."
Effective care coordination requires numerous participants, including health insurers. As an "America's Health Insurance Plans" article notes, "Health insurance providers are tailoring their chronic care outreach and resources to better suit patient needs. A key element of these initiatives is embedded clinical care coordinators who help patients with chronic conditions navigate the health care system and provide counseling with behavior and lifestyle changes. Health insurance providers are in ongoing communication with patients through a wide range of channels … to empower and provide them with the support they need to effectively manage their chronic conditions."
An article from The Consultant Pharmacist discusses the role pharmacists can play in chronic disease management, noting the value of provider-pharmacists partnerships, such as those through collaborative practice agreements.
To further highlight the importance of care coordination for chronic disease management, a study published in the American Journal of Managed Care (AJMC), reported on by Health IT Analytics, found that a lack of care coordination can prove harmful and expensive. "Insufficient patient care coordination can increase the average costs of chronic disease management by more than $4,500 over three years … while failing to provide patients with a higher chance of adherence to recommended protocols."
Want to have a significant impact on chronic disease management? Spend some extra time discussing chronic illnesses with patients. That was the conclusion of a study published in The Journal of the American Osteopathic Association. Researchers measured the effects of second-year students providing chronic disease education to patients for 45 minutes following a routine 15-minute office visit. The "Other 45" program, as it was called, was "effective in improving patients' ability to manage their chronic disease(s)." The program also improved the students' ability to educate chronic disease patients.
This is not surprising considering how much opportunity exists to strengthen patient education concerning chronic disease management. As the West report shared earlier notes:
- 43% of patients with a chronic condition are only somewhat confident, at best, they know their current health metrics (e.g., blood pressure, cholesterol, weight).
- 35% of patients with a chronic condition are unsure what their target numbers are for such key health metrics.
- 44% of patients are only somewhat confident, at best, that they are effectively managing their condition.
- 39% of patients admit they are only somewhat knowledgeable, at best, about how to effectively manage their chronic condition.
As a Commonwealth Fund report notes, "While there is strong evidence that a key to successful chronic care management is engaging patients in their care, only about half of those with chronic conditions in the United States … say that their regular doctor always tells them about treatment options and involves them in decisions."
Even something as simple as providing patients with a booklet can prove helpful, as an Internal Medicine Journal study shows. "Many patients with chronic disease do not possess the knowledge and skills required to access and interpret appropriate health information. A pilot study in people with liver cirrhosis identified that only 54% of patients could recall being given written information by a clinician and 64% had self-sought information... Many patients reported difficulties understanding the material and the majority wanted more accessible information. A pilot chronic disease educational booklet was well received by the study participants with 85% reporting it was helpful and 78% using it in between clinic appointments."
To maximize the benefits of patient education, efforts should extend beyond the healthcare industry, notes the Milken Institute report shared earlier. "Education is among the most important factors in a successful intervention. Aggressive health information campaigns through the media, schools, and other community awareness programs can work wonders."
Comprehensive Medication Management
Finally, let's briefly discuss a process that is receiving increased attention for its value in improving patient care, especially for patients with chronic diseases: comprehensive medication management (CMM). Providing better, more effective care is one of the motivators behind our development of the innovative Meds 360° patient medication history solution.
A Center for Health Care Strategies report notes, "Patients with multiple chronic conditions who are being managed by multiple providers are at particular risk of therapeutic duplication, especially when none of the patient's providers are aware of the patient's entire drug regimen."
CMM helps address such obstacles for patients with chronic illnesses. An AJMC article focused on diabetes states, "Clinical and financial outcomes associated with patients with diabetes receiving CMM have been positive. … Furthermore, CMM services have been associated with a positive impact on cardiovascular risk factors, such as blood pressure and low-density lipoprotein cholesterol in patients with diabetes.
An American Association of Colleges of Pharmacy article highlights a few successful efforts to leverage CMM for chronic patients, including a project undertaken by the Marshfield Clinic in North Central Wisconsin. There, pharmacists provided CMM to select high-risk, chronic disease patients. The clinic was hoping for a return on investment (ROI) exceeding 3:1 in the provision of care. They achieved an ROI of 10:1.
Finally, the results of a study, published in the Journal of Managed Care & Specialty Pharmacy, that examined the impact of exposure to face-to-face CMM services on medication adherence across four classes of chronic disease medications, found that such exposure led to improvements in medication adherence. "CMM is a powerful practice model that should be encouraged by insurers and health plan administrators to increase rates of medication adherence."
An Annals of Internal Medicine article estimates that a lack of adherence causes nearly 125,000 deaths, 10% percent of hospitalizations, and costs between $100–$289 billion annually.