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

Jane Horvath, M.H.S.A.Jane Horvath, M.H.S.A.Deputy DirectorDeputy Director

Partnership for SolutionsPartnership for SolutionsA Project of Johns Hopkins University and A Project of Johns Hopkins University and

The Robert Wood Johnson FoundationThe Robert Wood Johnson Foundation

Chronic Conditions in the U.S.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.

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.

118

125

133

141

149

157

164

171

100

120

140

160

180

200

1995 2000 2005 2010 2015 2020 2025 2030

Year

Nu

mb

er

of

Peo

ple

Wit

h C

hro

nic

Co

nd

itio

ns

(mil

lio

ns)

Almost Half of People with a Chronic Condition have Multiple Chronic Conditions

24%

11%

5%4%

1%

0%

5%

10%

15%

20%

25%

30%

1 2 3 4 5+

Number of Chronic Conditions

Per

cen

t o

f A

ll A

mer

ican

s

Source: Wu, Shin-Yi and Green, Anthony, Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000.

1/4 of Individuals with Chronic Illness also have Activity Limitations

Both

30 Million 7 Million90 million

Activity Limitation OnlyChronic Illness Only

• 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 19:3, May 2000).

Source: Medical Expenditure Panel Survey, 1998.

n = 127 Million

Most People with Chronic Conditions have Private Health Insurance

Unknown2%

Other Govermnet Insurance

3%

65+ Medicare only 8%

Uninsured7%

65+ Medicare/ Private

13%

Medicaid9%65+ Medicare/

Medicaid3%

Private Insurance55%

.

Source: Medical Expenditure Panel Survey, 1998.

Population of People with Chronic Conditions in 1998 n =120 million

Health Care Spending for People with Chronic Conditions Accounts for 78 % of All Health Care Spending

78%

96%

97%

95%

68%

58%

77%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

All Americans

Ages 65+ with MedicareOnly

Ages 65+ with Medicareand Medicaid

Ages 65+ with Medicareand Private Insurance

Privately Insured

Uninsured

Medicaid Beneficiaries

Percent of Spending on People With Chronic Conditions

Source: Medical Expenditure Panel Survey, 1998.

Health Care Spending Increases with the Number of Chronic Conditions

$800

$1,900

$3,400

$5,600

$8,900

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

$11,000

0 1 2 3 4 5+

Number of Chronic Conditions

Ave

rage

Per

Cap

ita

Hea

lth

Car

e S

pen

din

g

Source: Medical Expenditure Panel Survey, 1998.

People with Chronic Conditions are the Heaviest Users of Medical Care

76%

72%

88%

96%

0% 20% 40% 60% 80% 100%

Inpatient Stays

Physician Visits

Prescriptions

Home HealthVisits

Percent of Services Used by People With Chronic Conditions

Source: Medical Expenditure Panel Survey, 1998.

4%

7%

12%

16%

26%

5%

9%

12%

16%

27%

12%14%

19%21%

34%36%

33%

3%

0%

10%

20%

30%

40%

0 1 2 3 4 5+Number of Chronic Conditions

Per

cent

of

Peo

ple

With

Inp

atie

nt H

ospi

tal S

tays

All No Limitations With Limitations

People with Multiple Chronic Conditions are Much More Likely to be Hospitalized

Source: Medical Expenditure Panel Survey, 1998.

More than Half of People with Serious Chronic Conditions Have Three or More Different Physicians

Number of Different Physicians Seen By People with Serious Chronic Conditions

2 Physicians26%

3 Physicians23%

4 Physicians15%

5 Physicians6%

6+ Physicians11%

No Doctors3%

1 Physician16%

Source: Gallup Serious Chronic Illness Survey 2002.

People with Chronic Conditions Report Getting Conflicting Advice

18%

17%

16%

14%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

Had duplicate tests orprocedures

Received conflictinginformation from

providers

Received informationabout drug interactionsupon filling prescription

Received differentdiagnoses from different

providers

Percent of Population with Chronic Conditions Reporting Problem

Source: Chronic Illness and Caregiving, a survey conducted by Harris Interactive, Inc., 2000.

Physicians Believe that Poor Care Coordination Produces Bad Outcomes

Source: National Public Engagement Campaign on Chronic Illness–Physician Survey, conducted by Mathematica Policy Research, Inc., 2001.

24%

34%

34%

36%

44%

49%

54%

0% 10% 20% 30% 40% 50% 60%

Unnecessary nursing home placement

Experience of unnecessary pain

Patients not functioning to potential

Unnecessary hospitalization

Adverse Drug Interactions

Emotional problems unattended

Receipt of contradictory information

Ad

vers

e O

utc

omes

Percent of Physicians Who Believe that Adverse Outcomes Result from Poor Care Coordination

Poor Care Coordination Leads to Unnecessary Hospitalizations

0 718

36

62

95

131

169

219236

261

0

50

100

150

200

250

300

0 1 2 3 4 5 6 7 8 9 10+

Number of Chronic Conditions

Hos

pita

lizai

tons

for

A

mbu

lato

ry C

are

Sens

itiv

e C

ondi

tion

s P

er 1

000

Med

icar

e B

enef

icia

ries

Age

s 65

+

Source: Medicare Standard Analytic File, 1999.

How do we Improve the System?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

• 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