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Multiple Chronic Conditions:
Policy Changes & Patient Needs
Ken Thorpe, Ph.D.Professor Health Pol icy and Chairman PFCD
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You cannot manage health care costs
without managing chronic disease
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7/28/2019 Multiple Chronic Conditions: Policy Changes & Patient Needs
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Key Drivers of Rising Health Care
Spending
Doubling of obesity since the mid-1980s
accounts for 10% of the rise in spending
Lack of effective care coordination in many
private plans and Medicaid. No care
coordination so far in traditional Medicare
Low rates of disease detection for some
conditions (diabetes only 72% of total diabetes
is diagnosed and treated)
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Overall Policy
Areas of InterestACA Implementation
Entitlement reforms
New delivery models
Cost containment
Quality in a cost-
containment world
Pressures
Expiring SGR fix
Sequestration
Deficits and debtDemographics
Obesity
Managing chronically ill patients in an acute care
financing and delivery model.
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The LandscapeWhile entitlement reform is at the top of the national agenda as a
way to reduce the deficit, more than 95 cents of every Medicare
dollar is spent on patients with one or more chronic conditions
Source: Partnership for Solutions
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Medicare Spending Dramatically Higher
for People with Multiple Chronic
ConditionsPercentage of Medicare Spending on Patients with Chronic Conditions,by Number of Treated Chronic Conditions
Source: Health Affairs
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Policy Changes Accountable Care
Organizations
Pay for performance
Bundled payments
Patient-centeredmedical homes
Lynchpin is quality
Changing waycare is financed toencourage on-going care
management, notepisodic, crisesmanagement
Must consider
patient populationbeing served
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Single Disease Focus...
... Multiple Disease Population
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7/28/2019 Multiple Chronic Conditions: Policy Changes & Patient Needs
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Meet Jane
Age 79
Lives alone
Five chronic conditions: COPD, depression, diabetes,
hypertension, and arthritis Each year
Sees 14 different doctors
Makes 37 physician visits
Fills 50 prescriptions
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See Jane Meet Evolving Health Care
System
Accountable Care Organizations
Patient-centered medical homes
Bundled payments
Pay-for-performance and shared
savings
Readmission penalties
Performance evaluation
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PFCD: MCC Research Agenda
Empowered: Informing
and enabling decision-
making and self-care
Informed: Interpreting
and applying theevidence
Equipped: Effective
models of care
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Empowered Patient Population
Communication tools (prognosis,options, complexity, QoL)
Self-care capacity assessments
Tools for coordination and
collaboration among providers
Adaptability for differences in
benefit/risk, prognosis,
preferences
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Informed Evidence Base Common challenges of people
with MCC to inform guidelines
Tools to evaluate clinical and
individual feasibility of Tx
regimens Evaluation means in P4P models
for patients with complex needs
Evaluate researchsubpopulations by factors other
than disease
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Equipped Health System Best models for self-
management, adherence,
caregiving for MCC
Prevention models for avoiding
MCC Training workforce for MCC
Care coordination/collaboration
models for people with MCC Outcomes relating to care
settings for people with MCC
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PFCD:A Vision for a Healthier Future
Questions?