multiple chronic conditions: policy changes & patient needs

7/28/2019 Multiple Chronic Conditions: Policy Changes & Patient Needs

1/15

Multiple Chronic Conditions:

Policy Changes & Patient Needs

Ken Thorpe, Ph.D.Professor Health Pol icy and Chairman PFCD


2/15

You cannot manage health care costs

without managing chronic disease
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3/15

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)


4/15

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.


5/15

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


6/15

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


7/15

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


8/15

Single Disease Focus...

... Multiple Disease Population


9/15

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


10/15

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


11/15

PFCD: MCC Research Agenda

Empowered: Informing

and enabling decision-

making and self-care

Informed: Interpreting

and applying theevidence

Equipped: Effective

models of care


12/15

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


13/15

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


14/15

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


15/15

PFCD:A Vision for a Healthier Future

Questions?

multiple chronic conditions: policy changes & patient needs

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