Healthcare in a Chronic Condition

Who are the biggest healthcare consumers? These days it is those with multiple chronic conditions. Almost half of all Americans live with a chronic condition. More than a quarter, and two out of three older Americans, are estimated to have at least two chronic physical or behavioral health problems. This number is projected to increase by more than 1% per year by 2030, resulting in an estimated chronically ill population of 171 million.

A chronic condition, as characterized by The Chronic Care Model, is characterized as any condition that requires ongoing adjustments by the affected person and interactions with the healthcare system. Treatment for people living with these multiple chronic conditions currently accounts for an estimated 66% of the Nation’s healthcare costs. As the U.S. population ages, the number of patients with multiple chronic conditions continues to grow. This mounting challenge has become a major public health issue that is linked to suboptimal health outcomes and rising healthcare costs.

As a result, many managed care and integrated delivery systems have taken a greater interest in correcting the many deficiencies in current management of diseases such as diabetes, heart disease, depression and others. Some of these deficiencies include rushed practitioners not following established practice guidelines, lack of care coordination, and lack of active follow-up to ensure the best outcomes.

Earlier this year Susan DeVore outlined some trends to look for in 2014 which included:

• Chronic Care, Everywhere – the implementation of accountable care organizations (ACOs) and the deployment of Ambulatory Intensive Care Units (A-ICUs)
• Put Me In, Coach – Early adopters of the A-ICU care model report that their biggest asset in the effort to manage chronic conditions isn’t a nurse or a doctor, it’s a health coach
• Health Care at Home – “Hospital at Home”, a program designed by Johns Hopkins that provides acute care services in the homes of patients who might otherwise be hospitalized, has been demonstrated to increase the quality of care patients receive, improve their satisfaction, and reduce costs by at least 30%.
• On-the-Job Health – The trend for companies to offer incentives for healthy behaviors or penalties for non-compliance is being driven by two forces, both spurred by the Affordable Care Act: the ability for employers to increase the dollar value of wellness incentives from 20%-30% of total coverage, and increased private insurance costs.
• Changes in the Exchanges – A growing number of employers are considering comparable, private exchanges for their employees which allow employers to contract with a benefits provider offering hundreds of competitive health plans from dozens of insurers.
• War of the Words – While there may not be much of a chance to repeal and replace the ACA before 2017, there are opportunities for health policy changes, including a permanent fix to the sustainable growth rate (SGR) method for calculating physician payments.
• Data Liberation – The big data revolution of 2014 will likely be a provider-led push to liberate data by making application programming interfaces open source tools that developers can use to design creative, new applications that make use of all data and turn it into something providers can truly leverage.
• Partners R Us – Unusual partnerships across healthcare designed to deliver care in new ways involve things such as drug chains partnering with physician groups to create ACOs based around retail clinics. The trend in 2014 will include community-based groups, including social service agencies, area gyms, and other non-health care service providers.

This is just a summary of the trends Susan DeVore predicted for 2014. Check out her entire article at healthaffairs.org to get even more in-depth information about these trends.

Bullets

• Teens who are victims of cyberbullying are more likely to have mental health and substance use problems, while regular family dinners appear to moderate these negative health effects, a JAMA Pediatrics study suggests. Roughly 19,000 students aged 12 to 18 completed surveys about cyberbullying and family dinners, a proxy for family communication. Teens who said they were often cyberbullied had two to five times the risk for mental health and substance use problems as those who were never cyberbullied. Meanwhile, a higher number of family dinners per week was linked with reduced health problems related to victimization — when adolescents had at least four family dinners, there was a four-fold difference in the rates of problems between those who were never victimized versus those who were frequently victimized. That gap increased to seven fold when there were no family dinners. (jwatch.org)

• Consumers have reported using mobile health and fitness apps to get in shape, and many industry sources believe that wearables are next. March 2014 polling by Makovsky Health and Kelton Research found high interest in wearable health and fitness devices: 81% of US internet users said they would use one. Tracking fitness was the top reason, cited by 48%. Keeping up with personal health issues landed in second place, while tracking diet and nutrition ranked third. (emarketer.com)

• Fewer U.S. teens are slathering on sunscreen, according to a study in Preventing Chronic Disease. High school students answered questions about sunscreen and tanning bed use as part of the Youth Risk Behavior Surveillance System in 2001 through 2011. The percentage of teens who reported ever using sunscreen in the past 12 months declined from 68% in 2001 to 56% in 2011. Girls were more likely than boys to report using sunscreen. Overall, tanning bed use declined slightly from 16% in 2009 to 13% in 2011, but rates in 2011 were still high among white females, at 29%. (jwatch.org)

• Between 31% and 55% of patients at very high risk for dying within 9 years underwent recent cancer screenings.Many health organizations recommend against routine cancer screening in patients with short life expectancies (generally, <10 years), but inappropriately high screening rates persist (NEJM JW Gen Med Mar 20 2014). Investigators assessed self-reported cancer screening in about 27,000 older adults (age, ≥65) who were queried periodically between 2000 and 2010. A validated instrument was used to calculate 9-year mortality risk for each participant, and participants were grouped from low (<25%) to very high (≥75%) risk. (jwatch.org)

• Millions of Americans get sick from contaminated food each year. In fact, the odds are one in six Americans will become ill in a given year from contaminated food, according to the Centers for Disease Control and Prevention (CDC). Of the 48 million afflicted, roughly 128,000 are hospitalized and 3,000 die, the CDC reports. (guardianlv.com)