Coping with multiple chronic conditions

Eighty-three percent of Medicare beneficiaries have at least one chronic condition, such as congestive heart failure, Alzheimer’s disease or diabetes. Two-thirds of Medicare spending is incurred by the 9.5 million beneficiaries with five or more chronic conditions. These percentages suggest that the Medicare program needs to address chronic conditions rather than the acute, episodic illnesses that have been the focus of the Medicare program since it began in 1966.

The Medicare Modernization Act of 2003 began the process of transitioning Medicare into a chronic care program, but additional changes are needed to complete this reorientation. “Significantly more needs to be done if the millions of Medicare beneficiaries with multiple chronic conditions are going to get the best possible care,” said Gerard Anderson, PhD, a professor in the Johns Hopkins Bloomberg School of Public Health’s Department of Health Policy and Management.

He identified three steps that will further the transformation of the Medicare program toward better care for Medicare beneficiaries with multiple chronic conditions. Anderson’s article is published in the July 21, 2005, issue of the New England Journal of Medicine.

The first step, according to Anderson, is to create an out-of-pocket maximum. It would protect beneficiaries with multiple chronic conditions from high out-of-pocket costs. Many private insurers already have a similar provision. The second step is to pay physicians to submit electronic medical records, which would reduce the number of duplicate tests, adverse drug reactions and unnecessary hospitalizations. Better care coordination among physicians is the final step. Medicare beneficiaries with five or more chronic conditions see an average of 13 different physicians per year. Quality of care suffers when their doctors do not know what types of treatments and tests the other physicians are prescribing. Paying one doctor to coordinate the care for a patient could improve patient outcomes.

Anderson, also director of the Johns Hopkins Center for Hospital Finance and Management, explained that because they ask the health system to make fundamental changes, these reforms will be difficult to implement. Active buy-in and participation by physicians are essential for the Medicare program to save money and improve care for patients with chronic conditions–and acceptance of these reforms by physicians in initial program trials has been slow. For example, Anderson said, paying doctors to complete electronic medical records would exceed $4 billion annually, but the cost would be far outweighed by the decrease in duplicate tests and unnecessary hospitalizations if all physicians complied and then relied on integrated electronic medical records.

“Nearly all of us have a relative with multiple chronic conditions. We know the multiple problems they face. They want one physician to help them coordinate all their care, ensuring proper treatment is being given to each of their health concerns and that all the various physicians are informed,” said Anderson.