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Chronic Conditions in the U.S. Implications for Service Delivery and Financing. Jane Horvath, M.H.S.A. Deputy Director Partnership for Solutions A Project of Johns Hopkins University and The Robert Wood Johnson Foundation. Chronic Conditions in the U.S.

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


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chronic conditions in the u s implications for service delivery and financing

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

Jane Horvath, M.H.S.A.

Deputy Director

Partnership for Solutions

A Project of Johns Hopkins University and

The 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.
slide3

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.

slide4

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

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

slide5

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

Both

Activity Limitation Only

Chronic

Illness Only

90 million

30 Million

7 Million

n = 127 Million

  • 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.

slide6

Most People with Chronic Conditions have Private Health Insurance

Population of People with Chronic Conditions in 1998

n =120 million

.

Source: Medical Expenditure Panel Survey, 1998.

slide7

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

Source: Medical Expenditure Panel Survey, 1998.

slide8

Health Care Spending Increases with the Number of Chronic Conditions

Source: Medical Expenditure Panel Survey, 1998.

slide9

People with Chronic Conditions are the Heaviest Users of Medical Care

Source: Medical Expenditure Panel Survey, 1998.

slide10

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

Source: Medical Expenditure Panel Survey, 1998.

slide11

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

Source: Gallup Serious Chronic Illness Survey 2002.

slide12

People with Chronic Conditions Report Getting Conflicting Advice

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

slide13

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.

slide14

Poor Care Coordination Leads to Unnecessary Hospitalizations

Source: Medicare Standard Analytic File, 1999.

slide15

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