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

1. 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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. Health Care Spending for People with Chronic Conditions Accounts for 78 % of All Health Care Spending Source: Medical Expenditure Panel Survey, 1998.

8. Health Care Spending Increases with the Number of Chronic Conditions Source: Medical Expenditure Panel Survey, 1998.

9. People with Chronic Conditions are the Heaviest Users of Medical Care Source: Medical Expenditure Panel Survey, 1998.

10. People with Multiple Chronic Conditions are Much More Likely to be Hospitalized Source: Medical Expenditure Panel Survey, 1998.

11. More than Half of People with Serious Chronic Conditions Have Three or More Different Physicians Source: Gallup Serious Chronic Illness Survey 2002.

12. People with Chronic Conditions Report Getting Conflicting Advice Source: Chronic Illness and Caregiving, a survey conducted by Harris Interactive, Inc., 2000.

13. 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.

14. Poor Care Coordination Leads to Unnecessary Hospitalizations Source: Medicare Standard Analytic File, 1999.

15. 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