Management of Chronic Disease
Our current health system presents multiple challenges to effective and efficient care of chronically ill patients. First, the fragmented nature of our system means patients have multiple care providers who don’t communicate with each other, and are not individually or collectively responsible for patients’ whole care. Second, health care is centered around care in a doctors’ office or hospital, while evidence shows the overwhelming proportion of the care needed by chronically ill patients is self-administered.1 Third, our predominant provider payment systems reward high-cost medical interventions over higher-value primary care; they reward volume of care over quality of care. Fourth, the trend toward patients assuming higher burdens of cost sharing (i.e. deductibles and co-pays) in the predominant health insurance market creates disincentives to patient utilization of chronic disease diagnosis and treatment services that contribute to effective disease management and cost control.
With 75% of all US health expenditures associated with treatment of chronic disease2 and 2/3 of cost increases driven by the rising prevalence of it,3,4 there is little disagreement that growth in America’s health costs cannot be effectively managed without reforming the delivery of chronic disease care. Innovations in health care delivery that address the sources of current costly inefficiencies and ineffectiveness in health care delivery focus principally on: a) coordination of care utilizing a team approach known as “The Patient-Centered Medical Home” and b) restructuring provider and patient incentives to reward provision of high quality, cost effective care and encourage patient utilization of it.