Managing Care for Adults with Chronic Conditions

A Workshop Brief for State and Local Policymakers

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An estimated 125 million Americans had at least one chronic condition in 2000, and that number is expected to increase to 157 million by 2020. The chronically ill account for 78 percent of all health care expenditures and 97 percent of all Medicaid expenditures for people age 65 and older. The number of people with chronic conditions and the cost of caring for them pose significant challenges to a range of State agencies that include departments of health, aging, and Medicaid as well as state employee health benefit agencies. Evidence suggests that the cost of caring for persons with one or more chronic conditions may be minimized and the quality of their lives improved if preventive measures are taken early or if more attention is given to coordinating the care and services they might need.

The following is a summary of a workshop on managing care for adults with chronic conditions cosponsored by the User Liaison Program (ULP) and the Centers for Medicare & Medicaid Services (CMS). It was held in Philadelphia, PA, December 11-13, 2002.

About the Workshop Sponsor.

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Workshop Objectives

By the end of the workshop, participants were expected to better understand:

• The prevalence, cost, and utilization of health and supportive services for people with chronic conditions.
• Strategies to manage costs and improve health outcomes.
• Approaches to care coordination.
• State models for coordinating acute, primary, and long-term care.

Summary of Key Workshop Themes

Why This Focus?

Identifying and Managing Chronic Conditions

Numerous strategies exist to promote the prevention and management of chronic conditions. They include:

• Identifying individuals at risk of developing a chronic condition and helping to prevent its occurrence.
• Promoting chronic disease self-management through education.
• Using technology to manage chronic conditions.
• Implementing disease management programs.

Delivering and Coordinating Services

States have begun to develop innovative programs aimed at influencing the delivery of care and focusing more attention on the coordination of health and supportive services. These efforts are designed to foster seamless systems of care that cross settings, providers, and financing entities. Their goals are to improve the quality of care for the chronically ill, encourage more efficient use of health care services, and reduce health care costs.

Managing Complex Populations

The dual eligible population has a higher proportion of chronic, disabling, and complex conditions than other Medicaid and Medicare beneficiaries. The Centers for Medicare and Medicaid Services (CMS) has formed a technical advisory group to improve the coordination of policies, procedures, and regulations between Medicare and Medicaid. The group's goal is to promote an integrated delivery system for dual eligibles and to support individuals in community care settings through innovations in chronic care management.

Using Managed Care Networks to Fully Integrate Care

Traditional fee-for-service systems lack incentives to control the use of health services, use evidenced-based practice guidelines, or coordinate multiple service providers for people with chronic conditions. The most intensive interventions currently being used by States include programs that combine acute and long term-care-services that are funded by Medicaid and Medicare and that use managed care networks to fully integrate care. These models use interdisciplinary care teams and comprehensive provider networks to coordinate care across payers, settings, and service providers. The Wisconsin Partnership Program (WPP) and VNS Choice are two comprehensive programs that serve Medicaid beneficiaries who may be elderly or adults with disabilities, including dual eligibles. Both programs integrate health and long term support services, including home and community based services, physician services, and other medical care.

AHRQ's User Liaison Program (ULP) disseminates health services research findings in easily understandable and usable formats through interactive workshops. Workshops and other support are planned to meet the needs of Federal, State, and local policymakers, and other health services research users, such as purchasers, administrators, and health plans.

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