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HHS Initiative on Multiple Chronic Conditions

Background

Approximately 75 million Americans have multiple (2 or more) chronic conditions (MCC). Chronic illnesses are “conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living.”1 2 Although older adults are more likely to have multiple chronic conditions, the majority of Americans with multiple chronic conditions are in fact below 65 years of age. As the number of chronic conditions in an individual increase, the following outcomes also increase: mortality, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice. Moreover, 65% of total health care spending is on care for the approximately 25% of Americans with multiple chronic conditions. Individuals with MCC also face substantial challenges related to the out-of-pocket costs of their care, including higher prescription drug and total out-of-pocket health care spending. Prevention of exacerbations of their chronic conditions and of the occurrence of additional chronic illnesses should reduce the burden of MCC to society and improve the health of patients with MCCs.

HHS Role

Due to the increased cost and complexity of managing individual patients with MCC, it is important that the Department of Health and Human Services (HHS) develops and coordinates programs and policies that optimally reduce the burden of MCC to our society as well as improve the health of individual patients. To achieve this goal HHS will also need to coordinate its efforts by engaging external stakeholders in the development of effective strategies to address the health status of individuals with MCCs.

HHS Interagency Workgroup

To determine how to improve the health of this heterogeneous population, in mid-2008, the Office of Public Health and Science (OPHS) convened a departmental workgroup on individuals with multiple chronic conditions. Nearly all HHS operating divisions have participated in this workgroup at a senior staff level. To date, there have been four interagency meetings, including one with an academic external stakeholder panel in November 2008 (see meeting summary). The first major effort of the workgroup is a collation of existing HHS programs, activities, and initiatives focused on improving the health of individuals with multiple chronic conditions. This inventory (PDF) contains over 50 current efforts across HHS in which the following approaches are taken to improve the health of this population: a) Assisting healthcare providers to care for individuals with MCCs; b) Assisting individuals with MCCs with self-care management; c) Health system changes to improve the health status of individuals with MCCs; and, d) Research to develop the tools and methodologies that optimally guide providers, patients and the healthcare system in the care of patients with MCCs. The workgroup is now engaged in determining areas of synergy between existing initiatives as well as discussing the implementation and evaluation of new programs, activities, and initiatives throughout HHS divisions to improve the health status of this population. Additional roundtables with external stakeholders focused on exchanging ideas on how to improve health services to this population will be planned in the future.


 

1 Hwang, W., et al. 2001. “Out of Pocket Medical Spending for Care for Chronic Conditions.” Health Affairs 20: 268-9.
2 Note: Chronic conditions are inclusive of mental illness and addiction disorders.