Why Chronic Conditions Need Continuous Care Coordination

Why Chronic Conditions Need Continuous Care Coordination

At 58 years old, Ms. G had diabetes and high blood pressure. She was also overweight and battled depression. After a regular visit with her primary care physician (PCP), Ms. G was referred to a mental health center for heightened depression and was later sent home. That’s where her journey began.

During the next few weeks, she met with a mental health professional, visited the ER twice, took the wrong medication, became bedridden, and ultimately ended up back in the hospital with a stroke. Her outcome was an unfortunate culmination of poorly-managed chronic illnesses.

Chronic disease has reached epidemic status, with the CDC reporting that it is the leading cause of death and disability. Sixty percent of adults in America have at least one chronic condition, and 40% have multiple. With an aging baby boomer population, the number of people with chronic conditions is expected to spike even further, increasing from 30.8 million to 83.4 million by 2030. And it will come with a whopping price tag of $42 trillion. 

The most common chronic diseases include hypertension, high cholesterol, mood disorders, and diabetes. Any of these alone can be challenging to manage, but more than one can have a profound personal impact on functional, social and cognitive activities, ultimately leading to an overall lower quality of life.

Compared to Americans with no chronic conditions, those with five or more conditions spend 14 times as much on healthcare. Chronic conditions also tend to be the biggest drivers of Medicare costs. The rates of ED utilization double between those with no chronic conditions and those with just one. And, the 12% of Americans with five or more conditions visit the ED nearly five times as frequently those with none, driving 41% of all healthcare spending.

Though they may be some of the most detrimental and costly conditions, the good news is that chronic diseases are also some of the most preventable. The Partnership to Fight Chronic Disease estimates that we could save 1.1 million lives and $6.3 trillion between now and 2030 by focusing on preventing chronic disease and improving treatment.

Early intervention and prevention are becoming priorities in healthcare with more emphasis on population health management and attention toward the social determinants of health. But, as the Partnership to Fight Chronic Disease advocates, management of those already burdened with chronic disease should be as much of a priority as improving their quality of life.

In Ms. G’s situation, much of her deteriorating health condition could be attributed to a lack of coordination between her providers. Until she was in the hospital for the stroke, her PCP had no idea that her health status has worsened. Like Ms. G, 70% of seniors with chronic illnesses reported in a survey needing stronger care coordination from providers. 

While recent legislation has attempted to address this issue, it still has more hurdles to jump before it goes into effect. Until then, the message of prioritizing care coordination in chronic disease management rings loud and clear. Chronic diseases require 24/7 monitoring and treatment, making seamless care coordination essential.

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