This April 24th article published by the Commonwealth Fund is timely and a must-read. It highlights the challenges of engaging, treating, and supporting persons with multiple, complex, chronic health conditions (defined as three or more health conditions, often including mental health). It supports what the Hogg Foundation believes in: integrated health care, team-based care, care coordination and relationships. In short, treating people with respect, dignity and worth.
- People with multiple, complex, chronic health conditions (approximately 12 million persons) are among the 5 percent of patients who account for about 50 percent of health care spending.
- Collectively, these individuals account for more than $120 billion in health care spending annually.
- They also possess a functional limitation that interferes with basic activities of daily living.
- People with multiple, complex, chronic health conditions are impacted by social determinants of health (socioeconomic and cultural factors).
- A Commonwealth Fund survey of high-need patients found that 44 percent reported delaying care in the past year because of an access problem such as lack of transportation to the doctor’s office, limited office hours, or an inability to get an appointment quickly enough, often leading to a deterioration of their condition and resulting in more intensive care and more expensive care
That said, for all the money spent on multiple, complex, chronic health conditions, this particular patient population is not always receiving the best care or right type of care, where they need it, when they need it, and how they need it. One of the major dilemmas of health care.
A Way Forward: Care Coordination
Despite the challenges noted above, there are exciting and promising efforts to improve care being implemented, tested and evaluated across the nation. Collaborative, team-based initiatives with care managers such as social workers or nurses working within a clinic or medical home type setting show promise.
Many of these programs emphasize relationship-building and focus more on meeting patients’ non-medical needs outside the clinic visit. Most of these programs pair patients with a care manager who coordinates their care. Care managers may or may not have extensive medical training, but understand the complexities of the health care system well enough to help patients successfully navigate it. Importantly, these care managers also serve as effective advocates on behalf of patients for housing, mental health, legal assistance, nutritional support, transportation and other non-medical needs.
The Commonwealth Fund article highlights innovative programs, patients and care coordinators in Los Angeles, Chicago and Minneapolis, just a small sampling of programs involved these kinds of efforts.
The three examples have several commonalities: improved health outcomes (people get better), increased engagement (people attend clinic appointments, are more satisfied with their care and learn about self-management of their conditions), and fewer ER visits and hospitalizations (translating to lower costs). Lastly, all examples point to the value and benefit of a care coordinator, who provide frequent “touch points” that do not occur in the clinic or in the health care encounter.
At the end of the health care day, it’s about relationships. Relationship between provider and patient, relationship between team members, relationship between care manager and patient, and relationships between the patient and their family/caregivers and community. Relationship-building. Not taught in medical schools and in academic graduate training programs. And most importantly, relationship-building does not come in pill form.
There is increased recognition that non-medical factors and social determinants of health impact chronic health conditions. Coping with the day-to-day reality of living with serious, multiple, chronic illnesses, transportation challenges, a stable place to live, not knowing where the next meal is coming from, affording the copay for medicines versus buying food, etc. can impact both mental health and physical health, wellness and recovery. In the same way that medicine had to “learn” to assess and treat patients’ medical and mental health conditions, today’s real challenge for the next generation of health care providers is learning to also assess and treat patients’ non-medical needs. Integrated health care, team-based care, care managers, and relationship-building may be the bridge that connects and strengthens the relationship between the patient and provider.