Chronic
disease management is a high-priority competency for providers who wish to rein
in Medicare spending rates and deliver high quality care.
June
10, 2016 - Helping patients improve their chronic disease management
skills is one of the most common tasks for primary care providers, and also one
of the most costly.
Caring
for patients with hypertension, diabetes, asthma, chronic kidney disease, and
arthritis sap billions of dollars from the healthcare system, especially when
care is poorly coordinated and providers lack critical data for informed
decision-making.
While
Medicare has seen some early success with containing chronic disease management
costs through accountable care organizations (ACOs) and other value-based
reforms, a rapidly aging population and the continued technical challenges of
creating an integrated care continuum are making it difficult for providers to
keep up.
Over
the past few years, in conjunction with wider efforts to modernize the
healthcare industry through the adoption and use of electronic health records
and population health management tools, CMS has been releasing various datasets
to increase transparency and equip providers with the tools they need to
deliver quality care.
These
datasets can help providers understand their particular regional challenges as
they work to reduce racial and ethnic care disparities,
expand access to care for elderly chronic disease patients, and work with a new
array of partners to address mental healthcare, community
needs, and preventative services.
The Medicare Chronic Conditions Dashboard is
just one of several online interfaces designed to allow healthcare stakeholders
to access actionable insights about spending rates, disease prevalence, and the
impact of multiple chronic diseases on patients.
With
2014 data available at the regional, state, and county levels, the dashboard
may be an important addition to the chronic disease management toolkit for care
coordinators across the nation, especially as average per-capita spending on
patients with a constellation of six or more chronic diseases reaches nearly
$30,000 each year.
It
is no surprise that patients with the highest number of comorbidities are
likely to incur the most costs. Previous research from the Agency for
Healthcare Research and Quality (AHRQ) found that the top 5 percent of patients
with four or more chronic diseases are responsible for 30 percent of all
chronic disease spending, and the CMS data comes to a similar conclusion.
While
just seventeen percent of Medicare patients live with more than six chronic
conditions, they account for half of all spending on beneficiaries with chronic
disease.
In
contrast, the 35 percent of Medicare patients with a very low burden of chronic
disease – no chronic conditions or just one long-term health concern – are
responsible for less than ten percent of annual costs. On average, these
relatively healthy patients account for less than $2000 each year in per capita
spending.
Patients
who live in the Deep South and parts of the Southwest, including Texas, are
among the most likely to experience the greatest burdens of chronic
disease. Due to the population density of urban areas including New York
City, there are a high number of patients in New York and New Jersey who also
suffer from a number of complex conditions.
Even
though the New York region is marked as having the highest deviation from the
national distribution average, the difference in distribution rates between the
two Southern United States regions and the New York metropolitan area is only
about one percent.
In
each of the three areas, between 15.75 percent and 16.75 percent of Medicare
patients live with six or more chronic diseases.
On
the other end of the spectrum in the Pacific Northwest, only 9.16 percent of
Medicare beneficiaries experience such a high chronic disease count.
However,
while it seems reasonable to assume that increasing age produces more chronic
diseases and therefore more spending, the data does not show such a direct
correlation. Medicare beneficiaries who are under the age of 65 are
actually more likely to incur higher spending than older patients, the
dashboard reveals.
The
difference is more than $5000 per beneficiary per capita among patients with
the highest number of chronic diseases, yet the difference is minimal among
patient age groups with few or no long-term conditions.
There
is little difference between spending rates when beneficiaries are divided by
gender, although male patients tend to cost slightly more than female patients
overall.
The
same cannot be said when it comes to race and ethnicity, however. As a
separate Medicare data dashboard shows, there are stark differences between
spending rates for white patients and their counterparts across a variety of
ethnic and racial groups.
The Mapping Medicare Disparities (MMD) dataset shows
that some states exhibit significantly higher spending on chronic diseases such
as diabetes for black patients when compared to those identifying as white.
These
states include Florida and Texas, which are both named multiple times on the
list of counties with the highest prevalence of diabetes, hypertension, and
hyperlipidemia.
Ethnic
and racial disparities are also apparently when it comes to key chronic disease
management indicators, such as blood sugar control. Diabetic Medicare
patients who identify as black are nearly ten percent less likely than white
patients to report that their blood sugar is within an acceptable range.
For
patients with multiple conditions, failing to maintain proper blood sugar
control may also have an impact on their other diseases, and might indicate a
need for a new assessment of their chronic disease management capabilities and
skills.
Overall,
the data helps to illustrate the scope and challenge of maintaining a high
quality of life and quality of care for Medicare patients, whether they are
extremely complex and costly or experience a relatively low burden of disease.
Providers
who are unsure of how to best implement population health management programs –
including those who are trying to decide on where to start with interventions
that will produce the most immediate or cost-effective impact – may wish to
examine Medicare data from their particular region as a first step.
Using
all the available data analytics tools at their disposal will allow healthcare
providers to monitor patients at high risk of costly events such as preventable
admissions or readmissions, which improves quality of life for patients and may
reduce overall spending for the beleaguered healthcare system.
https://healthitanalytics.com/news/analyzing-medicare-chronic-disease-prevalence-spending-rates
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