Chronic care has major impact

By Paul Serini

A recent study published in Diabetes Care cites that diabetes rates are expected to double in the next 25 years, which would equate to roughly 17 percent of Georgia residents developing this chronic illness. The report acknowledges what many within the health care industry have cited for years: Rising prevalence of chronic conditions such as diabetes threatens the sustainability of our health system.

To truly “bend the curve” of health care costs in Georgia, local efforts must provide better support for those with chronic conditions. The rising cost of health care in Georgia is not a “coverage” issue as much as it is a “chronic” issue.

This “chronic curve” of rising health care costs is perhaps most evident in the country’s largest health insurer, Medicare. Seniors with multiple chronic conditions are among Medicare’s most costly, accounting for more than 75 percent of program spending. That’s right, of the $455 billion spent in Medicare last year, over $341 billion of it went to care for those with chronic conditions — representing 11 percent of the nation’s federal budget.

The harsh reality reflected in these numbers is that the nearly 79,000 Atlanta-area seniors in traditional Medicare with chronic conditions simply fall through the cracks that exist in the current program, suffering repeat admissions to the hospital and experiencing a frustrating and downward spiral of progressively poorer health and sky-rocketing medical costs.

What can be done? The rising cost of chronic disease among Georgia Medicare participants can be addressed through coordinated approaches providing meaningful support and added services that allow seniors diagnosed with diabetes, heart failure and other illnesses to improve their quality of life, receive better care and spend less time in the hospital. This includes Medicare coordinated care plans, which combine organized health care coverage with prescription drug benefits, a network of providers, and specialized programs to address the needs of their members.

A recent analysis from Johns Hopkins affiliated researchers proves that coordinated health plans in Medicare can successfully control costs and reduce preventable hospitalizations for those with chronic illnesses. In the analysis, Medicare recipients were 27 percent less likely to be readmitted after a hospitalization and 87 percent less likely to suffer a preventable ER visit.

For too long, Medicare and some health insurers have shown little interest in proactively managing care, being content to simply fulfill the insurance role of collecting premiums and paying medical bills. Now that the fall-out from this historical approach is clear, action must be taken to create opportunity for solutions applying the tools of preventive care, care coordination and disease management to improve patient outcomes.

Health reforms encouraging innovation in chronic care within Medicare will have a ripple effect throughout the health insurance industry.

Revamping the Medicare program to better encourage support of the chronically ill and improvements in the quality of care they receive should be the basis of any health reform package looking to have a meaningful impact on costs.

Paul Serini is executive vice president of XLHealth, which operates Special Needs Plans for Georgia Medicare beneficiaries with chronic conditions.