Supporting People With Multiple Chronic Conditions: A Health Priority

We live in a time of remarkable transformation in our health care system, accelerated by the Affordable Care Act. A focus on supporting those with MCC is critically important to enhance health, improve care, and lower costs.
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As physicians, we have both had the privilege and the responsibility of caring for individuals with multiple -- two or more -- chronic conditions. In fact, as our population ages, every provider will care for rising numbers of patients who fall into this category. Data released this year show that 26.0% of adults and 68.4% of Medicare beneficiaries now have multiple chronic conditions (MCC). This matters because as the number of conditions rises for any given person, their clinical outcomes -- with respect to mortality, hospitalizations, readmissions, adverse drug events, quality of life, and functional status -- worsen. However, to date, the health system has traditionally treated such patients condition by condition, resulting in fragmented care and patients shuttling between multiple providers. As a nation, we need to accelerate progress toward true patient-centered and person-centered care.

Fortunately, the tide is starting to turn on this critical issue. Three years ago, the U.S. Department of Health and Human Services (HHS) launched the Strategic Framework on Multiple Chronic Conditions: an innovative public and private sector initiative to improve the health status and quality of life of individuals with MCC. The overall goals are to foster system changes in health care and improve patient-centered care coordination, maximize proven self-care management services, provide better tools regarding MCC to providers, and promote research.

Three years into implementation, HHS and its partners have been able to:
•Launch innovative care delivery models, supported by the Affordable Care Act, for subgroups of the MCC population, such as the Independence at Home Demonstration, the Medicaid Health Home State Plan Option, and the Primary and Behavioral Health Care Integration Program.

•Deliver the Chronic Disease Self-Management Program to more than 194,000 individuals, the majority of whom have MCC.

•Sponsor development of a National Quality Forum-endorsed MCC Measurement Framework and challenge clinical guideline developers to include comorbidity information in clinical guidelines.

•Release eight funding opportunity announcements on MCC patient-centered health research, including development of the Agency for Healthcare Research and Quality's (AHRQ) MCC Research Network.

This week, we announced three additional initiatives:
•The Centers for Medicare & Medicaid Services (CMS), in its CY 2014 Physician Fee Schedule, included a new payment starting in 2015 for providing non face-to-face care management services to individuals with MCC. This will support health professionals who spend the time and effort for improved care coordination for individuals with MCC.

•The Food & Drug Administration issued new guidance to discourage unnecessary exclusions of MCC patients by drug sponsors. This will help to ensure that such individuals are more likely to be included in clinical trials.

•Our office, the Office of the Assistant Secretary for Health, in collaboration with the Health Resources Services Administration, will be working with a variety of organizations to develop training materials for healthcare professionals. This project will improve education and training of healthcare professionals who provide care and services to individuals with MCC.

Working together in public-private partnerships, we can empower those with MCC, support their caregivers, and better equip professionals to assist in their care. We've been encouraged by the commitment of our colleagues in the private and non-profit sectors, specifically the National Council on Aging's Self-Management Alliance, the American Geriatric Society's Guiding Principles for the Care of Older Adults Multimorbidity project, and the Guidelines International Network's newly created Multimorbidity Working Group. In addition, organizations such as the National Health Council, the Partnership to Fight Chronic Disease, and the Patient-Centered Outcomes Research Institute have all recognized the unique imperatives in this arena. We're making headway, but much work lies ahead.

We live in a time of remarkable transformation in our health care system, accelerated by the Affordable Care Act. A focus on supporting those with MCC is critically important to enhance health, improve care, and lower costs. How well we prevent and manage multiple chronic conditions will play a vital role in determining the future health of our country.

Dr. Howard Koh is the Assistant Secretary for Health and Dr. Anand Parekh is the Deputy Assistant Secretary for Health (Science and Medicine).

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