Chronic Care Management

Introduction

The Centers for Disease Control and Prevention (CDC) estimate that upwards of 117 million American adults are living with at least one chronic health condition. The CDC also estimates that as many as one in four American adults have been diagnosed with at least two chronic health conditions. Those statistics are staggering, and it is expected that they will increase.

Given the fact that so many American adults are suffering from chronic health conditions, there is an undisputed need for effective chronic care management.

What exactly is chronic care management and why is it important? In this article, we’ll touch on this exceedingly important form of healthcare.

What is a Chronic Condition?

To better understand what chronic care management means, it’s important to have an understanding of what a chronic health condition is. Chronic conditions are diseases or illnesses that are persistent or long-lasting, and as such, the effects that they have on an individual’s health is also long-lasting. Usually, a condition is deemed “chronic” if it lasts for a period of one year or more, require constant medical care, and reduce the daily life of the patient. There are a myriad of chronic health conditions, some of the most common of which include:

  • Asthma
  • Diabetes
  • Chronic obstructive pulmonary disease
  • Arthritis
  • Cancer
  • Acquired immunodeficiency syndrome (AIDS)
  • Hepatitis C

In other words, these conditions are considered life-long, meaning that those who are diagnosed with a chronic condition will experience the symptoms and side effects for the rest of their lives. Chronic illnesses, including diabetes, cancer, and heart disease, are the primary cause of disabilities and death in the US. They also contribute a gross amount to the yearly cost of health care; an estimated $3.3 trillion per year.

Chronic Care Management Defined

Chronic care management can be loosely be defined as the medical assistance and support that healthcare professionals offer patients who are suffering from chronic health conditions. In other words, this type of healthcare management involves any type of care that a medical professional offers patients who have been diagnosed with long-lasting health conditions.

Objectives of Chronic Care Management

The main objective of chronic care management is to improve the quality of life of those patients who are afflicted with chronic diseases and conditions. Care management for chronic conditions typically includes interventions, therapies, and medication assistance; however, the approach to this type of healthcare is not the same for every patient. In other words, it depends on the specific needs of each patient. Even though two people may be diagnosed with the same chronic disease, that disease can have very different effects on each person. Therefore, medical professionals assess the overall condition of each individual patient to determine his or her specific needs, and they devise a plan of action that is customized to meet those needs.

With that said, the overall goal of chronic care management is to provide the following for patients:

  • Minimize pain
  • Improve weight
  • Reduce stress levels
  • Increase mobility
  • Restore function

In other words, chronic care management aims to improve a patients overall quality of life by providing the specific care that each person needs to combat the effects of the illness that they are afflicted so that they can maintain a sense of “normalcy”.

The Importance of Chronic Care Management

Since chronic illnesses can have debilitating effects on an individual’s overall health and because they require on-going medical care to prevent death, chronic care management is crucial to the overall health and well-being of any individual that is diagnosed with such an illness. With this type of care, patients who are diagnosed with lasting illnesses could suffer immensely; not only will their quality of life deplete significantly, but the condition that they are living with could advance to the point that it could ultimately claim the patient’s life.

Issues with Chronic Care Management

Despite the obvious need for and importance of chronic care management, this type of healthcare is something that has been somewhat disjointed among healthcare providers, as well as insurers. There seems to be a lack of coordination between all of the agencies and individuals that need to be involved with this type of healthcare management. The communication between doctors, settings where care for chronic illnesses is provided, and insurance companies is severely lacking. To further complicate these issues, chronic conditions themselves can be complicated, which can make it hard for healthcare providers to fully understand exactly what type of care an individual requires.

Additionally, chronic conditions require much more frequent care for longer periods of time, and the visits to doctors generally need to be much more comprehensive, which further complicates things. Moreover, because of the very nature of chronic diseases, treatments that are suggested may not be as effective for one person as they are for another.

Lastly, the fact that chronic conditions can coexist makes managing healthcare for these patients even more difficult. For example, a patient who has been diagnosed with two chronic illnesses may only see a specialist for one condition, while the other condition does not receive adequate treatment. While medical care providers for one specific problem may try to offer assistance for the issues that they are not proficient in, typically, they cannot offer the extensive therapies and treatments that are needed.

With all of these issues, patients who are diagnosed with chronic conditions often find that they have a hard time complying with any efforts that are made on their behalf. They feel confused, or they just aren’t made aware of what they need to do in order to proceed.

The Development of Chronic Care Management

Given the complications that exist regarding care for chronic health conditions, numerous patients with long-lasting illnesses have, undoubtedly, not received the care that they need. Because of this, a new branch of medicine that aimed to provide customized care for chronic illnesses patients was developed – chronic care management.

During the 1980s and 1990s, medical researchers and healthcare professionals – specifically Sally Wellard, CS Burckhardt, and C Baker – really began to develop an understanding of the intricacies that surround healthcare for chronic diseases. During this time, this specialized type of care was implemented; and, in 2004, it advanced even further. It was then that the Fennel Four Phase Model was developed and published by Patricia Fennel. The development of this chronic illness model was a crucial development into even further understanding of the management of long-lasting health conditions.

According to the Fennel Four Phase Model, patients who are diagnosed with chronic health conditions experience four distinct phases, which include:

  1. Crisis
  2. Stabilization
  3. Integration
  4. Resolution

These phases refer to the manner in which patients discover how to adapt to changes in their health and incorporate the different therapies that they require into their lives, eventually recognizing, accepting, and adapting to the changes that their health will have on their lives.

Thanks to the developments in the understanding of chronic care management, there has been serious progress in the development of the care that patients who are afflicted with chronic illnesses require.

Chronic Care Management Today

Today, in the United States, chronic care management is not recognized as a crucial form of healthcare; so much so that it is now included with healthcare that is offered through Medicare and Medicaid. In 2015, Medicare started to cover the cost of services that are related to chronic care management for those who are afflicted with two or more serious conditions that are predicted to last for a period of at least one year. Patients who require chronic care services would pay their regular monthly fee, as well as their deductible and coinsurance. Patients that are covered by both Medicare and Medicaid, Medicaid may help to cover Medicare’s monthly fee. Patients who have supplement insurance and Medicare, their supplemental insurance may assist with Medicare’s monthly fee.

The Future of Chronic Care Management

Given the in-depth understanding of chronic care management and the importance of this division of healthcare, as well as the advancements of including coverage under Medicare and Medicaid, it is safe to assume that the future is looking positive. Experts say that the research indicates that the chronic care management program will continue to move forward; as such, it can be expected that the lives of many Americans who are living with chronic health conditions can expect better care, as well as a better overall quality of life.

It should be noted that each individual’s situation is unique; however, in areas where there are a large amount of Medicare beneficiaries, it is very likely that the progress of chronic care management will continue moving forward in the right direction.

Conclusion

Chronic health conditions can be debilitating and can dramatically alter an individual’s life. Thanks to the progress in chronic care management in recent years, it is safe to assume that this type of care will continue to advance. Patients who are diagnosed with chronic health conditions should expect to see an improvement in their overall care.

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