Chronic Care Becoming a Chronic Problem

To lower costs and increase quality of care, policymakers in California need to address how to better treat the chronically ill — those patients at the center of health care spending in the state.

That was the conclusion of a health care panel discussion last week in the Capitol Building in Sacramento, put on by the Center for Health Improvement as part of the California Health Policy Forum.

“This is a huge worldwide epidemic,” according to panelist Sophia Chang. “About two in five Californians have at least one chronic condition — and half of these people have two or more of these conditions.”

Chang is director of the Better Chronic Disease Care program at the California HealthCare Foundation, which publishes California Healthline.

She said chronic care is expensive care.

“About 84% of our health care expenditures are going to people with chronic conditions,” Chang said. “And we haven’t figured out how to grapple with their care yet, and we should.”

The most common chronic conditions are high blood pressure, diabetes and high cholesterol — Chang calls them the chronic disease triad. The cost of care rises quickly for patients with multiple chronic conditions, Chang said.

“The more conditions, the greater the cost of care, but it’s not a one-for-one thing. It’s not a steady increase. It’s an exponential increase,” Chang said.

Panelist Liz Helms of the California Chronic Care Coalition said a campaign in San Diego to curb heart attack and stroke rates has been extremely successful. Helms said the advertising portion of the campaign was vital.

“We wanted to not just wait to see health care reform be implemented, we wanted to be more active,” Helms said. “We felt we needed to get the word out to the community.”

To Sarah Steenhausen, a senior policy adviser for The SCAN Foundation, the key to addressing chronic care is to look at long-term care, since so many seniors suffer from chronic illnesses.

“There’s an intersection between long-term care and chronic conditions,” Steenhausen said.

The issue to solve, she said, is to better coordinate care between the medical care system and the long-term care system, and to make sure services are easy to access, so that conditions don’t worsen to crisis proportions.

“These are the people who are more prone to hospitalizations and nursing home admissions,” Steenhausen said, and that’s where health care expenses really start to rise in California, she said.

That hit a chord for Chang. “One of the key aspects to avoid is readmission,” she said, and avoiding readmission means better communication at the clinical level, she said.

“When the family goes home, you need to make it really clear: What is the red flag? When should you worry? That way, people know when to call a provider,” she said. “Otherwise, they just wait till they get to the point where they have to call 911.”

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