A Primer on Managed Care: Multiple Chronic Conditions

ments. However, African Americans and indi- viduals living in rural areas continue to have the higher cancer mortality rates and shorter survival times than other population groups in the nation (O’Keefe, Meltzer, and Bethea, 2015; Henley et al., 2017). Alzheimer’s disease : Consistent and adverse disparities exist among African Americans and Hispanics, compared to non-Hispanic whites, in the incidence of Alzheimer’s disease, and related Despite overall declining cancer incidence and mortality rates, African American and rural American mortality rates are higher. mortality. In addition, disparities exist in these two groups’ participation in clinical trials, use of medications and long-term services and sup- ports, healthcare expenditures, and quality of care received. More African Americans than Caucasians care for relatives with dementia, and they are less likely to ask for support. Caring for a loved one is considered a responsibility, not a burden (Alzheimer’s Association, 2004). There- fore, the impact of caregiving may be greater for this population. Demographic shifts that are taking place and leading to a more racially and ethnically diverse older adult population will magnify the impor- tance of addressing disparities in the develop- ment of chronic conditions. Chronic conditions are the leading causes of frailty, disability, and death in the United States. They lead to declines in ADLs and IADLs, caus- ing individuals affected to lose their indepen- dence, and resulting in the need for help from family and-or paid caregivers, and-or requiring use of other long-term services and supports. Many people with chronic diseases restrict their The Personal and Financial Impacts of Chronic Conditions

social engagement with family, friends, and com- munities (Meek et al., 2018). As the number of chronic conditions in peo- ple increases, complications associated with care are more common. Due to America’s frag- mented healthcare system, there occur more instances of unnecessary and often avoidable hospitalizations, duplicative and-or contrain- dicated medication prescribing, and scenar- ios in which patients receive conflicting advice from physicians and other healthcare provid- ers. Functional limitations often complicate access to healthcare and interfere with self- management, which leads to elevated reliance upon caregivers (U.S. Department of Health and Human Services, Office of the Assistant Secre- tary for Health, 2015). Also, chronic conditions are leading drivers of our nation’s $3.3 trillion in annual healthcare costs. They account for 71 percent of all health- care costs (Gerteis et al., 2014) and 93 percent of Medicare fee-for-service spending (CMS, 2012). Medicare beneficiaries with multiple chronic conditions are the highest utilizers of health- care services, such as physician and emergency department visits, hospitalizations, home health care, and prescription drugs. In addition, indi- viduals with multiple chronic conditions face substantial out-of-pocket costs for their care, including more co-pays and higher costs for pre- scription medication. Conclusion Due to the heightened levels of chronic illness in the United States, along with the tremendous personal and financial costs associated with such illness, integrated approaches among clini- cal providers and community-based organiza- tions are critically needed. Also, important to prevent further progression of chronic disease and onset of new conditions are broad-based implementation and payment mechanisms for self-management and engagement programs for those afflicted with chronic illness. Targeting racial-ethnic, geographic, and socioeconomic

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