GENERATIONS – Journal of the American Society on Aging

Managing Chronic Disease in an Evolving Healthcare Environment By Erin Westphal

Community-based organizations increasingly are addressing social determinants of health, and preventing more expensive medical interventions.

O ver the past 100 years, great advances have been made in medicine. These have resulted in increased human longevity, however, people are living longer with chronic conditions, as shown in Figure 1 (see page 4). A chronic condition can be a physical condition, such as chronic obstruc- tive pulmonary disease (COPD), or a mental health condition, such as Alzheimer’s disease or other dementias. These conditions persist for more than one year and result in functional limitations. Heart disease, cancer, stroke, COPD, and diabetes account for more than two-thirds of deaths and 75 percent, or $1.5 trillion, of health- care spending (Wullianallur and Raghupathi, 2018). The systems providing care and payment policies have not kept pace with these medical advancements. Medicare, the nation’s largest payer for healthcare, provides coverage to nearly 90 mil- lion people. Twenty percent of those people are dually eligible, meaning they also have Medi­ caid, the insurance for low-income individuals (Rudowitz and Garfield, 2018). Fourteen percent

of these beneficiaries have six or more chronic conditions, and 55 percent have between two and five (Better Medicare Alliance, 2017). When peo- ple have both functional limitations and chronic conditions, their use of healthcare services and the attendant costs increase drastically. A per- son who needs help with one or more activities of daily living costs twice as much to the Medicare The CHRONIC Care Act advances integrated, person-centered care for Medicare beneficiaries and dual eligibles. program as does someone with no functional limitations. Figure 2 (see page 4) illustrates this point (Tumlinson and Johnson, 2018). The Changing Landscape of Care Provision and Reimbursement In response to the older adult population living longer with chronic conditions and functional

abstract Now, more than ever before, people are living longer with chronic conditions. More than half of Medicare beneficiaries have two to five chronic conditions. In addition to managing their clini- cal conditions, many are dealing with social determinants of health. Beginning with the advent of the Affordable Care Act, the healthcare sector has seen a shift to value-based care and an increased focus on outcomes. As it has taken on more risk, the healthcare sector has recognized it must address the patient as a whole person and not merely focus on clinical conditions. | key words: chronic conditions, social determinants of health, community-based organizations

4 | Spring 2019

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