A Primer on Managed Care: Multiple Chronic Conditions

and Botoseneanu, 2016). This study also found that the com- bination of arthritis, hyperten- sion, and depression resulted in the highest level of people’s limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) compared to healthy partici- pants or participants with a single disease. Physical health and men- tal health conditions are fun- damentally linked. People living with mental illness are at a higher risk of experienc- ing a wide range of chronic physical conditions. Conversely,

Figure 1. Medicare: CCW Condition Period Prevalence, 2016

Source: CMS. 2016. “Chronic Conditions Warehouse.” Retrieved October 10, 2018.

disease is a chronic condition because an indi- vidual with this condition typically lives three to ten years after diagnosis, depending upon age at diagnosis (Brookmeyer et al., 2002). Behavioral health conditions, such as clinical depression, schizophrenia, bipolar disorder, and substance use disorders, also are chronic in nature. Adults older than age 65 are disproportionally affected by multiple chronic conditions (MCC), with MCC prevalence increasing dramatically with age. Eighty percent of older adults have MCC, while only about half of all people ages 45 to 64 experience MCC (Gerteis et al., 2014). A recent study identified the following most prev- alent two-condition combinations among inpa- tient older adult populations: hyperlipidemia and hypertension; hypertension and ischemic heart disease; diabetes and hypertension; chronic kidney disease and hypertension; anemia and hypertension; and hyperlipidemia and ischemic heart disease (He et al., 2018). Another study showed that the three most prevalent combinations among non-institution- alized older adults are the following: hyper- tension and arthritis; hypertension, arthritis, and cardiovascular disease; and hypertension, arthritis, and diabetes (Quiñones, Markwardt,

people living with chronic physical health con- ditions experience higher rates of mental health conditions than does the general older adult population. For example, depression is found to co-occur in 17 percent of cardiovascular cases, in 23 percent of cerebrovascular cases, in 27 percent of diabetes patients, and more than 40 percent co-occurs in individuals who have cancer (Cen- ters for Disease Control and Prevention [CDC], 2012). The association between depression and chronic disease appears attributable to depres- sive disorders precipitating chronic disease and to chronic disease exacerbating symptoms of depression (Chapman, Perry, and Strine, 2005). Causes of Chronic Conditions Most chronic conditions are caused by multiple factors, and premature death resulting from chronic conditions and poor health are influ- enced by determinants in the following five main areas: behavioral patterns (40 percent), socio­ economics (15 percent), genetic predisposition (10 percent), healthcare access and quality (10 percent), and environmental exposures (5 per­ cent) (Schroeder, 2007). The single greatest opportunity to improve health, prevent and manage chronic conditions,

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