The traditional medical care model may be insufficient to meet the needs of Medicare patients with multiple chronic conditions, according to a new study.
About 71% of all healthcare costs are due to chronic conditions, according to the CDC. Another big cost issue is medication nonadherence. Other research finds that patients with chronic conditions account for 83.1% of all prescriptions in the United States, and nonadherence is associated with approximately $100 to $300 billion of U.S. healthcare costs annually.
“That suggests that solutions to monitor for emerging health conditions, keep patients with chronic conditions out of the hospital, and address medication nonadherence could make a major dent in costs. The fact that those solutions are reimbursable is another major benefit,” according to Jeffrey Dlott, MD, medical director for chronic care management, Quest Diagnostics.
The Quest Diagnostics’ study, “Hidden Hazards: Closing the Care Gap Between Physicians and Patients with Multiple Chronic Conditions,” which was commissioned through Regina Corso Consulting, an independent research firm, shows that time constraints and a feeling of helplessness to address patients’ comprehensive needs concern physicians, while patients’ professed satisfaction with their care may mask social and behavioral risks and needs. The findings are based on an independent survey commissioned by Quest of primary care physicians (PCPs) and adults aged 65 years and older who have multiple chronic conditions and are Medicare beneficiaries.
Specifically, the survey results found physicians are too time-constrained to probe for complex care needs. Nearly all physicians (95%) said they entered primary care to care for the “whole patient.” Yet, 85% say they are too pressed for time to address complex clinical issues and 66% say they don’t have time to address social and behavioral issues, such as loneliness or financial concerns that could affect their patients’ health. Only 9% of physicians are very satisfied that their Medicare patients with multiple chronic conditions are getting all the attention they need to care for all medical issues.
The study also suggests patients may not recognize or share all health-related concerns. While physicians worry about care gaps, more than nine in 10 patients (92%) surveyed are satisfied they are getting all the attention they need to deal with their multiple medical issues from their PCP, the findings suggest patients may not recognize or communicate all health-related issues that may impact their care and health. Two in five patients say they do not tell their doctor about loneliness, isolation, transportation barriers and other factors that influence health. Many admit they “struggle to stay on top of my health issues and need more support.”
“There are two main reasons we wanted to explore this important issue,” says Dlott. “First, three in four Americans over the age of 65 have two or more chronic health conditions. This is significant part of the population. We wanted to better understand where there are gaps in care between PCPs and their Medicare patients with multiple chronic conditions, and what those gaps meant for patient health. We hope managed care organizations, which are already making great strides toward closing gaps in care, can use these insights to inform their provider strategies.”
But Dlott says the researchers also wanted to explore to what extent chronic care management (CCM) services could help bridge this gap. In January 2015, CMS began reimbursing for CCM services for Medicare beneficiaries with two or more chronic conditions to support patients in between physician visits. CCM services are non-face-to-face services, such as electronic and phone consultation, and often focus on medication management, coordinating visits with hospitals and other providers, personalized guidance on setting health goals, and 24-hour access to care providers.
But participation in CCM programs by PCPs has been slow, according to Dlott, although CMS estimates 70% of Medicare beneficiaries—roughly 35 million people—would be eligible. “It’s clear that broader adoption of CCM services would help to address many of the issues that came to light through our survey,” Dlott says. “We hope managed care organizations, which are already making great strides toward closing gaps in care, can use these insights to inform their provider and reimbursement strategies.”
The study found perception of complexity by PCPs is a clear deterrent to CCM use, so solutions that simplify the process (by providing counsel on coding, for example) stand a better chance of adoption, according to Dlott.
“Our analysis also suggests points of discussion providers in managed care networks can raise with patients to encourage their use of CCM,” says Dlott. “First, providers may wish to explain to patients that social and behavioral factors, including medication adherence, play critical roles in health, and extra monitoring may help identify potential problems. Second, they can reassure patients that CCM has only modest copays under Medicare, as they may otherwise assume a steep financial burden for participating. And perhaps most importantly, providers may wish to explain that CCM may help them identify issues before they become a major medical concern.”