Connecting Communities for Chronic Care Management

Introduction and Overview

The purpose of the eHealth Initiative Foundation's Connecting Communities Collaboration for Chronic Care Management is to explore and evaluate the feasibility and value of using electronic health information to support chronic care management efforts, and in particular, the ability of such efforts to more effectively engage both consumers and clinicians--with the goal of creating another “business case” for the use of electronic health information and standards-based health information technology (IT).

Chronic disease plays a significant role in both cost and quality in the United States. The number of Americans with chronic disease is increasing.  More than 125 million Americans had at least one chronic care condition in 2000, while this number is expected to grow to 157 million by the year 2020. As baby boomers continue to age, the number of individuals living with chronic conditions will continue to increase. While 12.7% of the population during the year 2000 was age 65 or older, this number is expected to grow to 20% by the year 2030. People with chronic conditions absorb a majority of health care spending in the U.S., accounting for 78% of all health care spending in 1998.

Efforts to effectively manage chronic care have been hampered by number of factors, including a fragmented health care system and the need for more coordination across health care settings as described above; people with serious chronic conditions having difficulty paying for their health care; the need for enhanced medical training and education which places an increasing focus on chronic care; the lack of interoperable clinical information systems which would help provide readily available, comprehensive information about the patient to those who deliver care, manage care, and receive care; and the current reimbursement system that does not reward key elements of chronic care management, including those related to patient counseling and education, physician-patient interactions, and care coordination, creating a negative business case for chronic care management.

The introduction of health IT and health information exchange holds great promise for addressing many of the barriers to effective chronic care management.  Interoperable health IT and health information exchange--or the mobilization of clinical information electronically--facilitates access to and retrieval of clinical data, privately and securely, among different entities involved in the care delivery system, to provide safer, more timely, efficient, effective, equitable, patient-centered care. Having information from the care delivery process readily available through health IT and health information exchange supports several key components of the chronic care management process, including those related to greater care coordination; clinical decision support at the point of care; the use of timely, accurate information for measurement and improvement; and greater patient engagement.

Disease management has long been a strategy that both employers and health plans have used to reduce the costs of and improve the quality of care for those individuals who have the largest impact on the health care system—those with chronic disease. The disease management industry has grown rapidly, with estimated annual revenues increasing from about $78 million in 1997 to almost $1.2 billion in 2005, with projections exceeding $1.8 billion by 2008. Some reports indicate that significantly more dollars are spent in this industry with estimates from $10 to $50 billion.

There is now evidence that suggests that traditional methods of disease management are in need of improvement. For example, in late January 2008, the Centers for Medicare and Medicaid Services announced that the set of demonstrations on chronic care management under the Medicare Health Support Program had not achieved expected results. Insights from one of the demonstration project participants included the fact that there is a greater than usual need for robust, accurate, timely and complete data; it is difficult to engage patients and caregivers but once engaged the program was embraced; and that there is a high need for the development of local infrastructure and support, especially with physicians.

eHI's Connecting Communities for Chronic Care Management Collaboration will provide much needed input at a time when there are rising concerns about current methods for disease management--for which billions of dollars are being spent; and at the same time—increased recognition that the challenges of current disease management methods can be addressed in part, by the promise that patient-engagement through personal health records or the mobilization of clinical information electronically at the local level to inform the care management team—can provide. Furthermore, access to even a small amount of the revenues currently spent on disease management by health plans and employers in the U.S., can help to defray some of the costs associated with supporting health IT and health information exchange initiatives which suffer from the lack of a sustainable business model, given predominant methods for health care payment in the U.S.