Chronic Care Management Facts
What is Chronic Care Management?
Chronic care management is an approach to improving health care for people living with chronic illnesses such as
diabetes and heart failure. Effective programs help patients avoid complications and hospitalizations by providing
them with disease management services, education, tools and resources that encourage them to take an active role
in managing their health. Programs also support physicians by providing resources and expertise to help them care for
their chronically ill patients.
The Magnitude of Chronic Illness
- More than 133 million Americans live with chronic illnesses. 1
- Chronic diseases such as diabetes and heart failure are the leading cause of death and disability in the U.S.,accounting for 70 percent of all deaths.1, 2
- Nearly 80 percent of Medicare beneficiaries have at least one of the following chronic conditions: stroke, diabetes, emphysema, heart disease, hypertension, arthritis, osteoporosis, Parkinson's disease or urinary incontinence.2
- People with chronic conditions are the most frequent users of health care in the U.S. They account for 81 percent of hospital admissions; 91 percent of all prescriptions filled; and 76 percent of all physician visits4
- About one-fourth of people with chronic conditions have one or more more daily activity limitations5
The Cost of Chronic Illness
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The medical care costs of people with chronic diseases account for more than 75 percent of the nation's $2 trillion medical care costs.1
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The costliest five percent of Medicare beneficiaries account for about half of all Medicare spending each year.
Among this top five percent, 47 percent had congestive heart failure and 35 percent had diabetes.6
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Cardiovascular Disease was estimated to cost the nation $475.3 billion in 2009 in health expenditures and lost productivity6
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People with chronic conditions are the most frequent users of health care in the U.S. They account for 81% of hospital admissions; 91 percent of all prescriptions filled; and 76 percent of all physician visits4
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About one-fourth of people with chronic conditions have one more more daily activity limitations5
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The estimated cost of diabetes in 2007 was $174.8 billion. Of this amount, 116 billion was due to direct medical
costs and 58 billion to lost productivity.8
The Power of Disease Management
Care Improvement Plus' care management program is based on a disease management model XLHealth has successfully
implemented for Medicare Advantage health plan clients over its twelve year history.
Over a two year period, XLHealth realized notable improvements in significant clinical outcomes for approximately
12,000 Medicare Advantage plan members with diabetes and/or heart failure, including:
- A 21 percent reduction in the number of inpatient hospital admissions
- A 25 percent decrease in the number of participants with "poorly controlled" blood sugar levels
- A 19 percent decrease in the number of participants with poor control of their LDL (bad) cholesterol levels
In addition, the program increased adherence to recommended best practices aimed at reducing participants' risk of developing complications, including:
- A 25 percent increase in the number of participants taking an ACE Inhibitor medication to reduce their risk of cardiovascular complications
- A 20 percent increase in the number of participants taking a Beta Blocker medication to reduce their risk of cardiovascular complications
SOURCES:
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1 CDC National Center for Chronic Disease Prevention and Health Promotion: Chronic Disease Prevention
http://www.cdc.gov/nccdphp/overview.htm
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2 Berenson R, Horvath J. Center for Medicare Advocacy, Inc., Conference on Medicare Coordinated Care. The
Clinical Characteristics of Medicare Beneficiaries and Implications for Medicare Reform. March 2002. Retrieved
from: http://www.medicareadvocacy.org/chronic_PartnerPaper_ClinChars.htm
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3 Lieberman S, Lee J, Anderson T, Crippen D. Reducing the Growth of Medicare Spending: Geographic Versus
Patient-Based Strategies. Health Affairs–Web Exclusive, W3-603. December 10, 2003. Retrieved 1/21/05
from http://content.healthaffairs.org/cgi/reprint/hlthaff.w3.603v1
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4 American Heart Association. Heart Disease and Stroke Statistics–2008 Update. Dallas, Texas: American Heart
Association; 2008. http://www.americanheart.org
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5 The Power of Prevention, a report by the U.S. Dept. of Health and Human Services (2003) found on the
CDC Web Site (http://www.healthierus.gov/steps/summit/prevportfolio/power/index.html
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6 "About Heart Disease and Stroke Prevention at CDC". Centers for Disease Control and Prevention: Division for Heart Disease and Stroke Prevention. August 9, 2010 http://www.cdc.gov/dhdsp/about_program.htm
- 7 "The Impact of Chronic Diseases on Healthcare". For a Healthier America. August 9, 2010 http://www.forahealthieramerica.com/ds/impact-of-chronic-disease.html
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8 Direct and Indirect Costs of Diabetes In the United States, American Diabetes Association,
2008 http://www.diabetes.org/diabetes-statistics/cost-of-diabetes-in-us.jsp
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9 Anderson G. Chronic conditions: making the case for ongoing care. Baltimore, MD: John Hopkins University; 2004
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10 The Growing Crisis of Chronic Disease in the United States”. Partnership to Fight Chronic Disease. http://www.fightchronicdisease.org/pdfs/ChronicDiseaseFactSheet.pdf
This page was last updated on: 8/23/2011 11:18:55 AM