Addressing Multiple Chronic Conditions Through Value-Based Care

It’s a startling statistic: The sickest 5 percent of people in the United States consume an estimated 50 percent of the country’s health care spending, notes physician and Stanford professor Robert Pearl in a recent article for Harvard Business Review.

The needs of two-thirds of the people in that group — those with newly discovered medical conditions and others with one-time catastrophic problems, such as injuries from an automobile accident — are unpredictable. The needs of those with multiple chronic conditions (MCCs) are predictable, but they’re often poorly managed. Addressing this segment of the patient population offers a great opportunity to reduce health care costs —and a value-based health care model is well-aligned to do just that, notes Daniel McCarter, MD, National Director of Primary Care Advancement for ChenMed.

Multiple chronic conditions include diabetes, congestive heart failure, arthritis, and asthma, as well as behavioral health conditions (such as addiction disorders) and mental illness, dementia, and other cognitive impairments. As many as three in four Americans over the age of 65 contend with multiple chronic conditions, according to the United States Department of Health and Human Services.

Prevention from the outset changes outcomes

With better preventive care at the outset, many of these conditions could be avoided completely or managed more effectively. But for too many elderly patients, particularly those at the lower end of the socioeconomic scale, a preventive approach has been lacking, finds McCarter, who is based in ChenMed’s JenCare Senior Medical Center in Richmond, Va. “We tend to be in very under-served areas,” he says. “People have had a lack of good medical care, and it’s been very fragmented care, so they develop these chronic conditions.”

Under the value-based care model used by ChenMed, which focuses on care quality and patient outcomes rather than the quantity of services delivered, new patients have an hour-long initial appointment with their primary care provider, who asks questions about the patient’s current and past medical conditions and reviews their medical records. A thorough set of tests ensues, including bloodwork, heart tests, blood sugar testing, depression screening, and more.

“This helps us identify any existing problems, which may be previously known or unknown, then come up with a game plan,” McCarter says. That game plan may include connecting the patient with specialists within the ChenMed practice as well as any external practitioners — connected care that is crucial for successfully treating patients with multiple chronic conditions.

Personalized approach via small patient panels

McCarter has found that having a smaller panel of patients, another common element of the value-based care model and a key element of the ChenMed model, gives him and his colleagues the opportunity to personally quarterback their patients’ care. For example, one of McCarter’s patients visited an oncologist last year, and during the visit, some questions came up. The patient gave the oncologist McCarter’s business card. When he called, the oncologist was shocked to reach McCarter directly.

“Specialists and our patients like that we’re this involved, that we’re available,” says McCarter, who lists only his personal cell phone number on his card.
 

Managing multiple chronic conditions with a team

He also lauds the importance of a team-based approach to care when it comes to managing patients with multiple chronic conditions. At ChenMed, each care center houses not only medical professionals but also social workers and other staff who can assist with ancillary needs patients have in receiving care. These needs may include transportation to and from their homes or coaching on how to use medication. McCarter recalls a patient he treated at a previous practice who had an accident after misinterpreting her cardiologist’s instructions about which beta-blocking medication she needed to continue using and which one she should curtail. After taking a double dose, becoming lightheaded, and falling in her home, she called McCarter and asked him for help. His office, unfortunately, did not have the resources to do so.

By contrast, he says, “we have case managers we can send to the home and go over medication with patients. And because we have a cardiologist in our practice, if a cardiologist here made that change, we’d physically take the bottle we wanted to stop away and give her a new one.”

McCarter has found that this value-based approach doesn’t just benefit patients — it’s also preferable for physicians. He recently interviewed a doctor interested in joining one of ChenMed’s Georgia practices who expressed frustration at how, in his current role as a primary care physician, he was basically stamping tickets for patients to go to specialists or hospitals.

“He said he wasn’t able to practice the kind of medicine he was trained for,” McCarter says. “Here, we’re restoring the doctor-patient relationship. Our doctors feel like resources. You get to know your patients very well, and you wind up getting to know their family members, too. The physicians who gravitate toward us are those who went to medical school to help people.”

It’s hard to argue with the results. According to a study in the American Journal of Managed Care, ChenMed patients have 50 percent fewer hospital admissions, 28 percent lower per-member costs, and significantly higher use of evidence-based medications than a standard primary care practice.

“Well-done primary care requires specializing in patients,” McCarter says. “While we’re very competent at taking care of conditions, we excel at specializing in the patient.”

Value-based care is changing both outcomes for patients and how physicians practice medicine. At ChenMed, we make value-based care work, translating higher-quality patient care with real results. If you’re ready to practice medicine differently, view our open positions today.