My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual.
Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a weakened immune system, it is often compounded by an inability to keep up with the battery of medicines and new responsibilities of having a serious illness.
Patients living with complex illnesses require extra help, from medication adherence to finding stable housing; however, the majority of chronic care takes place in a primary care setting, preventing clinicians from fully addressing the spectrum of health needs that come with managing a chronic illness. In order for a physician to provide high-quality chronic care to a typical patient panel, they would need to spend 10.6 hours per day on just chronic care, or 27% more than the amount of time available for all patient care.
Partly as a response to patient needs, the growing trend in the US moves away from this traditional model to a team-based approach. This allows multiple health care providers and other members of the care team—doctors, nurses, community health workers, mental health specialists, social workers, and others—to provide wraparound services for a more comprehensive patient care. The team works together to best address patients’ needs, communicate to each other on their findings, reduce trips to the emergency room, and ensure no one falls through the cracks.
Providing care for high-cost, high-need patients is expensive and challenging, but focusing on this population also has potential to make the biggest impact on national spending. Five percent of the U.S. population accounts for 50 percent of the nation’s health care costs. Fee-for-service has been a longstanding way to pay for health care, but new care management approaches may not always fit well with this payment model. The complexities of a chronic illness require a system that delivers coordinated health care, addressing an entire array of patients’ needs and risks, and rewarding improved health outcomes.
According to the Chronic Care Collaborative, one in four Coloradans are living with a chronic condition, such as cancer, lupus, Alzheimer’s, or any number of others, which makes this an important issue for our state. Finding the best way to deliver and pay for health care can have a huge impact on the health of this population. It could be your neighbor, your sister, my dad, or you.
Improving health care services for our most vulnerable is important. It’s both the right thing to do and a big step toward a more high-quality, financially-sustainable health care system for us all. As for my dad, we will continue to work to make sure he has the best care and support he can get, whether it’s from a large system of crazy relatives or a more comprehensive, coordinated health care system.