Professional Documents
Culture Documents
PARTNERSHIP TO FIGHT CHRONIC DISEASE
Rising rates of chronic disease pose a significant and unsustainable
burden on us as individuals and as a nation. Our ability to bend the cost‐
curve sustainably depends upon our ability to improve health in America
by better preventing and managing chronic disease.
Educate the public about chronic disease and potential solutions
for individuals and communities
Mobilize Americans to call for change in how governments,
employers, and health institutions approach chronic disease
Challenge policymakers on the health policy changes that are
necessary to effectively fight chronic disease
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MEDICAID: THE PERFECT STORM
Projected combined state deficit in FY2012 =
$125B
Projected Medicaid spending FY2012 =
$195B
Enrollment to rise 35% over 10 years, including 16M
from Affordable Care Act expansion
More than 60% of acute care spending remains in
fragmented fee‐for‐service system
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THE CHRONIC DISEASE PROBLEM
“The United States cannot effectively address escalating health
care costs without addressing the problem of chronic diseases.”
– US Centers for Disease Control and Prevention
They affect the Chronic diseases
Chronic diseases
quality of life for 133 account for more
are the leading
million Americans than 75 cents of
causes of death
and is responsible for every dollar we
and disability in the
seven out of every spend on health care
United States and
ten deaths in the U.S. in this country. In
account for the vast
– killing more than 2007, this amounted
majority of health
1.7 million Americans to $1.65 trillion.
care spending.
every year.
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INCREASING DEMANDS ON HEALTHCARE
$0.83 of every dollar spent in Medicaid goes to treat
highly preventable and manageable chronic diseases
Cancer
Diabetes
Heart Disease
Asthma
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FOUR KEY AREAS OF OPPORTUNITY
Cool the Fill costly
“hot spots” gaps
Promote
Enhance
coordinated
care adherence
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1. COOLING THE “HOT SPOTS”
Though more than 60 percent of adult Medicaid enrollees
have a chronic or disabling condition....
....a mere 4 percent of Medicaid enrollees absorb half of all
Medicaid funding.
PROVEN INTERVENTIONS
Team‐based, Integrating
Responsibility
coordinated with Regular
Personalized and
care that community‐ monitoring
action plans accountability
supports self‐ based and follow‐up
for outcomes
management resources
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2. FILLING COSTLY GAPS
Fee‐for‐service (FFS) System
Gaps in continuum of care
High rate of readmission within 30 days
Disconnect among patients receiving
Medicaid and Medicare
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3. ENHANCING ADHERENCE
• One in four • Nearly two‐thirds of all
Americans do not medication‐related
follow directions in hospital admissions have
taking medications been attributed to poor
adherence
• 3 out of 4 Americans
• Poor medication
admit to having not
adherence costs more
taken their
than $100 billion a year
medicines as
nationwide
prescribed at some
point
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4. PROMOTING COORDINATED CARE
Pursuing working models in
coordinated care
• Integrated medical practices
• Medical home models
• Growth in Accountable Care
Organizations
• Medicaid health plan models
• Community Health Teams 10
SUPPORT IN THE AFFORDABLE CARE ACT
Medicaid medical homes (section 2703). Enhanced 90
percent match for two‐years when adopt (through
state plan amendment) team based care coordination
Need to get Medicare involved –dual eligibles and fee‐
for‐service Medicaid.
• Innovation Center potential source for partnering.
• Waiver process for coordinated long‐term care
States need to act now to create care coordination
and prevention infrastructure to manage rising
program costs 11
TURNING THE TIDE
The smoking rate of Medicaid recipients is approximately 53
percent higher than in the general US population
Smoking‐attributable costs to the states under Medicaid were
$22 billion in 2004
Medicaid also has a much higher prevalence of obesity than
other health insurance providers and pays more for inpatient
and outpatient services and medication for obese patients
Improving overall health is the best
way to improve our health care costs. 12
CAPITALIZING ON OPPORTUNITY
Entitlement reform—both
Adopting evidence‐based
Medicare and Medicaid –
care coordination
need to include national
throughout the Medicaid
program to prevent chronic
program has the potential to
disease and more effective
save a total of nearly $250
care coordination. Both have
Billion over the next decade
large potential savings.
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For more information, please go to:
www.fightchronicdisease.org
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