Mccs: A Case Study

Patients with long-term, chronic illnesses like Mr. Davis’s, care can be very costly, especially when the patient is unable to maintain routine medical care or visits and medications. Without routine medical care and maintenance medications, patients like Mr. Davis tend to have more frequent emergency room visits and hospitalizations; increasing costs for state and local government as well as tax payers. Though Mr. Davis is able to receive care during an emergency room visit, the providers are not fully aware of his health history and are only able to provide a temporary fix of his symptoms and not address his health care needs.

In 2004, the Healthcare Effectiveness Data and Information Set (HEDIS) stated that “Kaiser Permanente Southern California (KPSC) region, where approximately 6,000 physicians in the Southern California Permanente Medical Group, and where approximately of 3.5 million adults and pediatric are treated, there performance was below the national 50th percentile”. (Kanter et al., 2013) Since the performance was below what they aspired to achieve, in 2005 KPSC recognized the potential to improve quality of care through providing complete care for patients who have chronic illness.

The Triple Aim provides guidance for the creation of strategies to address the suitable delivery of health care services such as, improving patient care coordination and chronic disease management, preventative health, and eliminate the misuse of healthcare services. The fundamental idea with initiating the triple aim is to simultaneously work at all three goals to achieve better patient health and health care systems. According to Bucher & O 'Day (2014), Triple Aim is the answer to optimize health system performance and patient outcomes. An analysis of Triple Aim reveals several difficulties with implementation, the importance of population health, attempts to “bend the cost curve”,

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.

In united states, 45% of all citizens have at least one chronic disease (4) and there is growing evidence that as a person age, he is more prone to develop other chronic condition if he is suffering from one (5). According to cdc, Heart diseases, diabetes, stroke, obesity, cancer and arthritis are the most prevalent yet preventable chronic conditions leading to hospitalizations, disabilities and decreased quality of life (6).

Chronic conditions accounted for around 9 in every 10 deaths in Australia in 2015. Often more than 1 disease are associated with a death and 3 diseases is the average. About 20% of deaths have 5 or more associated diseases. The National Strategic Framework for Chronic Conditions (the Framework) is the overarching policy document for chronic conditions that sets the directions and outcomes to achieve its Vision that “all Australians live healthier lives through effective prevention and management of chronic

Many people throughout the United States (US) have some form of chronic disease. Chronic diseases are conditions that are not passed from person to person (noncommunicable), have a long duration, are commonly slow in progression, and generally have no cure (World Health Organization (WHO), n.d.b). Currently, chronic diseases are the leading cause of disability and death in the US and about half of all adults have at least one chronic illness (Centers for Disease Control and Prevention [CDC], 2016b). This means that nearly every person in the US will be affected by chronic conditions whether it be personally or through loved ones having these diseases. The most prevalent types of chronic

Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the

Not only has the cases of preventable chronic diseases increased over the years affecting half of the U.S population, they account for 86% of the health care costs. Programs and policies that address risk factors and causes of these diseases at their roots would not only promote public health but reduce the cost of health care both in treatment and hospitalization.

The patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People

healthcare services.2,3 Taken together, these challenges place significant stress on the healthcare system, prompting system stakeholders

This is true for insured, uninsured, and under-insured Americans. These problems are exacerbated by a lack of coordination of care for patients with chronic diseases. The underlying

The health care system must change to improve our nation’s health and takes strong steps to address the unsustainable growth of health care costs in America. We still have a long way to go before our health system become effective. We still have population that do not have insurance, have difficulties accessing their health care, or their needs are not met within the healthcare system. It is an investment in prevention and wellness and increasing access to primary care physician.

Unnecessary services are provided far too often because there is little coordination across sites or among providers, yet care management, cross disciplinary care, and preventive care are often uncovered or poorly reimbursed. Notably, 45% of the U.S. population have chronic conditions requiring care management. Of this population, 60 million, or roughly half of those with chronic conditions, have multiple conditions. Current care delivery systems are not designed to support the care of these complex patients, which requires multiple providers and services.

Seven in ten deaths in the United States, are attributable to chronic disease (“Leading Causes” 1). These diseases are not on account of bacteria or viruses, which could be treated with an appropriate prescription or vaccine. Chronic conditions are developed through unhealthy lifestyles and behaviors such as a lack of exercise, poor nutrition, poor sleeping habits, and substance use (e.g. tobacco). Consequently, seven in ten of every death can be prevented with changes in lifestyle. The CDC states that these conditions, “are among the most common, costly, and preventable of all health problems” (“Chronic Disease” 1). Although these conditions have clear and definite causes (knowing the exact reason and “cure” for them), they are becoming more prevalent rather than domesticated. According to Wu and Green, “Between 2000 and 2030 the number of Americans with chronic conditions will increase by 37 percent, an increase of 46 million people” (1). This increase comes with an increase in health care costs: the CDC reported that the U.S. spent three trillion dollars on health care in 2014 (“Health Expenditures” 1). 86% of these costs was associated with these conditions (“Prevention” 1). Despite there being a range of causes of why patients make these choices, one issue that may be less familiar to others is the lack of knowledge in preventative medicine among health care professionals. Current training standards are not adequately educating or equipping health care professionals