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Chronic Care World: What a New California Report Tells Us About the Future of U.S. Healthcare

May 1, 2015
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A new report from the California Healthcare Foundation adds one more piece of documentation to the evidence for the emergence of the new healthcare

I’ve just finished reading an important new report published by the San Francisco-based California Healthcare Foundation, a healthcare policy think tank dedicated to spreading knowledge and ideas about healthcare policy and improving the healthcare system in the Golden State. The report, Californians with the Top Chronic Conditions: 11 Million and Counting, looks at five major chronic conditions—asthma, diabetes, heart disease, high blood pressure, and serious psychological distress—and how each of those conditions affects Californians. The statistics in the report are deeply sobering.

Among the report’s key findings:

  • About 40 percent of adults in California reported having at least one of the five chronic conditions studied.
  • High blood pressure is the most common of the five conditions, affecting about one in four, or 7.6 million, adults in California.
  • Of Californians with psychological distress, 34 percent delayed needed medical care, and 27 percent delayed filling prescriptions. Cost or lack of insurance was frequently cited as the reason for those delays.
  • The prevalence of chronic conditions increases with age. Of Californians age 65 or older, 70 percent have at least one chronic condition, compared to 26 percent of those age 18 to 39.
  • The proportion of California adults with chronic conditions did vary by region, from 36 percent in Orange County, compared with 45 percent of adults in the Inland Empire, San Joaquin Valley, and northern and Sierra counties.
  • In terms of age-based categories, 23 percent of 18-to-39-year-olds had one chronic condition; 31 percent of 40-to-64-year-olds had one; and 45 percent of 65-plus-year-olds had one. Meanwhile, 3 percent of the youngest corhort had two chronic conditions, 11 percent of the middle-aged cohort had two; and 20 percent of over-65s had two.  Fewer than 1 percent of the youngest cohort had three of the five chronic conditions studied, 3 percent of the middle-aged cohort had three to five of the conditions, and 5 percent of over-65s had three to five of them
  • Meanwhile, interestingly, obesity was a huge factor in chronic illness, with 53 percent of those with three to five of the chronic conditions studied being obese, 46 percent of those with two chronic conditions, and 29 percent having one chronic condition being obese. Conversely, only 18 percent of those residents with none of the chronic conditions studied were obse.
  • And importantly, of those Californians with no usual source of medical care, 18.8 percent had serious psychological distress; 10.7 percent had asthma; 8.4 percent had high blood pressure; 8.1 percent had diabetes, and 6.6 percent had heart disease.

Here’s the thing: extrapolating these numbers nationwide—and California, statistically, actually has overall a considerably healthier population than many states—one can see the immense weight of chronic disease that will fall as a responsibility onto the U.S. healthcare system, and American society, in the coming decades. While only 9.6 percent of Californians are diabetic, some states have significantly higher percentages of diabetics: Arkansas (10.3 percent), Ohio (10.5 percent), Oklahoma and South Carolina (10.6 percent), West Virginia (11.1 percent), and Mississippi (11.7 percent), according to the federal Centers for Disease Control and Prevention (CDC)—and those are only the statistics for diagnosed diabetics (and if you’re wondering, Montana and Vermont have the lowest percentage of diagnosed diabetics, at 6.2 percent and 6.4 percent of their populations, respectfully—slightly above half the rate of Mississippi). Furthermore, rates of type 2 diabetes are now soaring among children nationwide.

What frightens policy, purchaser, and payer leaders the most is the explosion in the numbers of Americans with multiple chronic diseases, as clinical and policy experts alike agree that those individuals will need intensive care management and monitoring.

Not surprisingly, federal healthcare officials are using every opportunity to try to push providers forward to engage in population health management, and also to participate in outcomes measure-facilitated value-based purchasing initiatives. Very significantly, the SGR repeal legislation passed last month encompasses a huge change for physician payment incentives under Medicare, with a new incentive payment system, called the Merit-based Incentive Payment System (MIPS), which will drastically change how physicians are paid under Medicare going forward.

Providers moving forward to address care for high-risk populations