Healthcare Systems Fail Chronic Care Management

Part 1


Over the past year, I have been examining the future of chronic care management in the United States. I was seeking to answer a seemingly simple question:  

How can we develop a cost effective model that allows hospice providers to successfully care for chronic patients until they are ready to transition to hospice?

This seemed like a simple enough question, but in my search for an answer, what I have found is alarming to say the least. This alarm being raised through in-depth conversations with providers, vendors, payers, suppliers, and carriers. It would surprise many to learn how many healthcare providers, hospital systems, and stop loss providers are still managing broken, outdated models of care with lucrative payment schemes that often take priority over thoughtful and proven transformational healthcare solutions. 

If the statistics are correct, 11% of the patient population in today’s healthcare systems are using 44% of the total dollars spent, and this enormous spend is going towards services that do not offer any real hope of curing chronic conditions, but rather serve to line the pockets of the physicians, clinics, and hospitals. If the payers in healthcare were looking for real solutions to the dismal state our national healthcare, then the at-risk parties should be running to adopt the types of solutions for chronic care management offered by hospices who are the true experts in this kind of care.

Chronic care management models administered by hospice providers are estimated to save carriers in excess of 25% of the cost to care for patients in their last three years of life. In addition, the hospice community is demonstrating patient and family satisfaction results from a care-in-place model that are outperforming any known standard "fee-for-services" solution.

The real problem is a result of two primary service failures of modern chronic care:

  1. Communication between parties in a traditional care setting is pitiful at best.  Not only are there too few master patient index systems that would collect comprehensive data about any patient and allow more informed decision making, but there is no cost-effective methodology that allows different care providers in diverse systems to access information about the patient.  This communication and data collection failure results in uncontrolled cost and waste - waste that explains why healthcare costs are approaching 1/6 of America’s GDP.  

  2. Compensation arrangements within healthcare that reward volume, not outcomes and require exclusivity, not choice is the second primary service failure of modern chronic care.  Because of these crippling arrangements, even the most forward thinking healthcare systems are unable to challenge the current models of chronic care management and migrate to a new model for success.  This good-old-boy system serves the establishments and leaves the hospice providers out of the equation entirely.    

What Comes Next?

Individuals cannot afford healthcare coverage.  Employers are struggling to offer employee benefits.  Physicians are leaving systems to go out on their own.  Top students are fleeing medicine as a career.  Our nation is sick and obese.  Waste is rampant.  Outcomes are pitiful. 

Hospice providers have a solution, but they have yet to be able to break into the chronic care community to offer comprehensive solutions which would almost surely bend the cost curve downward...  What can be done?