Disease Management and Population Health Fast Facts

Population Health Improvement
 
DMAA: The Care Continuum Alliance has framed the discussion of Population Health Improvement as follows: "Chronic diseases—diabetes, obesity, congestive heart failure, asthma and many others—affect millions of individuals worldwide and place a substantial burden on society through lost productivity and increased health care costs. Population health improvement empowers individuals, in concert with physicians and other care providers, to effectively manage disease and prevent complications through adherence to medication regimens, regular monitoring of vital signs and healthful diet, exercise and other lifestyle choices."

DMAA defines the population health improvement model as incorporating three components: "the central care delivery and leadership roles of the primary care physician; the critical importance of patient activation, involvement and personal responsibility; and the patient focus and capacity expansion of care coordination provided through wellness, disease and chronic care management programs. The convergence of these roles, resources and capabilities in the population health improvement model ensures higher levels of quality and satisfaction with care delivery. Further, coordination and integration are important tools to address health care workforce shortages, individual access to coverage and care, and affordability of care."
 

Overall Adult Population with Chronic Conditions:

• About 60 percent of the adult U.S. population has at least one chronic condition The proportion of adults with at least one chronic condition ranges from 36.4 percent of young adults age 18–34, to 91.5 percent of the elderly age 65 and over. The proportion of persons with two or more chronic conditions also rose dramatically with age, ranging from only 14.4 percent among persons age 18–34 to 76.6 percent of the elderly age 65 and over.

• Overall, just over half of total expenses for medical care in 2005 for adults were for treatment of chronic conditions. About 29 percent of all expenses for medical care for persons age 18–34 were for treatment of chronic conditions versus about half for persons age 35–54 . In contrast, more than half of medical expenses for the near elderly (55–64) and elderly (65 and over) populations were for treatment of chronic conditions (56.6 and 58.9 percent, respectively).

• While about 6 of every 10 persons age 18 and over had at least one chronic condition, these persons accounted for about 9 of every 10 dollars spent on care for chronic and acute conditions combined. Persons with one or more chronic conditions accounted for the vast majority of expenses for most services—in particular prescribed medicines (96.5 percent) and home health care (98.9 percent).

• Among persons age 35 and over, those with one or more chronic conditions accounted for the overwhelming majority of total medical expenses for all conditions—88.4 percent for those age 35–54, 95.8 percent for the near elderly age 55–64, and 98.8 percent for the elderly age 65 and over. In contrast, 63.3 percent of total medical expenses for young adults age 18–34 were attributable to persons with chronic conditions.

• Among adults age 18 and over with one chronic condition in 2005, an average of $1,064 per person was spent on care for the condition. Per capita expenses for chronic conditions were substantially higher for persons with two or more chronic conditions ($4,571). Per capita expenses for chronic conditions were highest for the elderly with two or more conditions ($5,966).

Source: Statistical Brief #203: Health Care Expenses for Adults with Chronic Conditions, 2005. Medical Expenditure Panel Survey, AHRQ. Published May, 2008

Medicare Beneficiaries with Chronic Conditions:
 

Excerpted from presentation: Predictive Modeling in the Context of Healthcare Reform: Issues and Opportunities
Jonathan P. Weiner, DrPH, September 14, 2009, Third National Predictive Modeling Summit, Washington, DC
 

Medicaid Beneficiaries with Chronic Conditions:

• Fewer than 5% of beneficiaries account for more than 50% of overall Medicaid costs.

• The proportion of Medicaid beneficiaries with disabilities who are diagnosed with three or more chronic conditions increases is 45 percent.

• The frequency of psychiatric illness among Medicaid beneficiaries with disabilities is 49 percent. Similarly, the prevalence of cardiovascular disease increases is 44 percent.

• Costs for Medicaid-only beneficiaries with three or more chronic conditions is 75 percent of total spending for beneficiaries with disabilities.

Source: The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions
Center for Health Strategies, Inc. October 2009


Most Commonly Offered Disease Management Programs by Employers

Source: DMAA. Publication: Employee Benefit News (benefitnews.com), January 2009.