Chronic care challenges
Chronic conditions account for about half of all healthcare dollars spent so it’s worthwhile to consider how to better manage them. Having one chronic disease predisposes patients to have another, said Jeff Rideout, MD, managing partner of Ziegler HealthVest Venture Fund. But, “the system is designed for acute care.”

Another problem is patient confusion, said Jay Sanders, MD, president and CEO of Global Telemedicine Group. Studies have shown that, on average, patients only retain one-third of the information given to them during an office visit. It’s not necessarily that they don’t want to comply with their treatment, they simply may not understand how to do so.

Messages are confusing, said Cheryl Austein-Casnoff, associate administrator for health IT, Health Resources and Services Administration of HHS. Many patients think that when test results are “positive,” that’s good. Electronic records can help providers understand patient issues in real time, she said. For example, women weren’t getting their recommended mammogram in one area. Providers saw this and were able to learn that it was because of transportation problems. So, they could set up mobile mammogram vans or transportation services.

“Patient activation is a goal in itself,” said Sanders. “The science on how to do that is more and more solid.”

But changing incentives for providers may be an important goal as well, said Justine Handelman, director of federal relations for the Blue Cross and Blue Shield Association. Chronic conditions such as heart disease, diabetes and asthma could be prevented or better managed in many cases. The current system, however, rewards payors and providers for volume. “We need to figure out how to realign incentives.”

Current government policy allows for reimbursement once a patient is admitted to the hospital, said Sanders, “not to prevent a stay.”