Are We Prepared to Care for People with Complex Chronic Conditions?

Tying physician reimbursement and incentives to quality outcomes will improve the care delivered to patients with complex chronic conditions.

Two-thirds of all health care expenditures are directed at one-fourth of the population -- those suffering from multiple chronic conditions. Such patients or their families are being particularly hard hit by enormous pharmaceutical and other direct, indirect, and out- of-pocket costs.

For these patients the glass is half empty; the more chronic the medical condition, the more likely there will be unnecessary or avoidable hospitalizations, redundant testing, red herrings, blind alleys, conflicting medical advice and worse, poorer functional status, depression, morbidity, and mortality.

What can be done to improve the efficiency and effectiveness of the care rendered to these patients? For one thing, the practitioner and the health care system should be incentivized to deliver optimal, if not maximal value. To do this, funding or reimbursement must relate to the "value" of care defined in a previous post (“Sharing Perspectives — The Value Equation) as a relationship of quality, accessibility, and cost-effectiveness.

In other words, the incentives should be aligned.

One caveat, however: patient characteristics and case-mix are factors that can bias any quality improvement program or incentive.

I’ll discuss these issues in more detail in two upcoming blog posts: “Don't Mess Up Incentives” (next week) and “Physician Characteristics Don't Predict Quality” (in two weeks).