The U.S. Department of Health and Human Services (HHS) has issued a strategic framework for achieving optimum health and quality of life for individuals with multiple chronic conditions. The report notes that one in four Americans have two or more chronic conditions, including arthritis, asthma, chronic respiratory conditions, diabetes, heart disease, human immunodeficiency virus infection, and hypertension. Chronic conditions are defined as illnesses that last a year or more and require ongoing medical attention and/or limit activities of daily living. The framework establishes four goals:
1. Foster health care and public health system changes to improve the health of individuals with multiple chronic conditions.
2. Maximize the use of proven self care management and other services by individuals with multiple chronic conditions.
3. Provide better tools and information to health care, public health, and social services workers who deliver care to individuals with multiple chronic conditions.
4. Facilitate research to fill knowledge gaps about, and interventions and systems to benefit, individuals with multiple chronic conditions.
The framework reflects a high degree of intra-departmental collaboration, with a work group convened by the Assistant Secretary of Health and the involvement of almost all the HHS operating divisions. Earlier this year, the work group released an inventory of all HHS initiatives and activities related to care for individuals with multiple chronic conditions.
Improved health care for individuals with multiple chronic conditions is one of the priorities for quality improvement (and payment reform) under the Patient Protection and Affordable Care Act (PPACA). For example, under PPACA section 2703, state Medicaid programs may conduct demonstration programs for Medicaid beneficiaries with two or more chronic conditions. Final guidelines for those state Medicaid demonstrations are expected imminently since the demonstrations are supposed to begin in January 2011. The framework also highlights the cost implications of treating such individuals, noting that 66% of U.S. health care spending is on the 27% of Americans with multiple chronic conditions.