Complex, Chronic Illnesses That Last a Lifetime and Are Expensive to Treat

[Stephen C Schimpff]

I appreciate the comments to my earlier post on the state of America's health care delivery system. We have incredible medical advances, of the type often referred to on MedTecIQ, but if they cannot be dellivered to the right people at the right time, then they are not being fully utilized to best advantage. One pressing need is to recognize the marked shift in disease prevalence from acute illness to chronic illnesses that has occured over the years; it is a real medical megatrend.
Our medical care system has developed around diagnosing and treating acute illnesses such as pneumonia, a gall bladder attack or appendicitis. The internist gave an antibiotic for the pneumonia and the patient got better. The surgeon cut out the gall bladder or the appendix and the patient was cured. But as the population ages, more and more individuals are developing what I will call complex, chronic diseases like heart failure, diabetes, chronic lung disease or cancer. These are diseases that remain with the individual for life and these diseases and patients need a different approach to care. and our behaviors - poor nutrition, over weigth, lack of exercise, not dealing with stress and tobacco usage - are driving more and more of these complex chronic illnesses. These patients need long term care, not episodic care; they need a team-based approach where one physician serves as the orchestrater or quarterback and manages the myriad physician specialists and the other caregivers to allow for a unified, coordinated care management approach. And these diseases are very expensive to treat today; 70% of our medical care expenditures go to treat 10% to 15% of us, i.e., those with these chronic illnesses. As I will describe in detail later, it will take a new approach to organizing the care of these patients to both improve care and reduce the costs. It will mean better use of technologies, more focus on primary care, more preventive medicine and especially care coordination. The new approach actually exists in some locations – the need is to understand what works and then replicate it nationally. This will be a critical element of any rational health care reform program.