1) What is Chronic Condition Management?
Chronic condition management is a broad term that encompasses benefit programs to help people manage or reduce symptoms and control disease progression. According to the CDC, 6 in 10 Americans live with at least one chronic condition, with 40 percent of US adults having two or more conditions. Chronic conditions are the leading causes of death and disability, as well as a leading driver of health care costs. Chronic condition management helps people live happier, healthier lives while preventing unnecessary healthcare utilization.
By definition, chronic diseases are those that stay with a patient long-term. Examples include asthma, cancer, diabetes, hypertension, heart disease, and mental health. Depending on the provider, care is administered by a variety of professionals, including nurses, health coaches, and pharmacists. Through the evolution of technology, many providers have deployed remote monitoring devices to track the progression of a disease state and share data between the patient and the provider, allowing for point-in-time improved care opportunities.
To be an effective chronic condition management program, participants should receive:
i. An improved understanding of their health and treatment options, including lifestyle modification, preventative care, and medication therapy (health literacy).
ii. A comprehensive health and medication review, followed by an individualized care plan.
iii. Care coordination between the treating physicians, health plan, and other benefits offered by the employer.
2) Chronic Conditions Are Primarily Managed With Medications, Which Is Why a Pharmacist Should Be a Key Part of the Patient’s Care Team
Chronic conditions are managed through lifestyle modifications like improved diet and exercise, as well as medication therapy. In fact, 80% of chronic conditions are treated with medication therapy, which is why clinical pharmacists play a vital role in the care management of people with chronic diseases. When you think of a pharmacist, the image that comes to mind for most people is the person in the white coat behind the retail pharmacy counter. However, pharmacists work in a variety of settings, including education, hospitals, pharmaceutical manufacturing, government agencies, managed care, and chronic condition management providers.
Having a pharmacist involved in chronic condition management is important because patients with chronic conditions can easily become overwhelmed by their medications. Pharmacists are trained to conduct complete medication reviews to ensure medications are safe, tolerated, and achieve the intended outcome. As an example, at Tria Health, our average patient takes 9 medications, has 6 health conditions, 3 of which are chronic, and is seen by 3 physicians. This is a lot for one person to manage. Pharmacists are doctors and have the expertise needed to help patients and their physicians improve clinical outcomes by managing complex medication regimens.
3) Non-optimized Medication Management Is a Costly Healthcare Problem That Chronic Condition Management Can Impact
There is a saying among pharmacists that the most expensive medication is the one that is not taken correctly. To add context to this, according to the 2018 Annals of Pharmacotherapy, in 2016 dollars, the cost of non-optimized medication use in the US is $528 billion (16% of total health care spend). This cost exceeded the actual cost of the prescription medications themselves (13% of total healthcare spend).
The cost of non-optimized medications incorporates both the cost of the medication and the added medical and mortality costs resulting from medications that are not optimized. These fall into three categories:
1) Treatment failures, where the medical problem is not treated.
2) A new medical problem where the prescribed medication contributes to a new problem.
3) The combination of both treatment failures and new medical problems.
An example of non-optimized medication use is evident in the Million Hearts Campaign. Here it was found that for those diagnosed with hypertension and then prescribed lifestyle modifications and blood pressure medications, 74% did not achieve the target blood pressure range needed to prevent the risk of stroke, heart attack, and other significant complications.
Since chronic conditions are managed with medications, a chronic condition management program should include pharmacists to help patients and physicians optimize medications for people with complex medication regimens.
If you'd like to learn how to avoid the biggest mistake in chronic condition management, you can register for a free webinar taking place on April 5, 2022.
4) Only 12% Of US Adults Have Proficient Health Literacy and Chronic Condition Management Can Improve This Number.
According to Health and Human Services, only 12% of US adults have proficient health literacy, meaning they can understand and make proper health decisions. According to the same study, over one-third of adults have problems reading a prescription drug label and adhering to immunization schedules.
Improving health literacy is critical to improving overall condition management. Each person’s background, beliefs, and behaviors (3 B’s) shape how they manage their health. It is paramount that the patient understands not only their disease, but also the proper ways to treat and control the condition to avoid health complications, according to their 3 B’s. The best way to achieve this is through a personal conversation with a patient. During a one-on-one consultation, the pharmacist can determine the level of health literacy and adapt their care plan accordingly.
5) Remote Monitoring Devices Are All the Rage, but Not Everyone Needs One
Remote monitoring devices, such as blood glucose meters and blood pressure cuffs, have a positive impact on chronic condition management. These devices send readings automatically to providers and the patient. The readings are analyzed, and intelligent messaging is sent back to the patient to promote immediate behavior change. In addition, providers can monitor trends and conduct outreach when readings are consistently out of range to provide more personalized care. These devices have proven to close care gaps, improve adherence and help people better control their disease states.
However, not all patients with chronic diseases need remote monitoring devices. Providing a device to every person with diabetes is costly and creates healthcare waste. For example, a person with type 2 diabetes that has a history of controlled A1C most likely does not need to test on a regular basis. However, a person on insulin or with a history of uncontrolled diabetes is likely a viable candidate for remote monitoring. Healthcare is a journey. And each patient’s needs are unique. Understanding these nuances will limit healthcare waste.
6) Coordinating Care Among Providers Will Improve Chronic Condition Management
Coordinating care means supplying information to the health care providers treating the patient and arming the patient with the information they need when working with other providers. Because most people with chronic conditions see multiple providers, providing resources and tools to share information is critical. Ultimately, the goal is to make sure the patient has the appropriate health literacy and tools to be able to share necessary information with their providers as they seek to improve their health.
Dr. Lea is a founding member of Tria Health and has been leading the team since its inception in 2009. Prior to her current position, Dr. Lea worked as a Clinical Pharmacist at a regional PBM developing innovative solutions to reduce pharmacy costs for employers. Her background in academia and numerous pharmacy achievements continue to fuel her passion for providing patient-centered care that results in optimal health outcomes.
Lea has received several recognitions, including PharmaVoice’s “Most Inspiring People in the Life-Sciences Industry” and the Kansas City Business Journal’s “Women Who Mean Business.”