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By Monica E. Oss

New data from the Centers for Disease Control (CDC) has me thinking about population health management strategies again. The news? The proportion of the U.S. population with multiple chronic conditions (MCC) is on the increase. The just-released report shows that in 2014, 25.7% of adults were diagnosed with MCCs. These adults were managing two or more of ten health conditions: hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis, hepatitis, current asthma, weak or failing kidneys, and chronic obstructive pulmonary disease (see In 2014, 25.7% Adults Diagnosed With Multiple Physical Chronic Conditions). This is an increase from 2001, when estimates indicated that 21.8% of adults had multiple MCCs (see Prevalence Of Multiple Chronic Conditions Among US Adults: Estimates From The National Health Interview Survey, 2010).

Another recent report from the CDC also caught my attention. There are wide geographic differences in the prevalence of MCC – from 19.0% in Colorado to 38.2% in Kentucky (see 25% Of U.S. Adults Diagnosed With Multiple Non-Behavioral Chronic Conditions In 2014). In total, ten states had higher than average MCC prevalence: Kentucky at 38.2%, Alabama at 35.8%, West Virginia at 34.6%, Mississippi at 34.2%, Montana at 33.2%, New Mexico at 32.9%, Maine at 30.9%, Michigan at 30.3%, Ohio at 29.6%, and Pennsylvania at 29.6%.

What struck me about this data wasn’t the cost curve – we’ve seen and reported on that before. In fiscal years 2009 through 2011, the most expensive 5% of Medicaid-only enrollees accounted for 48% of Medicaid expenditures — and over those three years, individuals who were eligible for Medicaid on the basis of disability represented a disproportionate share (64%) of high expenditure Medicaid-only enrollees (see 5% Of Medicaid-Only Enrollees Account For Nearly Half Of All Medicaid Spending). And, consumers with chronic, complex physical and behavioral health conditions are often also in need of additional social services and supports, which leads to high rates of emergency department use and hospitalization (see Are Superutilizers Your New Market?). Between 10.5% to 26.2% of emergency department visits in 2014 — depending on the payer (Medicare, Medicaid, or private insurance) — were made by this group (for a great breakdown of some of the costs, see 10% To 26% Of Emergency Department Visits In 2014 Made By Superutilizers).

Consumers with MCCs compared to other consumers in the ED were as follows:

  • Medicare aged 65+ years: 33.3% of consumers had MCCs vs. 26.7% of other beneficiaries with ED visits
  • Medicare aged 1-64 years: 20.1% of consumers had MCCs vs. 16.7% of other beneficiaries with ED visits
  • Private insurance: 5.3% of consumers had MCCs vs. 3.3% of other beneficiaries with ED visits
  • Medicaid: 7.3% of consumers had MCCs vs. 2.7% of other beneficiaries with ED visits

What struck me was the challenge of developing health management strategies for the diverse group of consumers that fall under this “superutilizer” umbrella group. All stakeholders need to: rethink how to define specific populations (see How To Define A Superutilizer Population); how to design care management practices and coordinate care (see What Does Care Management Look Like For Superutilizers? and The Strategic Implications Of HIV & The Addiction Epidemic); and how this population fits into the behaviorally-focused medical homes or health homes (see Superutilizers & Mental Illness). For that, analytics, population segmentation, and targeted solutions will be key to successful population health management.

For health plans and accountable care organizations, executive teams need to adopt population segmentation strategies to match specific subgroups of consumers to the most appropriate “best practice” solutions. And, for provider organizations, this has implications for both health plan contracting and service line development – the need to tailor solutions by health plan and population. For more on emerging approaches to specialty care coordination programs, check out:

  1. Aetna Launches Patient-Centered Medical Home For Oncology
  2. Walgreens Launches Health Coaching Pilot for Type 2 Diabetes
  3. Automated Telephonic Case Management Improved Diabetes Care
  4. Telephone-Based Collaborative Care Model Manages Depression & Anxiety In Patients With Heart Disease
  5. AbilTo Telehealth CBT Program Following Cardiovascular Event Cut Hospital Admissions By 31%
  6. Medical Home Linked To Lower Pediatric Readmission Rate
  7. Wisconsin Implementing Foster Care Medical Home Program In Six Counties
  8. Collaborative Mental Health & Primary Care Benefit Older Adults With Sub-Clinical Depression
  9. Hackensack University Medical Center ‘autism medical homes’ program expanding
  10. Allegheny Health Network launches one-stop shop for moms-to-be with addiction

For even more on the use of analytics for population segmentation, take a look at these web briefings developed by Candace T. Saldarini, M.D., the Director, Medical Strategy of ODH, Inc. and myself – Must-Have Technology Solutions For Competitive Population Health Management: Optimizing Behavioral Health For Better Plan Performance & Patient Health and How To Optimize Complex Consumer Care Using Next Generation Population Risk Management Tools.


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