Topic#2: Chronic care management support that improves health and lowers costs Overview of topic: In an article from Chronic Care Management it addresses the fact that proper chronic care management support, can improve health and lower costs. According to the Centers for Disease Control and Prevention , “chronic diseases such as cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and asthma, affect nearly half of US adults and account for 84% of all healthcare costs”(). Something i found very interesting is that People living below the federal poverty line have a shorter life expectancy and higher incidence of chronic disease than those with higher incomes. The poor, however, are less likely than …show more content…
the non-poor to have recent contact with a physician or engage in preventive care. While reading an article by the University of Chicago it discusses the significance of chronic disease management in improving health outcomes for low income individuals and in reducing preventable health-related expenses from a provider's perspective.
Chronic disease management requires individuals to be knowledgeable about the direction of their disease so that the patient and family members are able to identify abnormal symptoms and recognize if something is getting worse or more symptoms are presenting themselves. The University of Chicago department of Chronic disease management says “the goal of chronic disease management is to help patients self-identify an irregularity before the condition progresses to a life threatening or highly debilitating level. In order to monitor the disease, chronically ill individuals are expected to have a regular health care provision team that understands the patient’s unique medical and social history”(). As a result of having a provision team, the lead physician is able to work with the patient to maintain wellness through routine appointments even if the patient is not experiencing problematic symptoms. Therefore keeping the patient under a close watch to make sure that the individual's disease does not progress in a negative manner, increasing more medical treatments and increasing medical costs. Disease management can increase quality of life for the …show more content…
patient, but hospitals and physicians are also key beneficiaries of a chronic disease management approach. While there are many benefits of chronic disease management, the use of this model of care provision is currently flawed.
Especially with regard to low income, or inner city patients. “Adequate disease control requires that a patient have a regular health-care provider who coordinates and co-manages care, thereby preventing the patient’s hospitalization. Unfortunately, however, poor individuals receiving health insurance through public aid programs, such as Medicaid or the State Children’s Health Insurance Program (SCHIP), often have high “no-show” rates for medical appointments, which disrupts continuity of care”. The article describes a “no-show” as a patient who misses a scheduled appointment with a medical provider and does not call ahead to cancel or reschedule the appointment (). Missed appointments are harmful for patients because chronic illnesses often require a lot of work, from the patient to assess the progression of the disease. This means routine appointments are often needed in order to fill prescriptions, etc. Like said before a key to chronic disease management is the patients education on the subject and their ability to communicate with the necessary medical
professionals. Missed appointments also impact financial area of health care, as well and the direct health of chronically ill patients. In the “United States, the estimated cost of “no-shows” accounts for 3% to 14% of total outpatient clinic income” (). Because of this the physician is likely to not schedule another appointment during this time slot. In addition to financial burdens, missed appointments might aggravate medical providers from a social perspective. For example, if a higher number of patients who are on public aid as compared to being privately insured are observed to be no shows, medical teams might develop negative assumptions and stereotypes about those people on public aid. The article states that “ Internalized beliefs of providers about public aid patient patterns might negatively impact the quality of care or access to care that such populations receive. In order to prevent these outcomes, understanding and redressing the underlying causes of missed appointments without prior cancellation is essential for implementing effective chronic disease management”(). Conclusion/ Personal Reflection: In conclusion these two article have informed me that it's not hard to put in place helpful chronic care management! In short if the patients are aware of the disease, educated about the disease, and aid in staying on top of it by monitor their condition through regular contact with their health provision teams, it will in return help their health, lower their health care cost as well as become a financial bonus for the physicians and health care facilities. Perhaps even more important, however, this is likely to improve the health outcomes of low income populations struggling to manage chronic illness. In order to ensure chronic disease management is effectively put into place, appointment scheduling systems must be revised to reduce the rate of missed appointments among low-income populations.
People in lower classes are more likely to get sicker more often and to die quicker. People in metro Louisville reveal 5- and 10-year gaps in life expectancy between the city’s rich, middle- and working-class neighborhoods. Those who live in the working class neighborhood face more stressors like unpaid bills, jobs that pay little to nothing, unsafe living conditions, and the fewest resources available to help them, all of these contribute to the health issues.
Throughout this class we have talked about how various disparities can influence both how and when you need health care, be it for physical or mental reasons. Basically if you aren’t a middle class and above white male with a good job you’re basically fucked. Things such as race, gender, education, the environment you grew up in, who you know, and of course your insurance and income play a huge role in how you experience all aspects of healthcare. As explained in the Link&Phelan article, certain social factors can cuase specific health results. As explained in the article the Fundamental Causes Theory “claims that new mechanisms arise because persons of higher socioeconomic status are able to deploy wide range of resources- including knowledge, money power, prestige, and beneficial social connections- that can be used individually and collectively in different places and at different times to avoid disease and death.” What this means is basically those who are better off are more suited and have more chances to combat sickness and to elongate their lives.
For example, income often determines one’s access to health-care. Researchers have found that low-income families are less likely to fill prescriptions, have dental coverage, and have preventative care visits (Ives et al., 2015, p. 170). Further, Williamson et al. (2006) declared, “professional treatment services…not covered by provincial health care plans, social services, or Indian and Northern Affairs were most frequently cited by respondents…as services that they choose not to use because of their low-income status” (p. 113). In addition to being unable to afford services, low-income individuals are often unable to afford transportation to appointments (Williamson et al., 2006, p. 116). Clearly, although individuals have the right to health, low-income individuals and families face many barriers in accessing and affording health-care services in
Variations in life expectancy and its changes are one major cause of rising income inequality. How long a person lives, as well as their quality of health, can have an important and huge impact on their income and social mobility. The life expectancy of the bottom 10% increases at only half the rate that the life expectancy of the top 10% does (Belsie). This shows that improvements in medicine benefit the wealthy more than the poor. The less wealthy have decreased access to good medical insurance and cannot afford more expensive, quality medical care. The poor are less likely to invest in healthy food and exercise, lowering life expectancy and overall health. These changes result in a cycle that causes the poor to be less healthy, and the less healthy to become increasingly poor. On the other side, the rich have different variations of habits, education, and environments, which can affect life expectancy, often positively for the
Allowing the patients to choose the scheduled time of when to make an appointment with the physician makes them feel welcome. The flexibility is increased significantly; besides, the fact is a personal commitment makes them feel the need to see the doctors for treatments. The clinics may also consider moving hospitals closer to their patients. Alternatively they may opt to have mobile clinics when they have the highest patient turn out and take treatment to those who feel they may otherwise not be able to afford treatment (Humphries & Eddy, 2000). Reminders also helps to increase the attendance rate since patients may fail to attend due to finances and busy schedules (Phipps, 2003).
Chronic illness can consist of a single or multiple illnesses that last over a period of time (Kaakinen, Coehlo, Steele, Tabacco, & Hansen, 2015). For this assignment, I will choose a chronic illness that could affect a patient in my nursing practice. I will discuss three ways I could promote the health of the patient and the family dealing with the chronic illness. I will end this discussion with a conclusion.
Nordqvist, Christian stated some facts about health, “ health can be defined as a physical, mental, and social well being, and a resource for living a full life. It refers not only to the absence of disease, but the ability to recover and bounce back from illness. Factors for good health include genetics, the environment, relationship, and education.”(page2). Health can be defined in many factors, but they all relate to a person's status and where their class in the economy. If one is wealthy, he or she can have access to healthcare that provides treatment to any of their health issues. But for the people who have low income, they can not afford health insurance and have a higher risk of becoming ill because they don’t have the resources to live a full healthy life. Most of those individuals have mental health issues because they often stress about living and surviving everyday with so little income. Christian Nordiqvist also said, “According to the WHO, the higher a person's socioeconomic status (SES), the more likely they are to enjoy good health, a good education, a well-paid job, afford good healthcare when their health is threatened” (pg.2). Christian is correct because the wealthier a person is, the higher chance of being in good health because he or she has the privilege of good health
One of the most prevalent and pervasive social issues in the United States today is the provision of equal access to health care for the impoverished. Far too many people live in conditions of poverty and struggle to find the means by which to meet their basic needs. For those without insurance, access to medical care is often preempted by other necessities. An unexpected medical expense can push this group further into poverty. Those who do have insurance may find themselves underinsured in the event of an emergency and unable to make the necessary co-payments. Alternatively, the insured’s provider may refuse to cover certain conditions. Besides the cost of adequate insurance and the booming cost of medical care, there are other factors that affect equal access to medical care for the impoverished. Among these are race, age, and geographic location. Poverty and the resulting inadequate medical care is a ubiquitous social problem that merits further discussion of the issue’s causes and implications.
One reason health care costs are increasing are due to an increase reliance on the emergency department (ED) where many medical conditions could have been prevented or directed to a low-cost health clinic for care. Not only does this take away human capital for people who have actual medical emergencies, but also wastes hospital resources where many of these visit are billed frequently to Medicare, Medicaid, and low-cost health insurance (Choudhry et al., 2007). This problem can be attributed to people who live under the poverty line that cannot afford healthcare or qualify for Medicare and Medicaid. According to the U.S. Census Bureau’s Income, Poverty, and Health Insurance Coverage in the United States: 2012 report, the official poverty rate was at a staggering 15.0 percent, or approximately 46.5 million people are in poverty with an income of less ...
Pincus, T., Esther, R., DeWalt, D.A., & Callahan, L.F., (1998) Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med. 1998 Sep 1;129(5):406-11.
In the United States of America, there are millions of individuals that live with chronic medical problems. In which these conditions require some sort of medical attention at least once a month for revaluation, and possible treatment. Thankfully, for the majority of those individuals with their health insurance covers those costs that essentially would cripple their bank accounts. On the contrary, there are millions of people living in the United States, who are uninsured. Even with the implementation of the Affordable Care Act or as it is known by the public Obama Care, there are still individuals who cannot afford the basic needs of healthcare. Health care should not be looked at as a privilege but a right for everyone regardless of their
Less is known, however, about how differences in the use of preventive services vary across subgroups of the uninsured population. As a whole, the uninsured receive less preventive care. When issues are discovered it is typically at more advanced disease stages, and once a diagnosis is received, the uninsured tend to receive less therapeutic care. 21 The uninsured population is not monolithic and spans all levels of household income, education, and age. Even though there has been a large amount of information created by work on preventive services, a gap remains in the literature. According to the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (DHHS), an estimated 48.6 million people were uninsured in 2011. This figur...
... more prone to chronic illnesses. As for Medicaid, it needs to improve its chronic care management. Chronic care management should be made more affordable to those with chronic illnesses (Baicker, Katherine, & Amy Finkelstein, 2011). This way, the program will be more beneficial to more people. The program should also introduce, and support home and community based services. Providing care in home settings will be much cheaper than nursing homes. Moreover, Medicaid needs to come up with customized beneficiary services. Patients’ needs are not equal. Therefore, Medicaid should be flexible enough to abandon the one size fits all mentality. Anyway, that notwithstanding, we cannot ignore the fact that Medicare and Medicaid have revolutionized healthcare in the United States. Giving credit where it is due, these two programs continue to save millions of helpless lives.
The chronic care model calls for an organizational change in the way individuals with illnesses are cared for, and the involvement of nurses, social workers and patients themselves. The challenge is moving in an effective way of improving quality from research carried out predominantly in health maintenance organizations to the mainstream of health care practice (Wielawski, 2006). Wagner’s explanation is to substitute the customary physician-centric office structure with one that supports clinical teamwork in association with the patient. The notion spreads outside the health care organization to collaborative associations in the community. Wagner et al. (2001) termed this approach the “chronic care model.” With this model, physicians, nurses, case managers, dieticians, and patient educators
There are many ways to categorize illness and disease; one of the most common is chronic illness. Many chronic illnesses have been related to altered health maintenance hypertension and cardiovascular diseases are associated with diet and stress, deficient in exercise, tobacco use, and obesity (Craven 2009). Some researchers define the chronic illness as diseases which have long duration and generally slow development (WHO 2013); it usually takes 6 month or longer than 6 month, and often for the person's life. It has a sluggish onset and eras of reduction for vanishing the symptoms and exacerbation for reappear the symptoms. Some of chronic illness can be directly life-threatening. Others remain over time and need intensive management, such as diabetes, so chronic illness affects physical, emotional, logical, occupational, social, or spiritual functioning. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, all of these diseases are the cause of mortality in the world, representing 63% of all deaths. So a chronic illness can be stressful and may change the way a person l...