White Paper
The Importance of Multi-disciplinary Teams in Chronic Condition Management Care coordination for improved cost & outcomes
The Importance of Multi-disciplinary Teams in Chronic Condition Management The impact of chronic disease carries a significant cost to society, both in terms of the direct money spent on healthcare and the indirect social costs of impaired productivity and disability. These outlays continue to trend upward due to a growing population of older adults in the US and a complex healthcare system that has not developed cost-effective and efficacious solutions for containing and managing chronic conditions. The on-going expense of chronic condition management is of significant interest as health plans, employer groups, and other healthcare-related industries struggle to deliver the promise of the triple aim to contain cost, improve outcomes, and increase patient satisfaction.
pain, the combined cost of this medical care and lost productivity are a significant and costly impact on the US economy, health insurance expenditures, and population health. The unconstrained costs associated with chronic conditions can be attributed to many factors. Chief among them are patient non-compliance with prescribed medical treatments and the lack of integration across multi-disciplinary specialties. This lack of coordination and compliance contribute to poorer outcomes, lower patient satisfaction, and increased costs.
Costs of chronic pain in the US are estimated at $261-300 billion; lost productivity adds an estimated $297-300 billion to the economic burden
The medical and social costs of chronic pain are staggering. In their 2011 report, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research”, the Institute of Medicine estimated that the cost of chronic pain in the US was upwards of $600 billion in medical treatment and lost productivity (often defined as absenteeism and presenteeism). With the same report from the IOM showing that over 100 million adult Americans experience chronic
Coordinated Care for Patient Compliance Research points to the impact of patient noncompliance as a significant factor in the failure to curb the rise of chronic condition management costs. This research indicates that up to 50%
All research cited in this white paper was drawn from The CHP Group research paper “Reducing the Cost of Chronic Conditions”, published April 2021. To read the research paper, visit chpgroup.com/publications.
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of adults do not follow through with long-term medication regimens. The reasons that patients fail to follow-up adequately with long-term care plans are varied and include the costs of medication, undesirable side effects, and a failure to establish a collaborative therapeutic alliance with their physician. The last issue cited can be generally defined as a difficulty with provider-topatient communication. Despite the best efforts, patients often fail to fully comprehend their physician’s instructions. A seminal article by Thomas Bodenheimer, published in JAMA in 2007, observed that significant obstacles in the typical primary care practice center on communication issues between the physician and patient. This communication issue is twofold: • First, clinical practice guidelines often fail to achieve the goal of educating patients about planned interventions • Second, the difficulty in clear communication about the patients’ condition and their role in the treatment regimen These communication issues – generally about the scope and nature of the condition and the proposed treatment – have been shown to
negatively impact the desired patient outcome and their wellness. Bodenheimer’s publication showed that this communication issue results in a majority of patients leaving a typical office encounter not fully comprehending what their physician told them about their conditions and treatments. An effective partnership, therefore, between physicians and patients, based on open and clear dialogue, is an essential feature in promoting healthy behaviors, compliance with physician orders, and positive therapeutic outcomes. The effectiveness of treatment regimens is further compromised by a complex delivery system that is often not centered around patient needs. This also contributes to non-compliance, as well as a lower rate of positive patient outcomes, increased cost, and decreased patient satisfaction. Combined, these issues and concerns merge into a potentially negative situation that has the unintended consequence of breaking down the cohesion of coordinated and integrated care. Finding a solution to counter this consequence is especially important to achieve the triple aim. Various research papers and studies have shown that improved coordination is an effective way to better serve patients’ health needs. It should not be surprising that there is significant evidence that shows that designing treatment pathways that are organized to respond rapidly and efficiently have a
Communication issues have been shown to negatively impact the desired patient outcome and their wellness
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positive impact in both cost containment and the treatment outcomes. In their 2001 research paper, “Improving Chronic Illness Care”, Wagner, et al. outlines multiple elements of an improved health system designed around improving the care and outcomes for chronic diseases. One significant feature was better self-management interventions. Another key element of efficient and effective chronic condition management is better coordination across all caregivers. While self-care can be motivated through more effective communication between patient and physician, the coordination of care requires better communication across the entire healthcare continuum.
Optimal Coordination for CostEffective Care One issue facing better coordination is that while primary care is still correctly considered to be the optimal setting for cost-effective care delivery – as opposed to, for example, consulting with a specialist – this approach continues to have difficulties in delivering efficient, highquality, and cost-effective solutions. One option, research argues, is for the full integration of multi-disciplinary approaches, including evidence-
based and patient-centered integrative healthcare disciplines such as massage therapy, acupuncture, and naturopathic and chiropractic medicine. While many practices and health systems continue to focus on a non-coordinated, conventionallyfocused treatment for chronic disease, research indicates that the integration of care that incorporates conventional and integrative healthcare may help deliver better outcomes for patients. Additionally, research indicates that patients with uncomplicated lower back pain receiving care from a chiropractor in conjunction with a medical physician incurred “appreciably fewer charges” than medical care alone, with or without a physicial medicine provider. CHP’s belief in coordination of care is not unique. Healthcare approaches which have been developed and practiced outside of conventional medicine have a long and rich history. In a 2010 publication the IOM’s Roundtable on Value & Science-Driven Healthcare offered a similar vision: “…for a healthcare system that draws on the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nation’s health.”
Patients with uncomplicated lower back pain receiving care from a chiropractor in conjunction with a medical physician incurred “appreciably fewer charges” than medical care alone 4
Surveys and other research revealed that true “alternative” medicine use (meaning being utilized outside of conventional medicine) is uncommon. Most people who use complementary approaches, such as acupuncture and chiropractic, use them alongside and in coordination with conventional treatments.
In its 2005 report, the Institute of Medicine stated that the successful integration of integrative healthcare must have the goal of “…the provision of comprehensive care that is safe and effective, care that is collaborative and interdisciplinary, and care that respects and joins effective interventions from all sources.”
Effective integration of all forms of healthcare As providers become more focused on delivering depends on coordinating the best of conventional high-value healthcare they will be driven by the and integrative healthcare together. The goal evidence about the safety, effectiveness, and continues to build therapeutic alignment with lower cost of clinical interventions. The Health other disciplines. There is a growing body of evidence that demonstrates Percentage of US Hospitals Offering the clinical and 42% Integrative Healthcare Options cost-effectiveness 1998 – 2010 of this coordinated 37% approach. Research shows that: “…Better integration of chiropractors into conventional care spine management algorithms could represent a sensible approach to enhancing patient-centered care for patients with chronic musculoskeletal pain.”
26%
15%
6% 1998
2001
2005
2007
2010
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Forum, a subsidiary of the American Hospital Association, published a 2005 survey that revealed just over 26% of respondent hospitals offered at least some level of integrative healthcare services. This grew to 37% in 2007 and to 42% in the 2010 survey.
The Right Partner for Integrative Healthcare Coordination As organizations – both health plans and employer groups – realize the potential positive impact of coordinating conventional medicine with integrative healthcare, they will need to find partners to provide these patient-focused, high-quality services. There are three key issues to evaluate in choosing an integrative healthcare partner: the size, the scope, and the quality of their network. While some groups approach network management as ‘any willing provider’, a quality-focused organization will recruit licensed, high-quality providers that are delivering evidence-based care. While this may result in a somewhat smaller network, the benefits and cost-savings with a high-value group of providers appropriately utilizing services are significant. Having the right size network is important, but managing that network requires experience and expertise. Combining the network with professional provider services is critical to an effective and efficient integrative healthcare program. Key among these services are utilization management services, on-going provider education, proprietary clinical pathways, realtime network monitoring and oversight, and credentialing that exceeds NCQA standards.
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Right-sized and well-managed networks also require significant administrative services to run smoothly and efficiently. Areas of particular interest are professionally-trained, live customer service representatives; customized benefit design services; advanced claims processing with high levels of auto-adjudication and crossaccumulation capabilities; and a state-of-the-art IT infrastructure. Since its inception in 1989, The CHP Group (CHP) has proven itself to be the authority and partner of choice in integrative healthcare. CHP combines the most essential elements of building and managing high-quality networks with IT, administrative, and clinical services excellence. CHP currently manages high-quality networks throughout the West, including Oregon, Washington, Montana, Idaho, Utah, and Colorado. With over thirty years of healthcare experience, CHP provides a range of services from network lease, to administrative services only (ASO) that leverages our extensive expertise, to a fully capitated program that combines all of our strengths as an end-to-end solution. To learn more about CHP, and find out about getting the IH authority on your side, visit our website at chpgroup.com, e-mail us at sales@ chpgroup.com or call our Sales Department at 503-203-8333, option 3.
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