The ‘Chronic Care Trifecta’

This article is a part of the From Volume to Value series sponsored by Astellas. To read more articles in the series, visit here.

An innovative and brutally frank doctor in Augusta, Georgia, Rob Lamberts, tells people with chronic diseases: “you scare doctors.” And with good reason—a chronic disease does not yet have a cure and that can make doctors feel like they are coming up short. The only way to treat a chronic disease is to prevent it from either getting worse or causing other problems. That requires a very different approach to medicine from what people typically see and that public programs and private health plans have historically covered.

But since two of every three Americans now live with a chronic disease—either their own or a loved one’s­­—we need to change the way we care for people.

{mosads}While typical medical care involves treating a patient’s medical needs, there is no quick fix with chronic conditions. Instead, we call for an innovative new approach to health care called the Chronic Care Trifecta. Under this approach, providers customize care based on three elements: a person’s aspirations, life experience, and medical needs. While health care traditionally addresses the third element—the medical needs of people with chronic diseases and disabilities—the first two are often missing.

Start with a person’s aspirations. A doctor may assume that a patient’s goal is living longer, but it is seldom that simple. Take, for example, Teri Griege who was diagnosed at age 48 with stage 4 colon cancer, a deadly disease requiring intense chemotherapy. Her dream was to compete in the Ironman World Championship in Kona, Hawaii. Instead of letting the cancer treatment control her life, she worked hard to get her four specialists in agreement on a treatment plan that would help her fulfill her personal goal. Against all odds, at the age of 50, she crossed the finish line of the Ironman World Championship.

Her effort should not have been extraordinary. Health care providers should routinely ask people about their aspirations and explain how health care can serve those goals. Policymakers should set standards so electronic health records display a patient’s personal aspirations to every provider who treats that person. Not only is that a humane approach, it is much more likely to motivate people to get through the tough parts about health care. It can also save money when people with chronic diseases avoids trips to the ER and other expensive care down the road.

Next, life experience should also shape the care people receive. We all have different values and abilities when it comes to health care—and these are magnified for someone with a chronic disease or disability. Whether it is remembering to take pills to prevent a heart attack or check blood sugar levels to manage diabetes, people with a chronic condition need strong partnerships with providers in medical care.

To see how life experience matters, consider the burdens facing a woman in northern Maine. She has two elementary school children, works part time, and is the family caregiver for her mother who was diagnosed with Alzheimer’s. She also has breast cancer and has to drive eight hours to the closest university medical center to get the care needed by herself and her mother. This woman’s lack of financial resources and limited health literacy skills greatly impact her care experience. For her to get the care she requires, her doctors and specialists must acknowledge her need to save for her children’s future and the struggles she goes through caring for her mother.

None of these three elements of the Chronic Care Trifecta—a person’s aspirations, life experience, and medical needs—should be viewed in isolation. Creating the time and space in health care to have those ongoing conversations will require policymakers to reform payments to providers so that communication and care planning are valued as much as care delivered. Innovative doctors like Rob Lamberts are already doing this, but they often lose money under the current payment structure.

Over the next several months, Congress—under the leadership of the Senate Finance Committee—will take up the challenge of improving chronic care. The debate needs to be grounded in what people with chronic diseases and disabilities really need: support for living their lives as they wish despite the condition they have. The key to that is the Chronic Care Trifecta.

Public policy should reward clinicians for working out clinical outcome goals with each person based the individual’s aspirations and life experiences. The result will be a care plan that is easier for both parties to follow, leading to greater hope and success for people as they struggle with their chronic condition and resulting in better health at a lower overall cost to our health care system.

Boutin is chief executive officer of the National Health Council. Kendall is senior fellow for Health and Fiscal Policy at Third Way.