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Managing Costs and Improving Care: Team-based Care of the Chronically Ill

Thursday, August 11, 2011

The high and rising cost of health care is a central concern for governments at all levels, employers and families. A large portion of the cost problem can be traced to the care received by persons with chronic conditions like asthma or diabetes. Treating those with multiple chronic conditions, including the elderly and disabled populations, accounts for 30 percent of total U.S. health care spending as of 2010. Half of this amount is spent by Medicare and Medicaid on behalf of beneficiaries eligible for both programs.

It may be possible to improve the quality of care for the chronically ill while altering the trajectory of spending for their care. Savings have been shown in some private and public sector approaches using teams that span multiple sites of care, reduce fragmentation and improve health outcomes. In addition, the Patient Protection and Affordable Care Act establishes new pilots and innovations that could change the way we deliver care to the chronically ill and the way we pay for it.

How can Medicare, Medicaid, private plans and providers partner to develop new approaches and achieve public health goals? Could these programs address the different needs of populations in institutional care versus community-based care? How do these new models differ from former approaches? What infrastructure and training enhancements are needed? What have we learned from states that have tried Medicaid case management for the chronically ill?

To address these and related questions, the Alliance for Health Reform and The Commonwealth Fund sponsored an August 11 briefing. Panelists were: Lois Simon, Commonwealth Care of Massachusetts; Pam Parker, Minnesota Senior Health Options; and Randy Brown, Mathematica Health Policy Research. Cathy Schoen of Commonwealth and Ed Howard of the Alliance co-moderated.


 Cathy Schoen, The Commonwealth Fund, Moderator
 Randy Brown, Mathematica Policy Research, Speaker
 Lois Simon, Commonwealth Care Alliance , Speaker
 Pam Parker, Minnesota Senior Health Options, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Adobe Acrobat PDF), 8/11/2011
Full Webcast/Podcast: Managing Costs and Improving Care: Team-based Care of the Chronically Ill

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Simon Presentation (PowerPoint), 8/11/2011
Parker Presentation (PowerPoint), 8/11/2011
Schoen Presentation (PowerPoint), 8/11/2011
Brown Presentation (PowerPoint), 8/11/2011

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Materials List: Managing Costs and Improving Care: Team-based Care of the Chronically Ill (Adobe Acrobat PDF), , 8/11/2011
Sourcelist: Managing Costs and Improving Care: Team-based Care of the Chronically Ill (Adobe Acrobat PDF), , 8/11/2011
Agenda (Adobe Acrobat PDF), , 8/11/2011
Speaker Biographies (Adobe Acrobat PDF), , 8/11/2011

Offsite Materials (briefing documents saved on other websites)

Health care team tackles cost and quality of care for dual-eligible patients, Washington Health Policy Week in Review, 6/13/2011
- Adams, Rebecca
Tackling care as chronic ailments pile up, The New York Times, 2/21/2011
- Brody, Jane E.
Strategies for reining in Medicare spending through delivery system reforms: Assessing the evidence and opportunities (Adobe Acrobat PDF),Kaiser Family Foundation, 9/1/2009
- Brown, Randall.
Health policy brief: Patient-centered medical homes (Adobe Acrobat PDF),Health Affairs, 9/14/2010
- Cassidy, Amanda
Innovations in preventing and managing chronic conditions: What’s working in the real world? (Adobe Acrobat PDF),Center for Studying Health System Change, 6/1/2010
- Cassil, Alwyn.
Coordination between emergency and primary care physicians (Adobe Acrobat PDF),National Institute for Health Care Reform, 2/1/2011
- Carrier, Emily, Tracy Yee and Rachel A. Holzwart.
Chronic disease management, Health Reform GPS,, 2/23/2011
- Cartwright-Smith, Lara.
Chronic care: Making the case for ongoing care (Adobe Acrobat PDF),Robert Wood Johnson Foundation, 2/1/2010
Seeing Spots, The New Yorker, 1/1/2011
- Gawande, Atul
Ten small-scale reforms for pre-existing (chronic) conditions, Health Affairs Blog, 1/27/2010
- Goodman, John C.
HHS offers new tools to help states lower Medicaid costs, provide better care, Department of Health and Human Services, 5/11/2011
Long term services and supports and chronic care coordination: Policy advances enacted by the Patient Protection and Affordable Care Act (Adobe Acrobat PDF),National Institute for State Health Policy, 4/1/2010
- Justice, Diane.
In Brief: A new care paradigm slashes hospital use and nursing home stays for the elderly and the physically and mentally disabled, The Commonwealth Fund, 3/1/2010
- Klein, Sarah.
MGH Medicare demonstration project for high-cost beneficiaries (Adobe Acrobat PDF),Massachusetts General Hospital, 9/1/2010
A new care paradigm slashes hospital use and nursing home stays for the elderly and the physically and mentally disabled, Health Affairs, 3/1/2011
- Meyer, Harris.
The roles of patient-centered medical homes and accountable care organizations in coordinating patient care, AHRQ Report, 12/1/2010
- Meyers, David, et. al.
Are higher-value care models replicable?”, Health Affairs, 8/20/2009
- Milstein, Arnold and Pranav Kothari.
Why accountable care organizations won’t deliver better health care – and market innovation will (Adobe Acrobat PDF),Heritage Foundation, 4/18/2011
- Numerof, Rita E.
New flexibility for states to improve Medicaid and implement innovative practices, Department of Health and Human Services, 4/14/2011
Health reform that passes the buck is short-sighted, U.S. News & World Report, 7/18/2011
- Thorpe, Kenneth.
Tracking and sharing observations from daily life could transform chronic care management, Robert Wood Johnson Foundation, 3/3/2010
MassHealth Senior Care Options Program Evaluation: Nursing Facility Entry Rate in CY 2004–2005 Enrollment Cohorts,” (Adobe Acrobat PDF),Jen Associates, Inc, 3/5/2009
Testimony to the meaningful use workgroup panel 1: Care coordination among specialists, primary care, care management & patients (Adobe Acrobat PDF),Center for Studying Health System Change, 3/13/2011
- O’Malley, Ann S.
Coordinating care in the medical neighborhood: Critical components and available mechanisms, Agency for Healthcare Research and Quality, 6/1/2011
- Taylor, Erin et al.
Comparative Effectiveness Research and Patients with Multiple Chronic Conditions, New England Journal of Medicine, 6/22/2011
- Tinetti, Mary E. and Stephanie Studenski.


Cathy Schoen, senior vice president for policy, research and evaluation at The Commonwealth Fund, points out why it's so important to coordinate care more efficiently for those with chronic conditions. From the Aug. 11 briefing cosponsored by the Fund. (12 min.)

Randall Brown of Mathematica Policy Research discusses what works in efforts to more effectively coordinate care for patients, and potential barriers to success. From the Aug. 11 briefing cosponsored by The Commonwealth fund. (11 min.)

Pam Parker of the Minn. Dept. of Human Services outlines the success of her state's Medicaid managed care programs for those with chronic illnesses. From the Aug. 11 briefing cosponsored by The Commonwealth Fund. (12 min.)

Lois Simon, a founder of the Commonwealth Care Alliance in Mass., describes how the alliance redesigned primary care for Medicare - Medicaid dual eligibles in her state. From the Aug. 11 briefing cosponsored by The Commonwealth Fund. (13 min.)


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