The most expensive Medicare beneficiaries are not those with multiple chronic conditions. They are those with chronic conditions AND functional impairment (i.e., those needing help with routine life activities). For example, the 15% of Medicare enrollees with both chronic conditions and functional limitations disproportinally account for one-third of Medicare spending. Alternatively, Medicare enrollees with three or more chronic conditions but no functional impairment (48%) account for roughly the same percent of spending (51%). The challenge therefore both in improving quality care for the chronically ill and reducing costs (via, for example, reduced hospitalizations) is in improving long term care supports and services (LTSS).
During this 26-minute podcast Dr. Alkema defines "functional limitation" and "care coordination", explains the current lack of care coordination for Medicare patients with chronic conditions and functional limitations, describes three exemplary models of care coordination and what Medicare can or should do to improve care for these patients.
Dr. Gretchen Alkema currently serves as Vice President of Policy and Communications for The SCAN Foundation. Prior to joining SCAN Dr. Alkema was the 2008-09 John Heinz Health and Aging Policy Fellow serving in the office of Sen. Blanche Lincoln. Dr. Alkema earned her PhD at the University of Southern California’s Davis School of Gerontology and and completed her post-doctoral training at the VA Greater Los Angeles Health Services Research and Development Center of Excellence. Her academic research focused on evaluating innovative models of chronic care management and translating effective models into practice. She is a Licensed Clinical Social Worker and has practiced in government and non-profit settings including community mental health, care management, adult day health care, residential care and post-acute rehabilitation.
For background information concerning this topic see this paper by Georgetown's Harriet Komisar and Judy Feder: http://www.cahpf.org/docuserfiles/georgetown_trnsfrming_care.pdf See also too SCAN's "10 Conversations to Plan for Aging with Dignity and Independence" at: http://www.thescanfoundation.org/10-conversations-plan-aging-dignity-and-independence.