Managing multiple conditions: A challenge for Medicare

A Medicaid project in North Carolina has cut costs and improved care for patients with chronic diseases. Can Medicare do the same?

By Markian Hawryluk, AMNews staff. Dec. 1, 2003.

The office of pediatrician Charles Willson, MD, seems like a strange place to find ways to improve Medicare.

Dr. Willson participates in a program that coordinates the care of North Carolina Medicaid patients with chronic conditions. Medicare, although serving a very different clientele of elderly and disabled Americans, has in common an abundance of patients with chronic diseases.

The Medicaid project has taught Dr. Willson, a professor of pediatric medicine at the Brody School of Medicine at East Carolina University in Greenville, a thing or two about how to handle this complex patient population.

"For the first time ... I was getting feedback to see how my outcomes, emergency room visits and hospitalizations compared with others," said Dr. Willson, who serves as co-medical director for one of the Medicaid program's community care management networks. "I thought that my asthma care was as good as anybody else's in the country, but when I looked at my own practice with the nurses and audited my own charts, I found for only 50% of the patients that I'd seen did I do the full thing that was needed."

He discovered that he was not staging his asthma patients as was recommended under National Institutes of Health guidelines. Now whenever an asthmatic patient comes in for an appointment, the nurse attaches an action plan to the front of the medical record and circles the place where the stage should be documented.

Many policy-makers would like physicians and others providing care to Medicare patients to learn similar lessons about dealing with chronically ill patients. Disease management, they say, is desperately needed. A recent study from Johns Hopkins University, Baltimore, found that patients with two or more chronic conditions make up 63% of Medicare beneficiaries but account for 95% of the program's $250 billion annual cost.