[Report] County-Level Variation in Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, 2012

From the US Centers for Disease Control and Prevention 

[High-resolution JPG for print]

The map illustrates the geographic variation across counties and shows that counties with the highest prevalence of Medicare beneficiaries with 6 or more chronic conditions are located predominantly in southern states (eg, Texas, Florida, Kentucky) and northeastern states (eg, New York, Pennsylvania). Counties with the lowest prevalence are found mostly in western states (eg, Oregon, Montana, Wyoming). [A text description of this figure is also available.]

Background

Preventing chronic conditions and controlling costs associated with the care for people with chronic conditions are public health and health care priorities. The number of chronic conditions increase with age: more than two-thirds of Medicare beneficiaries 65 years or older have 2 or more chronic conditions, and more than 15% have 6 or more (1,2). People with multiple chronic conditions use more health care services than people who do not have them, and they account for a disproportionate share of health care spending (2,3). The prevalence of multiple chronic conditions varies substantially by state (4); more granular geographic information on multiple chronic conditions can provide a better understanding of the burden of chronic conditions and the implications for local public health programs and resources. The objective of this geographic information system (GIS) analysis was to describe county-level prevalence patterns of Medicare beneficiaries with 6 or more chronic conditions.

Navigate This Article

• Background
• Methods
• Main Findings
• Action
• Acknowledgments
• Author Information
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[Medical Journal Editorial] Using Drugs to Discriminate — Adverse Selection in the Insurance Marketplace

From the Perspective article by Douglas B. Jacobs, Sc.B., and Benjamin D. Sommers, M.D., Ph.D.at the 5 Feburary edition of the New England Journal of Medicine

Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA). Before the legislation was passed, insurers in the nongroup market regularly charged high premiums to people with chronic conditions or denied them coverage entirely. To address these problems, the ACA instituted age-adjusted community rating for premiums and mandated that plans insure all comers. In combination with premium subsidies and the Medicaid expansion, these policies have resulted in insurance coverage for an estimated 10 million previously uninsured people in 2014.1

There is evidence, however, that insurers are resorting to other tactics to dissuade high-cost patients from enrolling. A formal complaint submitted to the Department of Health and Human Services (HHS) in May 2014 contended that Florida insurers offering plans through the new federal marketplace (exchange) had structured their drug formularies to discourage people with human immunodeficiency virus (HIV) infection from selecting their plans. These insurers categorized all HIV drugs, including generics, in the tier with the highest cost sharing.2

Insurers have historically used tiered formularies to encourage enrollees to select generic or preferred brand-name drugs instead of higher-cost alternatives. But if plans place all HIV drugs in the highest cost-sharing tier, enrollees with HIV will incur high costs regardless of which drugs they take. This effect suggests that the goal of this approach — which we call “adverse tiering” — is not to influence enrollees’ drug utilization but rather to deter certain people from enrolling in the first place.

…

We found evidence of adverse tiering in 12 of the 48 plans — 7 of the 24 plans in the states with insurers listed in the HHS complaint and 5 of the 24 plans in the other six states (see theSupplementary Appendix for sample formularies). The differences in out-of-pocket HIV drug costs between adverse-tiering plans (ATPs) and other plans were stark (seegraphAverage HIV-Related Costs for Adverse-Tiering Plans (ATPs) versus Other Plans.). ATP enrollees had an average annual cost per drug of more than triple that of enrollees in non-ATPs ($4,892 vs. $1,615), with a nearly $2,000 difference even for generic drugs. Fifty percent of ATPs had a drug-specific deductible, as compared with only 19% of other plans. Even after factoring in the lower premiums in ATPs and the ACA’s cap on out-of-pocket spending, we estimate that a person with HIV would pay more than $3,000 for treatment annually in an ATP than in another plan.

Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans. A recent analysis of insurance coverage for several other high-cost chronic conditions such as mental illness, cancer, diabetes, and rheumatoid arthritis showed similar evidence of adverse tiering, with 52% of marketplace plans requiring at least 30% coinsurance for all covered drugs in at least one class.3 Thus, this phenomenon is apparently not limited to just a few plans or conditions.

Adverse tiering is problematic for two reasons. First, it puts substantial and potentially unexpected financial strain on people with chronic conditions. These enrollees may select an ATP for its lower premium, only to end up paying extremely high out-of-pocket drug costs. These costs may be difficult to anticipate, since calculating them would require knowing an insurer’s negotiated drug prices — information that is not publicly available for most plans.

Second, these tiering practices will most likely lead to adverse selection over time, with sicker people clustering in plans that don’t use adverse tiering for their medical conditions.

Read the entire Perspective here

Related articles

• Health insurers using drug coverage to discriminate
• Do insurers still discriminate against sick people despite the ACA?
• Medicaid ‘fee bump’ to primary care doctors associated with better access to appointments
• Have Insurers Found Way Around Obamacare ‘Pre-Existing Conditions’ Rule?
• Unfair HIV-Drug Pricing Found in US Health Plans
• Blog: Health Insurers May Be Finding New Ways to Discriminate Against Patients
• HIV Drugs Priced Too High for Most Patients Says Study

[Press release] Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012 | Full Text Reports…

Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012 | Full Text Reports….

This report presents detailed tables from the 2012 National Health Interview Survey (NHIS) for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, education, current employment status, family income, poverty status, health insurance coverage, marital status, and place and region of residence. Estimates (frequencies and percentages) are presented for selected chronic conditions and mental health characteristics, functional limitations, health status, health behaviors, health care access and utilization, and human immunodeficiency virus testing. Percentages and percent distributions are presented in both age-adjusted and unadjusted versions.

 

 

Living Sick and Dying Young in Rich America – Leah Sottile – The Atlantic

Living Sick and Dying Young in Rich America – Leah Sottile – The Atlantic.

From the 19 December 2014 article at The Atlantic

We were standing at Target in an aisle we’d never walked down before, looking at things we didn’t understand. Pill splitters, multivitamins, supplements, and the thing we were here to buy: a long blue pill box—the kind with seven little doors labeled “S M T W T F S “ for each day of the week, the kind that old people cram their pills into when they have too many to remember what they’ve already taken.

My husband, Joe Preston, shook his head. “Do I really need this?”

I grabbed it off the shelf and threw it in our basket. And when we got home, Joe—then a fit and fairly spry 30-year-old man with a boss-level beard—stood at the kitchen counter, dropping each of his prescriptions with a plink into the container.

I guess it’s true that life is full of surprises, but for the three years since Joe’s crippling pain was diagnosed as the result of an autoimmune disease called Ankylosing Spondylitis, our life has been full of surprises like this one. Pill boxes, trips to the emergency room, early returns from vacation. Terms like “flare-up” have dropped into our vocabulary. We’ve sat in waiting rooms where Joe was the only person without a walker or a cane. Most of our tears have been over the fact that these aren’t the kind of surprises either of us thought we’d be encountering at such a young age.

It’s not just that Americans are getting sicker. It’s that young Americans are getting sicker.

But here’s the thing: We recently realized we weren’t alone. Almost all of our friends are sick, too. When we met our friend Missy Narrance, Joe found solace in talking to her about his health. She’s 29 and has been battling lupus and fibromyalgia for the past 10 years. She’s been through chemotherapy twice, and her daily symptoms are so extreme that she was granted federal disability status when she was just 23 years old. In our close group of friends—who range from 25 to 35 years old—we know people with everything from tumors to chronic pain. Sometimes our conversations over beers on a Friday night turn to discussions of long-term care and miscommunication between doctors.

Despite the fact that America shells out more money on healthcare than any other country in the world, according to a report by the Centers for Disease Control and Prevention—and a hefty 75 percent of those dollars are going toward aiding people with chronic conditions—almost half of American adults had at least one chronic condition in 2005.

Read the entire article here

The rest of the article includes analysis on how personal choices must be backed up by facts. It points out that research has been done on how infrastructural changes (which need tax dollars) can improve public health. But there has to be political will.
Research on these aspects of public health have not been widely disseminated by the press.

Related articles

• Young Americans Are Sicker Than Ever
• [Press release] Living with chronic pain: The daily struggle with a ‘new self’
• [Article] Multiple Chemical Sensitivities Under Siege

 

[Press release] Dispelling an urban legend, new study shows who uses emergency departments frequently

“…frequent emergency department users have a substantial burden of disease, often having multiple chronic conditions and many hospitalizations.”

From the 3 December 2013 New York University press release via EurekAlert

While it has often been said that the most frequent users of overburdened hospital emergency departments are mentally ill substance abusers, a study out today (Dec. 3) by researchers from NYU Wagner and the University of California, San Francisco, has found that this belief is unfounded – an “urban legend.”

Co-authored by John Billings of NYU’s Robert F. Wagner Graduate School of Public Service and Maria C. Raven of the University of California and published in the December issue of Health Affairs, the new analysis of hospital emergency department (ED) use in New York City by Medicaid patients reveals that conditions related to substance abuse and mental illness are responsible for a small share of the emergency department visits by frequent ED users, and that ED use accounts for a small portion of these patients’ total Medicaid expenditures. However, according to the study, frequent emergency department users have a substantial burden of disease, often having multiple chronic conditions and many hospitalizations.

The article, “Dispelling an Urban Legend: Frequent Emergency Department Users Have Substantial Burden of Disease,” analyzes data on emergency department visits by 212,259 New York City residents who received their first emergency department care in 2007. The researchers reviewed each patient’s eligibility, ED use, Medicaid fee-for-service spending, and diagnostic history. The main part of the analysis covers the three years before each patient’s first visit to a hospital emergency department, the 12 months after the initial visit, and the subsequent two years. As the authors write, “contrary to urban legend, most repeat users in the study did appear to have relatively strong linkage to ambulatory care, at least as evidenced by their high rates of primary and specialty care visits. Except for ED users with ten or more visits in the index [initial] year, ambulatory care visit rates actually exceeded ED visit rates.”

While hospital emergency department use is not a major cost driver for the Medicaid program, an improved understanding of Medicaid beneficiaries who frequently obtain ED care could help inform the current policy debate over how to meet the significant needs of this population and how to contain Medicaid expenditures, according to the researchers.

Importantly, the analysis indicates that “predictive modeling” based on information provided at a patient’s initial ED visit could be used to identify individuals likely to return to the emergency department frequently. Billings and Raven write that the predictive modeling approach, coupled with an understanding of the characteristics of frequent ED users, offers health care institutions an opportunity to design targeted, cross-system health care interventions to keep future high users from having to return to the hospital for emergency care.

“It is also important to note that only a small number of ‘frequent fliers’ are ultra-high ED users or serial high ED users, with frequent ED use year after year,” Billings and Raven assert. “To date, most thinking by providers and policy makers about the problem of frequent ED users has focused on these serial users, but the overwhelming majority of frequent users have only episodic periods of high ED use, instead of consistent use over multiple years. More needs to be learned about these patients (they, too, could be interviewed in the ED), and predictive modeling and quick intervention will probably be critical since their repeat ED use is unlikely to continue over time.”

 

###

 

John Billings is a professor of health policy and public service at NYU Wagner, where he directs the Health Policy and Management Program. Maria C. Raven is an assistant professor in the Department of Emergency Medicine at the University of California, San Francisco, School of Medicine.

The authors are available for interview about their findings: contact NYU public affairs officer Robert Polner via the phone number or email address listed with this release.

 

Related articles

• Dispelling an urban legend, new study shows who uses emergency departments frequently (medicalxpress.com)
• [NCHS Data Brief] Emergency Department Visits by Persons Aged 65 and Over: United States, 2009 – 2010 (jflahiff.wordpress.com)
• Homeless people much more frequent users of emergency department and other health-care services (eurekalert.org)

 

[Reblog] A field guide to The Diagnosis Difference (with a request from the the blogger, Ms. Fox for responses)

From the 26 November 2013 posting at Susannah Fox – Internet geologist**. Health care gadfly. Community colleague.

The Pew Research Center released a report today on people living with chronic conditions: The Diagnosis Difference.

Policy makers, patient advocates, entrepreneurs, investors, clinicians — all health care stakeholders — can use the data to map the current landscape. There are still barren patches, where people remain offline and cut off from the resources and tools. But there are lush valleys, too, where engagement and change is happening.

I see e-patients as the guides to those valleys since unless you are living with chronic conditions — or love someone who is — you don’t see that side of the internet. So here’s my request: provide your evidence. Show what you have learned.

First, a quick summary of the report:

1. 45% of U.S. adults have a chronic condition (For some, that’s a revelation and there is still a considerable distance to go before that reality is widely known. For you, that’s not the news. That’s just proof that we have a sample that matches the CDC’s estimate and you can therefore trust the data.)

2. 72% of adults with chronic conditions have internet access, compared with 89% of U.S. adults who report no conditions. There are digital divide implications to this because having a chronic disease is an independent factor in predicting if someone has access — apart from things like age, income, and educational attainment.

3. Clinicians are central resources. People living with chronic conditions are more likely than other adults to consult a clinician when they need help or after they Google for a diagnosis.

4. Self-tracking is a massive activity, particularly for people living with 2 or more chronic conditions, and this group is more likely to use formal means, not just tracking in their heads as many “well” trackers do. For example, 41% of health trackers who report having one or more chronic conditions use pencil and paper and 14% of this group uses a medical device such as a glucometer.

5. Living with a chronic condition has an independent, significant effect on behaviors that are often described as signs of consumer health engagement, like reading up on drug safety, medical treatments, or delivery-of-care reviews. Internet users living with chronic conditions are more likely than others to read or watch someone else’s commentary or personal experience about health or medical issues online.

I want to stop a moment and give some examples of what that might look like.

• Someone living with cancer might follow Lisa Bonchek Adams’s blog, learning abouthow to prepare for having a port placed.
• Someone living with diabetes might check out Diabetes Mine to learn how other PWDs (people with diabetes) rank tech tools and quality of life measures.
• Someone living with a heart condition might read Carolyn Thomas’s blog to gain reassurance that their post-diagnosis PTSD is not in their head.
• Someone living with a lung condition might learn from Propeller Health about why they, in particular, should get a flu shot.
• Someone living with high blood pressure might search Inspire.com for insights on how to keep it under control.

And now we come to the category that personally means the most to me since I’ve spent time in rare disease communities: the 16% of U.S. adults who are living with “other conditions,” like rheumatoid arthritis, epilepsy, or fibromyalgia (to name a very few of thousands). They are hardly ever in the mainstream spotlight. They may have awareness days or weeks or months that their communities honor, but you won’t see the National Football League wearing their colors.

The internet is their spotlight. A blog, a hashtag, a YouTube channel, or a Facebook group can be their lifeline. Yes, they consult clinicians like everyone else, but those who are online know that the path to health — for them — is often found in the advice shared by someone like them or the person they are caring for. The feeding tip that will help their baby get the nutrients she needs to grow. The heating-pad tip that will ease their painsomnia.

As I wrote at the top, unless you are living with chronic conditions — or love someone who is — you don’t see that side of the internet. So let’s open up the landscape.

Please post in the comments what you have learned online from a fellow spoonie, from a fellow caregiver, from a fellow traveler along the path to health. What would you tell someone just diagnosed with your condition to do, especially in tapping into the resources available online? When someone asks you, maybe over Thanksgiving, about why you spend time online, what will you say?
Post it here [at Samantha Fox’s blog] . Links to blogs, videos, tweets — all are welcome.

Thank you.

** From Susannah Fox’s About Page (Internet Geologist definition)

I was at a cocktail party, struggling to describe in just a few sentences what I do for a living, when my friend Paul Tarini broke in and said, “You’re an internet geologist. You study the rocks, you don’t judge them.” Exactly. I study patterns in the online landscape and provide data so people can make better decisions about the social impact of the internet.

My other favorite description of the kind of research I do is “nowist” (meaning: instead of being a futurist, understand what people are doing now and be alert to changes).

“Health care gadfly” describes my role outside the fray, as an observer, hopefully contributing to the public conversation in a useful way.

Ted Eytan coined the phrase “community colleague” for people who collaborate by default. That’s me. My work is enriched by the health geek tribe. I can’t imagine doing the work I do without the help of my community.

Related articles

• How US adults with chronic health conditions share health information online? (gadgetrends.ro)
• Pew Report: Chronic Health Conditions Impact 45% Of American Adults, Contribute To 75% Of Health Care Costs (medicaldaily.com)
• The Diagnosis Difference: Those with Chronic Conditions Have Different Online Habits (drhiphop85.com)
• Increased frailty associated with childhood cancer survivorship (2minutemedicine.com)
• Chronic Conditions and Medical Complexity (rehabcare.com)
• What we see and what we cannot see. What we share and do not share. And why. (snideeffects.com)
• Ill workers ‘feared losing jobs’ (standard.co.uk)

The Biggest Urban Legend in Health Economics–and How It Drives Up Our Spending

Chronic Disease (Photo credit: tamahaji)

 

From the 24 August 2013 post at The Health Care Blog

 

The wellness emphasis in the Affordable Care Act is built around the Centers for Disease Control and Prevention’s (CDC) 2009 call to action about chronic disease:  The Power to Prevent, the Call to Control.   On the summary page we learn some shocking statistics:

• “Chronic diseases cause 7 in 10 deaths each year in the United States.”

• “About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness.”

• “More than 75% of health care costs are due to chronic conditions.”

Shocking, that is, in how misleading or even false they are.  Take the statement that “chronic diseases cause 7 in 10 deaths,” for example.  We have to die of something.   Would it be better to die of accidents?  Suicides and homicides?  Mercury poisoning?   Infectious diseases?    As compared to the alternatives, it is much easier to make the argument that the first statistic is a good thing rather than a bad thing.

The second statistic is a head-scratcher.  Only 223 million Americans were old enough to drink in 2009, meaning that 60% of adults, not “nearly 1 in 2 adults,” live with at least one chronic illness — if their language is to be taken literally.   Our suspicion is that their “133-million Americans” figure includes children, and the CDC meant to say “133-millon Americans, including nearly 1 in 2 adults, live with at least one chronic illness.”   Sloppy wording is not uncommon at the CDC, as elsewhere they say almost 1 in 5 youth has a BMI  > the 95th percentile, which of course is mathematically impossible.

More importantly, the second statistic begs the question, how are they defining “chronic disease” so broadly that half of us have at least one?    Are they counting back pain?   Tooth decay?  Dandruff?   Ring around the collar?

 

Read the entire article here

 

Related articles

 

• [Repost] Putting Chronic Disease on the Map: Building GIS Capacity in State and Local Health Departments (jflahiff.wordpress.com)
• Sick! Epidemic of Chronic Diseases (infographicsking.wordpress.com)
• BMI May Not Be The Best Measure of Body Weight (medindia.net)
• The Facts about Chronic Disease in America [Infographic] (loupdargent.info)

 

Information Connections – website for parents of children with developmental disabilities and chronic diseases

 

From the web page at the National Network of Medical Libraries

Connect with Information Connections

By Nalini Mahajan
Director, Medical Library
Marionjoy Rehabilitation Hospital

Information Connections is a website for parents of children with developmental disabilities and chronic diseases with a special focus on Autism, Cerebral Palsy, Attention Deficit Hyperactivity Disorder, Down Syndrome, and Traumatic Brain Injury. The informative website was developed and launched by the Marianjoy Medical Library with funding from the National Network of Library of Medicine, Greater Midwest Region (NN/LM GMR) and is sponsored by Marianjoy Rehabilitation Hospital. It is accessible to anyone from anywhere and it is free.

Since its initial launch in April 2011, InformationConnections.org has helped thousands of families seeking help on these topics. Website usage and feedback in our first year has been exceptional.

We would love to promote our Web site to everyone who could benefit from this wonderful resource and would appreciate any help from you. Please spread the word around; like us on Facebook, follow us on Twitter, feel free to blog about us, and place a link to us on your website. Our goal is to have 500 friends by the end of 2012. Once we reach the magic number of 500 friends, 3 winners be selected randomly and each will receive a $25.00 gift certificate.

This entry was posted on Wednesday, August 29th, 2012 at 12:45 pm and is filed under Consumer Health, Funding, News from the Region, Outreach. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.

 

 

Doctors Overlook Chemical Illnesses, Study Finds

While I know folks who are prone to conditions triggered by chemical intolerances….am blessed that environmental chemicals don’t seem to affect me for whatever reason..

Am posting this especially for folks with chronic conditions of any kind. Please ask your health care provider if screening, testing,prevention of,  and treating for chemical intolerances is right for you.

 

From the 10 July 2012 article at Science News Daily

Chemical intolerance contributes to the illnesses of 1 in 5 patients but the condition seldom figures in their diagnosis, according to clinical research directed by a UT Medicine San Antonio physician.

Clinical tools are available to identify chemical intolerance but health care practitioners may not be using them, lead author David Katerndahl, M.D., M.A., said. The study is in the July 9 issue of Annals of Family Medicine.UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio.

Avoidance of triggers

The study’s authors said physicians need to know how chemical intolerance affects certain people and understand that conventional therapies can be ineffective. Some patients would improve by avoiding certain chemicals, foods and even medical prescriptions, the authors said.

Patients with chemical intolerance go to the doctor more than others, are prone to having multi-system symptoms and are more apt to have to quit their job due to physical impairment, the authors said….

…Chemically intolerant individuals often have symptoms that affect multiple organ systems simultaneously, especially the nervous system. Symptoms commonly include fatigue, changes in mood, difficulty thinking and digestive problems.

Related articles

• Environmental Toxins to Blame for Declining Fertility Rates? (prweb.com)

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