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How the ACA is changing chronic care at hospitals

Healthcare professionals say the landmark health reform law, the Affordable Care Act, is accelerating changes in how hospitals treat patients with chronic conditions like diabetes, heart failure and obesity.

Successfully treating those patients, who use many more healthcare services, have higher rates of hospitalization and more frequent emergency department visits, is challenging because many of their conditions are aggravated by unhealthy eating habits and inactivity. Chronic disease rates increase steadily as patients age, making this issue particularly key to the Medicare program.

Medicare has been paying a set amount for each hospital admission, regardless of the length of stay or the outcome. If patients were readmitted, even because they were sent home too soon, Medicare would pay again.

America's health system has been structured to respond to major health episodes like heart attacks after the damage is done, said Jonathan Maner, senior vice president of Langhorne Physician Services at St. Mary Medical Center.

"That's the most expensive way to practice healthcare. It requires hospitalization, pricey tests and specialists that inflate the cost of care. Obamacare is turning that on its head. We're placing a greater emphasis on prevention and early detection. The cheapest way to manage diabetes is to never have it, to manage heart disease by monitoring blood pressure, weight and cholesterol, and teaching patients how to manage their conditions."

Now, as part of the health reform effort, new payment and delivery models and mandates are being implemented to reward or penalize hospitals for their rates of 30-day readmissions, infection control and patient satisfaction levels.

Maner said primary care physicians are the quarterbacks driving the patient care teams at St. Mary's care models inspired by the ACA.

"They have the training to understand how to get people healthier," he explained.

Like many hospitals, Temple University Health System is adjusting to mandates to improve patient health.

Vice President of Clinical Integration Steve Carson, who leads Temple's Center for Population Health, said its patients face challenges like transportation and childcare needs, access to healthy foods and safe housing, as well as lifestyle factors that include tobacco and substance abuse. Carson said Temple works with physicians and grassroots organizations that support patients.

"The goal is to provide infrastructure to help manage their daily lives and health," Carson said. Temple is participating in a federal initiative with the Einstein Health System and the Philadelphia Corporation for Aging on a care model called a "bridge coordinator." That program uses a social worker to connect with patients in the hospital at risk of readmission, follows them post discharge and continues to check on them at home by phone. He said readmission rates for those "bridge coordinator" patients dropped by 35 percent.

Marlton, N.J.-based Virtua Health System is exploring new ways to improve population health, said Vice President Michael Kotzen. Kotzen said hospital staff identify high-risk patients and connect them with community care managers, who track and guide them after discharge.

While individual hospitals may see improvements in care and cost reductions, healthcare economist Uwe Reinhardt said it's too soon to tell whether the U.S. health system saves money.

Reinhardt, a professor of economics and public affairs at Princeton University, said Obamacare may improve the quality of the healthcare experience for the patient, but the cost savings have not yet materialized.

"The process doesn't work this quickly. We will probably need 10 years to determine its effectiveness. The problem with Americans is we are extremely impatient people and we don't like to hear that some things take a lot longer to know."

By the numbers: A chronic burden

Chronic diseases, broadly defined as long-lasting conditions that can be controlled but not cured, are the leading cause of death in the United States. More facts:

More than one-quarter (26%) of all Americans and one in 15 children have multiple chronic conditions.

75 percent of seniors 65 and older have multiple chronic conditions.

People with multiple chronic conditions have increased mortality risks and comprise a disproportionately high percentage of U.S. healthcare spending.

In 2012 117 million people-half of U.S. adults ---had one or more chronic health conditions.

Seven of the top 10 causes of death in 2010 were due to chronic diseases.

Two of these - heart disease and cancer - accounted for nearly 48% of all U.S. deaths.

Nearly half (47%) of U.S. adults have at least one major risk factor for heart disease or stroke- uncontrolled high blood pressure, uncontrolled LDL cholesterol or smoking tobacco.

The total cost of heart disease and stroke in 2010 was estimated to be $315.4 billion. Cancer care cost $157 billion in 2010 and in 2012 diabetes care cost $245 billion.

Almost 20% of all Medicare patients discharged from a hospital-about 2.6 million seniors-are readmitted within 30 days, costing the program $26 billion annually.

SOURCES: U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, Robert Wood Johnson Foundation, American Heart Association and Centers for Medicare and Medicaid Services (CMS).

These articles were supported by the Journalists in Aging Fellows Program of the Gerontological Society of America and New America Media and sponsored by the John A. Hartford Foundation.