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Chronic disease spending in Minnesota from cover

more chronic diseases such as diabetes, asthma, or congestive heart failure spent on average $12,800 a year on health care. That is nearly eight times the $1,600 average spending by an insured resident without a chronic condition. For many families, this chronic disease spending makes it difficult to find the money to afford necessities such as food, housing, and education. Living with multiple chronic conditions adds an average of $4,000 to $6,000 in health care expenses per condition (see Figure 1). With costs that large, patients with at least one chronic condition (about 35.4 percent of Minnesotans) accounted for the vast majority (83.1 percent) of the state’s health care spending in 2012. The report found that patients’ costs vary significantly by geography within Minnesota, even when treating the same conditions. More work must be

done to determine what causes these cost differences, but they occurred even when our researchers controlled for age and other demographic factors correlated with chronic disease. The widest differences occurred among patients with renal failure. For example, the average medical spending by patients with chronic renal failure who lived in Houston County was about $24,690 compared to the average spending for residents with the conditions in Stevens County of $50,760 per patient. As part of that effort, the report provides cost and prevalence estimates for 10 diseases (see Table 1). Clarifying the cost of these diseases and showing some of the interplay between risk factors such as high blood pressure and high cholesterol can help disease advocacy groups make their case for the need for more prevention activities, resources, and research. For example, care for high blood pressure (and co-occurring

conditions), which affects more than 900,000 insured Minnesotans, cost nearly $13.5 billion and accounted for almost half of all medical spending for the insured in 2012. The total cost numbers, the disease-specific breakdowns, and county-level data make this an important report for Minnesota because it sets a baseline for chronic disease spending. This report was only possible through special access to the Minnesota All Payer Claims Database. The Minnesota Legislature granted temporary approval for MDH to use MN APCD data to establish this baseline and better understand the interplay of chronic disease and our health care system. This legislative approval expires this year and can only be renewed by legislative action.

Minnesota Physician February 2016

In recent decades, it has become evident that this focus and treatment alone will not create health and will be difficult to sustainably finance in the future. While it may repair some injuries, relieve some discomfort, cure some diseases, and prolong some lives, treatment alone will not improve our overall health. The reasons are that our lifestyles and environment are creating unhealthy conditions that are overwhelming the curative and rehabilitative capacity of our health care system. In the long run, I believe the best approach to turning the curve on chronic disease is to adopt what I call the Triple Aim of Health Equity.

Patients’ costs vary significantly by geography within Minnesota.

How we got here For most of history, infectious diseases and injuries were the leading causes of death and disease. Many of these diseases were beyond the ability of an individual to control. Community-wide efforts were essential to ensure clean air and water, effective sanitation, safe food, safe worksites, and immunizations necessary to reduce these threats and improve the health of community members. These community efforts in combination with clinical care dramatically reduced deaths from acute diseases and injuries. However, this opened the door for chronic diseases like heart disease, cancer, and diabetes to take their place. Surprisingly, the approach used so successfully for acute diseases has not been embraced to address modern-day killers. Instead, the focus has been on


clinical care and individual education about personal behaviors.

The “Triple Aim of Health Equity” The health care Triple Aim, well known among clinicians, is to improve quality and patient satisfaction while also reducing costs. This chronic disease report provides direction in those arenas and confirms that we must continue to pursue health care reform efforts that move the system toward increased care coordination, disease management, prevention of hospital readmissions, “hot spot” care for patients with multiple chronic conditions, and better use of health information technology. Minnesota has been a leader in all of these areas. The federal government awarded Minnesota a $43 million State Innovation Model Grant to support the Minnesota Accountable Health Model, which includes elements such as health care homes, integrated

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MN Physician Feb 2016  

Chronic disease spending in MN: Analyzing the MN APCD By Edward Ehlinger MD | Change mgmt: Anticipation vs reaction By Todd Archbold LSW | I...

MN Physician Feb 2016  

Chronic disease spending in MN: Analyzing the MN APCD By Edward Ehlinger MD | Change mgmt: Anticipation vs reaction By Todd Archbold LSW | I...

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