Chronic Care Management

You read a lot these days about chronic care management. What exactly is chronic care management? Chronic care management is management of chronic disease.

What are chronic diseases? This term refers to a long list of disease such as: diabetes, obesity, coronary artery disease or CAD, chronic obstructive pulmonary disease or COPD, cancer, Alzheimer’s etc.

Why is everyone talking about the importance of chronic care management? It is simple: 133 million American’s, almost half of the nation’s population are afflicted with at least one of these illnesses.

Individuals with chronic conditions account for 78% of our total health costs, largely resulting from hospital and emergency room costs associated with complication of their conditions.

Learning to manage chronic illness better has become a critical issue for all of us but most importantly for our aging population.

Ed Wagner is the most recognized expert in this area and his model for improving care throughout the delivery system has become the one everyone tries to incorporate. His model recognizes that a substantial part of chronic care takes place outside of a formal health delivery setting. In this arena patient self management, information systems, decision support and community resources are all critical.

Basically what this means is that most of chronic care management takes place at home. The paradigm shift has begun towards the development of new tools, new technologies and new relationships so that patients with chronic illness are cared for in a proactive manner at home. This prevents unnecessary hospitalisations and the poor outcomes so common with the current model of elder care.

Geriatric Care Management is at the core of this paradigm shift towards patient empowerment and better health outcomes for America’s elders.

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