No matter where you might fall on the health continuum, it is important to understand your health and how to manage it. You must make a conscious effort to be healthy. If you don’t, you will end up with major health issues, represented by the red box in Figure 1.

Health Management Along the Multiple Chronic Condition Spectrum

Each step in the spectrum involves a different type of intervention.

1. Early prevention includes avoiding metabolic syndrome conditions and staying ahead of their development.

2. If metabolic conditions exist, then maintain or improve them so those conditions don’t develop into one or more chronic conditions.
3. The next interventional step would be disease management through health coaches, medical adherence etc.
4. A multiple chronic condition (MCC) patient needs coordinated and integrated healthcare. It is important not to treat the conditions in a silo. A holistic approach is the best approach.

The problem is, not many methods of intervention have been tested to prove savings and improved health. A long duration longitudinal study is needed to appropriately study the effects of intervention.

Conditions that Frequently Occur Together

Certain chronic diseases occur together more frequently by virtue of independently high prevalence rates, common risk factors, or a synergistic relationship between the two, showing the relationships between chronic disease.

The same paper also produced the Figure 3, which highlights the relative contribution of risk factors to specific chronic diseases. The dark green demonstrates the high percentage of ischemic heart disease (IHD) attributed to various risk factors.

Osteoarthritis, Alzheimer’s disease, and low back pain on the other hand, are not attributed to many modifiable risk factors. They are primarily age-related, and therefore, less modifiable. Distinguishing the modifiable risk factors from non-modifiable risk factors is critical for developing effective interventions that prevent disease onset.

For example, the increasing burden of IHD with age can be attributed to several well-known modifiable risk factors, but the increasing burden of Alzheimer’s disease is a result of the aging process and the burden of other chronic diseases.

Smoking contributes to the burden of 8 of the 15 leading chronic diseases, whereas high sodium contributes only to cardiovascular disease and chronic kidney disease.

Distinguishing the modifiable risk factors from non-modifiable risk factors is critical for developing effective interventions that prevent disease onset.

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The following four charts show the importance of controlling metabolic syndrome conditions so they don’t advance into chronic conditions. The utilization of services for each number of chronic conditions is exhibited in a paper by RAND Corporation called “Multiple Chronic Conditions in the United States.” As you can see in figures 4-7, the utilization of services is directly related to an individual’s number of chronic conditions.

The number of visits for patients with multiple chronic conditions likely means they are seeing a number of different doctors. Historically, these doctors have not communicated with each other, leading to poorly coordinated care. Coordinated and integrated healthcare is needed to effectively treat and manage these multiple chronic conditions. Analogous to an employer managing risk by analyzing human capital data, doctors manage health risk using integrated information on patients.

Coordinated and integrated healthcare is needed to effectively treat and manage these multiple chronic conditions.

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As you can imagine, healthcare costs for members with multiple chronic conditions are much higher than for those with no chronic conditions. Figure 8 shows the distribution of the number of chronic conditions and the associated costs with each category. This chart provides an effective visual representation of how much spending individuals with multiple chronic conditions generate.

Figure 9 shows that inpatient costs alone are higher for an individual with 5 or more chronic conditions than are the total healthcare costs for a person with 0, 1, even 2 chronic conditions.

The impact of multiple chronic conditions on patients and families is profound. They experience:

• Deterioration of the patients’ quality of life
• Significant out-of-pocket expenses
• Difficulties with medication adherence
• Inability to continue working
• Symptom control (chronic pain, in particular)
• A considerable toll on caregivers.

It’s important to take steps to better manage health to increase quality of life and control costs.