Managing Patients with Multiple Chronic Conditions

The American Medical group Association (AMGA) is pleased to announce an American Medical Group Foundation (AMGF) research project that will develop insights and resources to help healthcare providers improve care for patients with multiple chronic conditions. AMGF is conducting this research project with Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., which is collaborating and funding the project.

As part of this project, AMGF is seeking case studies from medical groups in which chronic care programs have led to improvement in patients with chronic conditions including:

Early identification of patients at risk for chronic disease
Reduction in mortality and morbidity
Improved medication adherence and compliance
Improved continuity of care across care transitions
Increased efficiency and reduction in unnecessary or wasteful service and resources
Improved patient activation and self-management

Chronic diseases affect more than half of our patients, many with two or more chronic illnesses. In 2000, an estimated 125 million people had chronic conditions, with 48% having more than one condition. By 2020, those numbers are expected to grow to 157 million, with 81 million having more than one condition. Research has shown that a vast majority of these patients are not receiving the care they need.

Awareness of the growing prevalence of people with chronic conditions is not enough. We need to change the way health care is delivered to meet the common problems these patients face as they seek care to maintain their health and quality of life.

A CALL FOR CASE STUDIES

Medical groups, academic practices, integrated delivery systems, and other organized systems of care that have incorporated chronic care programs into their practices are encouraged to submit a case study. We are most interested in programs that hold the promise of impacting large populations of patients who have more than one chronic disease.

An expert panel of judges will review each case study and select those that merit publication in a compendium of chronic care practices. Those organizations selected for the compendium will be invited to participate in a year-long learning collaborative during which a “Best Practices” framework for managing patients with multiple chronic conditions will be developed and tested. The framework will serve as a blueprint from which physician practices can build a better system of care, the goals of which are to:

Reduce unwanted variation in care
Reduce fragmentation of care
Improve self management of patients
Offer alternative payment models that reward quality of care

Organizations selected to participate in the compendium and learning collaborative will be invited to appoint one or more subject matter consultants to participate in the Advisory Group that will guide the activities of the collaborative, serve as faculty for the collaborative’s educational sessions, and help develop the optimal chronic care framework. Organizations that are selected to participate in the Advisory Group may receive reimbursement of up to $10,000.

Case Studies are due August 13, 2010

For more information and application guidelines, download a copy of the Call for Case Studies.

If you have questions or need further information, contact Danielle Flowers at dflowers@amga.org or at (703) 838-0033, ext. 347.

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