Revolutionizing Chronic Care Managment in 2021

Posted by Noteworth on Jan 18, 2021 8:15:00 AM

COVID-19 clearly garnered all of the headlines in 2020 but that didn’t stop the rising tide of chronic conditions and the highest mortality rate attributions. It is never easy to report on leading causes of disease and death and while the entire world has its eyes on the current pandemic, the seven most chronic diseases continue to deliver devastating impact by orders of magnitude in comparison to COVID-19.

Chronic Care Management Revisited

Chances are that you or someone you know is currently affected by some form of chronic condition that may be disabling or even potentially fatal. According to the National Center For Chronic Disease Prevention and Health Promotion (NCCDPHP):

“Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. They are also leading drivers of the nation’s $3.5 trillion in annual health care costs.”

And more alarming is that:

“Six in ten adults in the US have a chronic disease and four in ten adults have two or more.”

The seven most chronic diseases in the US include:

  • Heart Disease: Heart disease is not only a common chronic disease in our country but one of the leading causes of death for all adults in the U.S.
  • Cancer: Cancer can affect any area of the body; sometimes it affects multiple areas at a time. Each type of cancer is different, and while treatment is available, there is no known cure.
  • Chronic Lung Disease: Chronic lung disease, such as COPD, affects a staggering number of American’s every year. Smoking, obesity, and sedentary lifestyles are the leading causes.
  • Stroke: A stroke occurs when there’s a blood clot in a vessel in the brain. Strokes can vary in intensity, but severe cases can lead to a total lack of independence and day-to-day function.
  • Alzheimer’s: Alzheimer’s disease is a disease that affects the memory and cognitive function of a patient. Short term memory will gradually decline, making it challenging to lead an independent life.
  • Diabetes: Diabetes comes in multiple forms. One form is reversible, while the other is not. The disease is managed with lifestyle changes and, in more severe cases, the use of medication to stabilize insulin levels.
  • Kidney Disease: Chronic kidney disease is a disease with high death rates overall. The only real cure for the condition is a kidney transplant, but the number of patients in need of a transplant greatly outnumbers the kidneys being donated.

Unfortunately, it is well known that these chronic diseases are the leading cause of death and disability in the US, so it is not surprising that automating chronic condition care is a priority.

Digitizing Chronic Care Management

The value of digital medicine to deliver patient-focused, high-touch interventions for condition management starts by providing continuous monitoring and then proactively identifies new symptoms or a decline in health in real time. If done correctly, built-in alerts will notify care teams when action is needed to provide timely interventions and reduce referrals to the emergency room.

Dr Daniel Yazdi wrote an article for Mobile Health News titled “How automated chronic disease management can help scale care” based on the Brigham & Woman’s Hospital study. In that article Dr. Yazdi reports:

“Management of many chronic conditions — including diabetes, hyperlipidemia (high cholesterol) and heart failure, to name only a few — are driven by a standardized set of medical society guidelines. This allows for the similar construction of algorithms that can codify the management of these conditions. The positive ramifications are manyfold, including efficient and rapid management of the condition, improved patient experience and a scalable solution that can reduce the burden on primary care physicians and the US economy.”

And goes on to further discuss the value of an automated solution:

  • Efficient and Rapid Disease Management
  • Improved Patient Experience
  • Reduction in Physician Demands
  • Scalable Solution

The bottom-line value in automating chronic care management is to increase clinical consistency across your organization as well as facilitating a standardized workflow, creating a repeatable care plan to provide the same level of care for each patient population and clinical condition. Not only does this provide consistency and improve the patient care journey, it reduces overhead and costs allowing you to scale more efficiently.

REvolutionizing Chronic Care Management

Just digitizing the capture of chronic condition data and automating communications with the patient is not enough to truly transform the patient care journey into something that will benefit both the clinician and patient alike. What is needed is an understanding that bridging all of the digital health data silos will allow better visibility across the entire patent care journey.

Noteworth’s comprehensive care delivery system allows integration and optimization with your EMR, and it can replace multiple remote offerings under one platform, reducing the need for multiple reporting overlaps. On top of which, it allows for a “walking diagnosis” and tracking of symptoms with Patient Reported Outcomes and Adherence to Care Plan, including Medication Management and RPM which allows for proactive care. Noteworth enriches the ambulatory patient experience and allows clinicians to practice at the top of their licenses by easily and effectively producing and managing the data that confirms superior clinical outcomes, reducing cost of care and improving patient safety and satisfaction.

Now is the time to extend continuity and streamline care coordination between interdisciplinary teams for greater visibility and alignment on care plans. Providing continuous connected care that passes key information to clinical staff can improve population health and reduce health care costs. Wouldn’t you like to see for yourself how you can provide unrivaled confirmation of superior clinical outcomes, reduce cost of care and improve patient safety and satisfaction by enriching the patient experience and allowing clinicians to practice at the top of their licenses or better yet, request a demo today.

Topics: digital medicine, digital healthcare, chronic care management