As healthcare performance priorities shift away from acute-care prowess and toward improving health status and quality of life, the measure of a comprehensive health network could hinge on how it handles chronic illnesses.
About 43 million people suffer from some chronic disability such as diabetes, arthritis or lung ailments, and the number is on the rise with the aging of the nation's population.
That's the concern motivating the National Chronic Care Consortium, created in 1991 as a national "laboratory" for not-for-profit health systems to develop innovative financing and care programs for the chronically ill.
Among the programs taken on: a mechanism to help networks assess their progress toward integrating a range of sites and services to manage chronic illnesses efficiently.
Last month the consortium capped a two-year effort to develop what it calls a "living tool," both practical and flexible, for health networks to use in integrating their care components. Called the Self-Assessment for Systems Integration, or SASI, the tool identifies nine essential objectives for chronic-care integration (See chart).
The regimen and supporting information were made available to the 27 health networks in the consortium. In addition, a licensing agreement for SASI materials is being offered to networks outside the coalition for fees ranging from $2,500 to $6,500 depending on the amount of additional support needed.
The main focus of the assessment program is to consider the individual in all aspects of care delivery-including the home-and not only guard against worsening conditions but also try to prevent further disability through preventive action, said Anjali Russano, project analyst.
That can't be done in a fragmented system that may discharge a hospitalized diabetes patient to an outpatient facility and then lose track of the person, Russano said. Like other chronic illnesses, diabetes causes complications that can get worse if not caught in early stages, she said.
People with chronic conditions are healthcare's highest-cost and fastest-growing group needing services, according to the consortium. About 80% of all deaths and 90% of all morbidity-complications of illness-can be traced to chronic conditions, according to the coalition's figures.
To begin the strategic process of developing chronic-care integration, networks need a way to get clinicians and managers communicating across boundaries and different healthcare disciplines, said Russano, and that's one of the goals of SASI.
Just getting key representatives together for an organized look at what each contributes to the care of a chronically ill person can foster ways to work together that were never considered, said a spokeswoman for the consortium.
When the SASI initiative was launched two years ago, it was intended to be a quantitative measurement system for progress toward integration, Russano said. But the "report card" focus was abandoned when a 15-member committee found it difficult to come up with such measures.
The project, funded by a $360,000 grant from the John A. Hartford Foundation, shifted its emphasis to a practical, step-by-step guide for knitting together chronic-care networks and assessing their performance, Russano said.
The process was field-tested by five of the consortium's members: Beverly (Mass.) Hospital; Henry Ford Health System, Detroit; Intermountain Health Care, Salt Lake City; Philadelphia Geriatric Center; and Sutter Health, Sacramento, Calif.
The Bloomington, Minn.-based National Chronic Care Consortium plans a general session on the integration tool on May 8 in San Francisco.