Engagement: The key to complex care

The U.S. Department of Health and Human Services estimates that 25 percent of all Americans – and 75 percent of those over age 65 – are dealing with multiple chronic conditions. A landmark study by the Center for Health Care Strategies found that about two-thirds of Medicaid patients with the five most common chronic physical conditions – asthma/COPD, congestive heart failure, coronary heart disease, diabetes and hypertension – also have a behavioral health comorbidity like depression or substance abuse (Figure 1).

Those who have a mental illness in tandem with chronic physical conditions have healthcare costs up to 75 percent higher than those dealing with physical conditions alone (Figure 2).

Despite the seriousness of their health situation, many people with comorbidities aren’t adequately engaged with the healthcare system for a variety of reasons. A recent study published in the New England Journal of Medicine found that fewer than half of those who survived a major heart attack adhered to their medication regimen after the attack. Study authors Lee Goldman, MD and Arnold Epstein, MD noted that “Perhaps the most sobering findings were the low baseline adherence and the small improvement in adherence in what should have been a highly motivated group of patients.”

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