Chronic Conditions Document Reflects NASW Input

The U.S. Department of Health and Human Services’ Multiple Chronic Conditions Strategic Framework, unveiled last December, incorporates a number of changes NASW recommended to reduce health disparities.

Through the framework; HHS aims to achieve four goals:

  1. Foster health care and public health system changes to improve the health of individuals with multiple chronic conditions;
  2. Maximize the use of proven self-care management and other services by individuals with multiple chronic conditions;
  3. Provide better tools and information to health care, public health and social services workers who deliver care to individuals with multiple chronic conditions; and
  4. Facilitate research to fill knowledge gaps about, and interventions and systems to benefit, individuals with multiple chronic conditions.

In a June 7, 2010, letter to HHS regarding the draft framework, NASW recommended adding age, economic status, gender identity and health literacy to the list of cultural factors that contribute to disparities in health care access and outcomes identified in the draft.

In the final document, HHS added gender identity and socioeconomic status: “It is likely that as racial and ethnic, gender, gender identity, disability, sexual orientation, age, geographic, and socioeconomic disparities of access to care and health outcomes exist in the total population, those disparities also exist in the [multiple chronic conditions] population.”

HHS added health literacy to the framework as a strategy to maximize self-care management by individuals with multiple chronic conditions so that it now says: “Foster improved and culturally appropriate health literacy to facilitate better informed decision-making about use of medications.”

NASW had noted that the draft framework’s section on enhancing health care professionals’ training made no mention of cultural and linguistic competence.

In response, HHS listed cultural competence as part of the training that health care, public health and social service professionals need to care effectively for people with multiple chronic conditions in the final document. It states: “Evidence suggests that many health care professional trainees feel uncomfortable with key chronic care competencies. Addressing these gaps, as well as the need for improving providers’ cultural competencies, will ensure that the current and next generations of providers are proficient in caring for individuals with [multiple chronic conditions] and in interacting with family caregivers.”

NASW also stressed the importance of health care professionals’ role in medication management and adherence in the treatment of chronic conditions.

Accordingly, HHS’ revised framework says: “[B]ecause most management of chronic conditions occurs outside the medical care setting, attention must be focused across the care continuum both to sustain and improve adherence with prevention and treatment strategies for improved health outcomes.”

Chris Herman, an NASW senior practice associate who helped craft the association’s recommendations, said that while HHS did not incorporate NASW’s suggestions word for word, she is pleased with the strategic framework.

“The changes signal an even stronger commitment on the part of HHS to improving the health of all people with multiple chronic conditions — and to reducing health disparities within this population,” Herman said.

In related news, the National Quality Forum, with support from HHS, is developing a framework for eventually creating standardized health care delivery performance measures for treating patients with multiple chronic conditions.

Health care providers who participate in pay-for-performance, public reporting or quality improvement programs currently rely on condition-specific performance measures — which the NQF warns may result in poor quality care and harm to patients with multiple chronic conditions and in misleading feedback for their physicians.

Nearly half of all Americans live with a chronic condition, such as asthma, diabetes, high blood pressure, multiple sclerosis, arthritis or Alzheimer’s disease. More than half of them have multiple chronic conditions, the treatment of which accounts for three-fifths of health care spending. These numbers are expected to rise as the number of older Americans increases.

The HHS’ Multiple Chronic Conditions: a Strategic Framework is available as a PDF.