Managing Multi-Chronic Conditions with eConsult+
Managing patients with multiple chronic conditions (MCCs) is a major challenge for primary care providers (PCPs). Nearly 30% of Americans and 4 in 5 Medicare beneficiaries fall into this category1. The complexity of overlapping conditions and lack of integrated care significantly increases the risk for these patients and brings particular challenges to their management2,3.
There is significant overlap across three of the most common multiple chronic conditions1, 4: Diabetes, Chronic Kidney Disease (CKD), and Heart Failure (HF). Management of the cardio-renal-metabolic system (see graphic) requires multiple specialists to focus on the heart, kidneys, and endocrine system.
Overlapping risk factors increase cardio-renal-metabolic risk5-9
An unmet need; multispecialty care for cardio-renal-metabolic disease
The current delivery models are focused on sub-specialization, where each specialty is considered a separate entity to manage a specific disease. However, RubiconMD understands that there is a complex interplay across conditions. Our eConsult+ platform provides the first step in leveraging more coordinated, integrated care delivery models.
Reasons to pursue innovative tech solutions to optimize MCC care:
- The prevalence of shared risk factors is increasing. Hypertension and obesity are global epidemics and multiply the risks for each of these conditions. HF, CKD, and diabetes mechanisms have a compounding effect.
- There is a multisystem impact on the way specialists and PCPs approach and treat patients with MCCs. In the past, a limited amount of therapies was available to manage these MCCs. More recently, a new wave of novel therapies has emerged with a shared benefit across different diseases.
- Integrated care coordination is necessary. The challenge is further exacerbated by the lack of coordination and understanding of the cross-connectivity and impact of the different systems on one another.
Providing high-quality multispecialty support for clinicians with MCC patients
The Cardiologist, Endocrinologist, and Nephrologist are available on the RubiconMD eConsult+ platform, all working to support the PCP. Here, we can see how each specialist addresses and recognizes the complex interplay of the various chronic conditions and recommends appropriate options acknowledging the interconnectedness of the other conditions.
This could not be efficiently accomplished in a traditional care setting as the patient would actually need to be referred to three different specialists, with the added risk of incomplete referral follow-throughs. Additionally, the lack of communication and documentation sharing between different specialists often leads to siloed care resulting in therapeutic inertia and conflicting recommendations10. Finally, communication between the specialists and the PCP is frequently fragmented which may limit opportunities to improve the management of patients with MCCs in primary care.
- The primary care team remains at the center of patient care
- Efficient cross-specialty collaboration across 140+ specialties and sub-specialties
- Accessible multi-specialty care for MCC patients from any demographic/region
- Cost-savings for patients’ overall care (avoided referrals, unnecessary tests, etc.)
- Boersma P, Black LI, Ward BW. Prevalence of Multiple Chronic Conditions Among US Adults, 2018. Prev Chronic Dis 2020;17:200130. DOI: http://dx.doi.org/10.5888/pcd17.200130
- AHRQ. (2014, May). Advancing Patient-Centered Care for People Living With Multiple Chronic Conditions. AHRQ. Retrieved February 2022, from https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/multichronic/mcc.html
- Benjamin, R. (2010, September). Multiple Chronic Conditions: A Public Health Challenge. NCBI. Https://Www.Ncbi.Nlm.Nih.Gov/Pmc/Articles/PMC2924996/. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924996/
- Centers for Medicare and Medicaid Services. (2012).Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. CMS. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/downloads/2012chartbook.pdf
- Centers for Medicare and Medicaid Services. (2021, November). Diabetes Disparities in Medicare Fee-For-Service Beneficiaries. CMS. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Data-Snapshots-Diabetes.pdf
- Centers for Medicare and Medicaid Services. (2020, September). Heart Failure Disparities in Medicare Fee-For-Service Beneficiaries. CMS. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Data-Snapshot-Heart-Failure.pdf
- Centers for Medicare and Medicaid Services. (2020, October). Chronic Kidney Disease Often Undiagnosed in Medicare Beneficiaries. CMS. Retrieved September 2021, from https://www.cms.gov/files/document/ckd-data-highlight102020-2.pdf
- Ahmed, A., & Campbell, R. (2008, October 4). Epidemiology of Chronic Kidney Disease in Heart Failure. NCBI. Retrieved July 9, 2010, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900793/
- USRDS. (2020). CKD in General Population. https://adr.usrds.org/2020/chronic-kidney-disease/1-ckd-in-the-general-population
- Vaduganathan, M., Tuttle, K., & Rangaswami, J. (2020, November 12). Cardio-Renal-Metabolic Care Models Toward Achieving Effective Interdisciplinary Care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673632/