Medical management of chronic disease is a mess

Senator Ron Wyden, with a focus on seniors, examines the problems Americans face with medical management of chronic diseases.

The struggles that people with chronic illness face are manifold. One problem is coordinating care. It’s hard enough for somebody who’s perfectly healthy to assemble medical records for a new doctor; consider how difficult it must be for an elderly woman who recently suffered a heart attack. Think about her journeying to a doctor appointment across town in the middle of the day. Or filling a hard-to-find prescription and adding it to an already-daunting battery of pills.

America’s health care system tells millions of seniors they’re on their own when it comes to managing their chronic illnesses. The result is a full-time job and far too many chances for dangerous errors and missteps.

Today, Medicare inexplicably charges older Americans a copay just to coordinate care among all their doctors. Doesn’t it defy common sense for seniors to pay extra for care coordination that holds costs down? In my view, this charge should be junked, and care coordination should begin right after seniors receive their free physical provided by the Affordable Care Act. This is one of many commonsense changes to Medicare that could improve the lives and health of seniors with chronic diseases, many of whom have stories all too familiar to every American family.

As Seth Mnookin shared last week, coordination of care is a huge problem. And, as Sen. Wyden’s article suggests, there’s little reason to believe care coordination would be much better if addiction treatment were housed within a doctor’s office.

This is an urgent need in the lives of many people with addiction. There are efforts to improve this inside and outside of traditional medicine. We started a primary care project 5 years ago to get all residential clients connected to recovery-informed primary care and improve coordination of care. It hasn’t been perfect, but there’s a stark difference between today and 2010. If only we could extend that into the rest of their medical care—specialists and emergency medicine.