Chronic disease management: improving outcomes for low-income patients

The relationship between poverty and poor health is undeniable.

People living below the poverty line have been shown to have lower life expectancy and higher incidence of chronic disease. Improving chronic disease management for low-income patients is not only the right thing to do; it can also lower costs for hospitals and the US healthcare system as a whole

The role of health care workers

Regular health care management for the low-income populations in this country can significantly improve if health care providers can effectively coordinate needed care service delivery with community health care workers. Community health care workers have better access to low-income communities and have a stronger line of communication with patients living there. These health workers can also help improve scheduling systems so that patients have better access to hospital appointments. They can communicate more often with patients and consistently educate them about their disease and how to best manage it.

The importance of health education

It is necessary to provide education about chronic disease care to patients and their families, especially those from poor communities who have less access to health information. Patients and families who have more knowledge about diseases will more easily recognize abnormal patterns and seek medical attention when necessary. Learning to effectively monitor chronic conditions will empower patients and their families to report any abnormalities before they worsen.

Community health workers can play a big part in educating patients and families from poor communities. They can bring health information directly and increase awareness of how the patient's environment can impact their chronic condition. Take, for example, community health worker providing written and pictorial information about controlling dust in asthmatic patient's bedrooms and play areas. The information that is provided by a caring and knowing community health care worker, prevents symptom triggers of asthmatic episodes. All of these interventions are instituted in the home and at very little cost.

Win-win situation

Proper management of chronic diseases will not only benefit patients but also healthcare providers and the US health system. All good providers seek to improve the quality of life of their patients. Improved care management will enable them to identify their patients' needs and address them before conditions worsen. Providers can also have better understanding of their low-income patient's environment and how this can impact treatment plans.

Hospitals can also benefit from better care of low income patients living with chronic diseases. The unavoidable pro-bono cases will require less treatments if their health is consistently monitored and improved. When chronic disease patients do well due to improved management, hospital resources can then be allotted to higher acuity cases that provide more income for the hospital.

What it will take

Chronic disease management, especially for low income patients, should be a priority for every hospital today. Providers should seek out the help of community health care workers who have better access to low income communities and the residents' particular needs. Patients and their families should be well informed about the patients' diseases and how to monitor them consistently and regularly. Engaging all stakeholders in providing more targeted chronic disease care services will not only improve patient outcomes but also benefit health care providers' sense of accomplishing by helping to keep their patients healthier.

After graduating from Yale with a B.A. in Economics, Richard Kimball Jr. spent over two and a half decades advising healthcare organizations on strategy and capital structure and leading and building both early stage and more established businesses. Rick started at Morgan Stanley and rose to Managing Director. More recently he was Chief Strategy & Growth officer at Accretive Health. Rick is a Trustee of The Brookings Institution, a Fellow in Stanford University's Distinguished Careers Institute and a member of the World President's Organization. Rick is currently CEO of HEXL, a population health management start up. Learn more about Rick Kimball by visiting his Wiki and blog

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