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A Preliminary Look at Chronic Conditions in Rhode Island

Key Findings

  • High blood pressure and diabetes are both the two most common and two most expensive chronic conditions in Rhode Island.
  • Depression is the third most common chronic condition among insured residents, with approximately 66,000 Rhode Islanders diagnosed (about 7% of the population), and many others undiagnosed.
  • People with chronic conditions are sicker than the general population and utilize expensive healthcare services at much higher rates than the general population. The older Medicare population has a higher rate of chronic conditions than the rest of the population

Introduction

If you are concerned about your family's health and the health of your community, then you have likely heard about chronic conditions like diabetes and heart disease. Among the most common and costly diseases in the U.S, chronic conditions are those that require ongoing medical attention, do not naturally resolve themselves, and often limit a person's daily activities.

Chronic conditions are also closely related to decreased productivity at school or at work; individuals with chronic conditions are more likely to miss school or work days because of illness, and are less able to focus on learning or the task at hand while at school or work.

People with multiple chronic conditions have more complicated healthcare needs than their peers, increasing the complexity and cost of their healthcare. While nearly half (45 percent) of all Americans suffer from at least one chronic condition, one in four suffer from multiple chronic conditions. In fact, research shows that having one chronic condition increases the chances of developing others, particularly as people age. According to the Centers for Disease Control and Prevention (CDC), 21% of Americans between the ages of 45-64 have two or more chronic conditions. This percentage increases to 45% for those ages 65 and older. citation In Rhode Island, certain diseases like diabetes and chronic obstructive pulmonary pisorder (COPD) are much more likely to co-occur with multiple – 3 or more – chronic conditions, significantly impacting the health, well-being and functional abilities of each patient.

The impact of different chronic conditions varies. Some chronic conditions like thyroid disease, when managed effectively, cause relatively little illness and result in relatively low healthcare costs. Other chronic conditions like congestive heart failure and chronic obstructive pulmonary disease (COPD) are often harder to manage and as a result are more costly and harmful. Chronic conditions are also associated with increased risk of other health problems. For example, conditions like depression, diabetes and high cholesterol increase people's risk of developing other more serious conditions such as heart disease, heart attack, and stroke.

Although some chronic conditions cannot be cured completely, many conditions can be prevented or safely controlled through lifestyle changes and self-management. State policies and programs can also provide better access to care, education, and necessary supports for individuals to better manage their health. In fact, better management of chronic conditions offers an opportunity to reduce illness burden, improve the quality and length of lives, and possibly save healthcare dollars.

Discussion

Top 10 Most Common Chronic Conditions in Rhode Island

* NOTE: Because many people have more than one chronic condition, they may be included in multiple lines in the graph. For example, an individual with both diabetes and high blood pressure is included in both the numbers for high blood pressure and diabetes.

Chronic conditions affect a large number of Rhode Islanders. High blood pressure and diabetes are the most common, affecting roughly 165,000 and 83,000 insured Rhode Islanders respectively (or about 17% and 9% of the entire Rhode Island population). It is important to remember that these percentages are for the entire insured Rhode Island population; the rates of certain conditions (such as high blood pressure) are higher in Rhode Island adults than they are in children.

Depression is the third most common chronic condition among insured residents. According to HealthFacts RI data, approximately 66,000 Rhode Islanders have been diagnosed with depression, and research tells us that many others suffer from undiagnosed symptoms. Depression and mental illness are not only debilitating and costly, but can also impact an individual's ability to manage other chronic conditions and their overall health. For example, according to the CDC, depression is strongly related to the prevalence and progression of diabetes, cancer, heart disease and asthma, and is associated with risk factors for these diseases, including smoking and lack of physical activity.citation

The good news is that, just like other physical chronic conditions, depression can be treated, and with the right treatment, most people improve.

Top 10 Most Expensive Chronic Conditions in Rhode Island

* NOTE: Because many people have more than one chronic condition, they may be included in multiple lines in the graph. For example, an individual with both diabetes and high blood pressure is included in both the numbers for high blood pressure and diabetes.

In addition to affecting people's quality of life, chronic conditions also result in billions of dollars in healthcare spending. For example, insured Rhode Islanders with diabetes account for $1.4 billion in healthcare spending annually (or approximately one quarter of the total claims included in the HealthFacts RI dataset above), while people with high blood pressure account for nearly $1.3 billion. Some chronic conditions are less common but cost the healthcare system hundreds of millions of dollars. For example, COPD is the 11th most common condition (affecting 3% of the entire population) but is the 3rd highest in terms of spending ($781 million). Congestive heart failure is the 22nd most common condition (affecting 2% of the population), but ranks fifth in terms of spending ($696 million). These high costs emphasize the importance of chronic disease management to minimize the need for costly medical care.

The Impact of Chronic Conditions on Utilization

* The above graph shows the number of inpatient hospital admissions, per year, for every 1,000 Rhode Islanders with each condition. For example, for every 1,000 people with congestive heart failure, there are approximately 3,111 inpatient hospital admissions each year – for an average of more than 3 hospital admissions per person per year.

The presence of chronic conditions is also highly correlated with increased inpatient hospital admission rates. Rhode Islanders with congestive heart failure are admitted to the hospital 13 times more often than the population as a whole, for an average of more than three hospital admissions per year. Similarly, Rhode Islanders with COPD are admitted to the hospital more than 7.5 times more frequently than the general population, and average close to two hospital admissions per year.

Although patients may be admitted to the hospital for a variety of reasons, including those that are not necessarily tied to a particular chronic condition, the data shows that individuals with chronic conditions are, as a whole, sicker than the general population and go to the hospital at much higher rates. Not surprisingly, this high utilization of hospital services is a significant contributor to the high cost of chronic conditions for the Rhode Island healthcare system.

Chronic Condition Interventions in Rhode Island

Rhode Island's health and human services agencies are committed to preventing, mitigating and measuring chronic conditions among our population. For example, the Rhode Island Department of Health aims to reduce the burden of chronic conditions through a range of disease prevention and management strategies. Examples of some of the Department of Health's ongoing chronic disease initiatives include:

  • Working with healthcare providers to identify high risk patients and refer them to affordable community-based lifestyle change programs;
  • Working with employers to expand worksite wellness programs; and
  • Providing training to healthcare providers on best practices for encouraging patient self-management of chronic conditions (e.g. monitoring blood pressure, medication adherence, etc.)

The Medicaid Program and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) are also focused on building interventions and systems of care that better support patients with chronic conditions through the following initiatives:

  • Creation of "Accountable Entities", in which teams of providers and insurers align their financial incentives and care management approaches to better coordinate patient care;
  • Growth of Managed Care programs, which offer wrap-around care management for all patients, including those with chronic conditions; and
  • Launch of the Integrated Health Homes (IHH) and Integrated Care Initiative (ICI), which provide person-centered services for patients with severe and persistent mental illness (as in the case of IHH) and those who are eligible for both Medicaid and Medicare (as in the case of ICI).

Beyond our state agencies, local and national efforts to combat the impact of chronic conditions provide important opportunities to build on our foundation. Such efforts include:

  • The Rhode Island Care Transformation Collaborative;
  • Home and Hospice Care of Rhode Island, Care New England, and other home care programs which provide in-home disease monitoring and management programs for high-risk patients in an effort to prevent chronic disease escalation and reduce hospital visits;
  • Medicare's Pioneer and Shared Savings Program Accountable Care Organizations (ACO) and other local value-based care organizations that provide operation and financial incentives to providers organize comprehensive, coordinated care for their patients; and
  • The work of the American Heart Association, American Cancer Society, and other advocacy groups which aim to provide education and awareness around chronic conditions.

Conclusion

Chronic conditions do not just affect those who suffer from them – they also have a large impact on our communities and the healthcare system. Fortunately, many chronic conditions can be prevented and controlled, leading to improved health outcomes and reduced healthcare costs. Rhode Island state agencies are committed to reducing the burden of chronic conditions on individuals, families, communities, and healthcare providers by investing in health promotion programs that improve health, improve quality of life, and save healthcare dollars. To learn more about how to prevent or manage chronic conditions and connect to existing programs in your community, visit http://www.health.ri.gov/chronicconditions.