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2012 Implementation Actions by HHS Agencies

Administration on Community Living/Centers for Medicare and Medicaid Services (ACL/CMS) – Framework Goals 1 and 2

Most older Americans have multiple chronic conditions (MCC).  ACL delivered Chronic Disease Self-Management Program services to over 140,000 adults in 48 states to mitigate the impact of MCC.  CL has emphasized continuity and sustainability of these programs beyond initial Recovery Act grant funding. 

Agency for Healthcare Research and Quality (AHRQ) – Framework Goal 4

Significant gaps exist in the approach to caring for individuals with multiple chronic conditions.  AHRQ produced a chronic disease self-management toolkit for use by healthcare providers. AHRQ also created the MCC Research Network through 45 grantees to advance the field of MCC research with focuses on comparative effectiveness, quality improvement, and patient-centered outcomes research.

Assistant Secretary for Planning and Evaluation (ASPE) – Framework Goal 3

With the growing prevalence of individuals with multiple chronic conditions, additional examination is needed of the disparities that exist for this population.  ASPE supported efforts that led to the National Quality Forum’s release of the “Measurement Framework on Multiple Chronic Conditions.”  ASPE also awarded a contract for extramural research on disparities and MCC, and on individuals with less common combinations of chronic conditions.

Centers for Disease Control and Prevention (CDC) – Framework Goals 1 and 4

Public health efforts are critical to understanding the burden of multiple chronic conditions on society at large and on individuals.  CDC produced MCC analyses of two national data sets (the National Ambulatory Medical Care Survey and the National Health Interview Survey) and produced reports on MCC-related patterns, health-care utilization, and costs.

Centers for Medicare and Medicaid Services (CMS) – Framework Goals 1 and 2

Through the Medicaid program, CMS supports its state partners in providing technical assistance for quality home and community-based services, innovative service delivery models, and person-centered programs and practice.  CMS implemented several Affordable Care Act provisions testing care models for populations with MCC.  CMS also released the 2012 Chronic Conditions Among Medical Beneficiaries Chartbook [PDF], with an MCC focus, and state-level patterns for MCC prevalence, utilization, and cost.

Food and Drug Administration/ Assistant Secretary for Planning and Evaluation (FDA/ASPE) – Framework Goal 4

Determining the extent to which individuals with MCC are being included or excluded from clinical trials for new therapeutic products had not been previously examined.  FDA published the FDA-commissioned report on Inventory of Clinical Trials Protocols and Clinical Study Data which examined the exclusion and inclusion of individuals with MCC in clinical trials.

Health Resources and Services Administration (HRSA) – Framework Goal 2

Through the Patient Safety and Clinical Pharmacy Collaborative (PSPC) – an initiative to improve health and safety among high-risk patients with MCC – HRSA supported over 250 community-based teams nationwide to deliver patient-centered care and comprehensive medication management to improve outcomes.

Indian Health Service (IHS) – Framework Goals 1, 2 and 3

American Indians and Alaska Natives are disproportionately affected by multiple chronic conditions.  To assist in improving the quality of health care for patients with MCC, the IHS, through its 30 Heart Healthy programs, and building on previous successes of the Special Diabetes Program for Indians, pursued intensive clinical case management efforts to reduce risks for coronary heart disease in individuals with diabetes and other chronic conditions.  IHS also developed a tool kit for dissemination to other IHS and tribal sites for implementing elements of these programs.

National Institutes of Health (NIH) – Framework Goal 4

Significant knowledge gaps exist regarding interventions that benefit individuals with multiple chronic conditions.  NIH addressed this gap by: 

  • Publishing an MCC-focused research funding opportunity announcement on secondary analyses of comparative effectiveness, health outcomes, and costs in persons with MCC,
  • Producing a report on universal health outcomes measures for older persons with MCC, and 
  • Planning an expert conference for 2013 to examine research questions and priorities for contextual issues in MCC.

Substance Abuse and Mental Health Services Administration (SAMHSA) – Framework Goal 1

Many individuals with multiple chronic conditions (MCC) have physical medical conditions in conjunction with behavioral health disorders.  SAMHSA funded new Primary Care and Behavioral Health Integration (PCBHI) Program grantees that include an emphasis on improving health status in adults with serious mental illnesses and MCC.