Success Stories

Collaborative combats the costs and consequences of chronic diseases

By Jeanne Zeidler

Some of the region's most effective and cost efficient health care is being practiced in unexpected places - like the aisles of a local grocery store.

That's where Kendra Robinson, a nurse educator, and Megan Cordova, a registered dietician, create health care solutions. Twice a month, the Olde Towne Medical Center staff members teach healthy shopping strategies to small groups of patients with chronic conditions such as obesity, diabetes and hypertension. "Shop the perimeter," Robinson advises. "That's where the good stuff is — whole grains, fruits, vegetables." The pair walk their patients aisle-by-aisle through the store, cautioning about processed foods. They talk about eating well on a limited budget. And they reveal important food secrets.

"Is ground turkey or ground beef healthier?" she asks. The seemingly obvious answer — ground turkey — is not always right. "Sometimes they grind the turkey skin along with the meat. That increases the fat content."

The program is innovative and effective, but it's just one of the creative ways a coalition of non-profit healthcare organizations is combatting the costs and consequences of chronic illnesses. The Chronic Care Collaborative, a group of six non-profit health care organizations primarily serving uninsured and underinsured populations, formed in 2006 as signs of the coming storm became apparent. It was one of the nation's first attempts to address chronic illnesses, and it's become a model for other communities. Collaborative members focus on improving care, but they also help patients make lifestyle changes and manage their own conditions.

"Fifty years ago the nation faced a health crisis posed by smoking," says Rob Bradley, executive director of Lackey Free Clinic, one of the clinics in the collaborative. "The bad news is we're on the brink of a new health crisis resulting from lifestyle-induced illnesses. It threatens to diminish the quality of life for many people and burden an already-stressed medical system. The good news is we are actively addressing it. We're sharing ideas and finding solutions."

Chronic illnesses represent a silent epidemic. The Center for Disease Control estimates nearly half of all Americans suffer from one or more chronic illnesses. Lackey Free Clinic reports 80 percent of its 10,000 patient visits in 2010 addressed chronic illnesses.

Type 2 diabetes, a disease exacerbated by poor eating habits, is a particular worry. The CDC estimates 25.6 million American adults — about 11 percent of the population - have some form of diabetes. Another 79 million people have prediabetes, a condition marking increased odds of getting diabetes.

While diabetes can be deadly, it's also expensive. Patients with diabetes incur about 2.3 times more medical expenses than other patients, according to the American Diabetes Association. The ADA calculates the direct cost of treating Americans with diabetes at more than $116 billion a year.

The challenge for health care providers is daunting. Collaborative members communicate regularly through an extranet, and they gather monthly to compare notes and discuss strategies. The highlight of every meeting, however, comes when members share "breakthrough" stories, such as the clinics' increased ability to address behavioral health issues, which often accompany chronic conditions.

The economic benefits of managing chronic illnesses can be dramatic. Because they're usually uninsured, many of the clinics' patients used to rely on local emergency rooms. In 2010, however, Lackey reports that only 1% of its patient visits were directed to emergency rooms. "The Collaborative has helped us improve in many ways," Bradley says. "We've adopted new clinical processes, gained valuable skills and produced better outcomes. It's made a tremendous difference for our patients, our staff and the community as a whole."

Olde Towne's Robinson puts it another way. "Controlling your own health means everything. Our patients learn to get excited about life again."