Multiple Chronic Conditions | Resource Center

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Multiple Chronic Conditions (MCC) means that a person is living with two or more chronic conditions at the same time. Currently, 1 out of 3 adult Americans have MCCs and for persons 65 and older 4 out of 5 Medicare Beneficiaries and a growing number of children have MCCs. This is the largest patient population and users of healthcare resources accounting for 64% of all clinician visits, 70% of all inpatient stays, 83% of all prescriptions, 71% of all healthcare spending, and 93% of Medicare spending. https://multiplechronicconditions.org/

Episodes

  1. MCCRC Podcast: Determinants of Health in Rural Healthcare

    11/18/2025

    MCCRC Podcast: Determinants of Health in Rural Healthcare

    This Podcast highlights the rural healthcare center established by Northern Michigan University (NMU) and its impact on the rural population who reside in the upper peninsula of Michigan. Former Director James K. Haveman of the Michigan Department of Community Health under two Governors, and Elise Bur the Director of the Center discuss the evolution of the NMU Rural Healthcare Center and its impact on providing determinants of health to a unique patient population. See omnystudio.com/listener for privacy information.

    24 min
  2. MCCRC Podcast: Cheryl Phillips, M.D, AGSF, John A Hartford Foundation

    08/01/2025

    MCCRC Podcast: Cheryl Phillips, M.D, AGSF, John A Hartford Foundation

    Cheryl Phillips, M.D, AGSF, is the senior program consultant for the John A Hartford Foundation’s Age-Friendly Health Systems initiative and discusses the 4Ms. What Matters, Medication, Mentation and Mobility and how these concepts interface with person-centered care planning for persons with and at risk for multiple chronic conditions. Dr. Phillips describes the administration’s policy changes with the Agency for Healthcare Research and Quality and how the John A. Hartford Foundation will continue to promote person-centered care for the nations aging population The Centers for Medicare & Medicaid Services released a new Age Friendly Hospital Measure  designed to improve the care and outcomes of older hospitalized adult patients.https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/cms-age-friendly-hospital-measure/Institute for Healthcare Improvement Patient and Family Resources on Age-Friendly Care https://www.ihi.org/library/tools/patient-safety-essentials-toolkit See omnystudio.com/listener for privacy information.

    27 min
  3. MCCRC Podcast: Looking at the Patient Perspective for those with Kidney Disease with Richard Knight

    04/07/2025

    MCCRC Podcast: Looking at the Patient Perspective for those with Kidney Disease with Richard Knight

    In this edition of the MCCRC Podcast, Dr. Kim Kuebler sits down with Richard Knight to discuss the Patient Perspective for those with Kidney Disease.   Hear Richard's key take away’s, specific information that would have helped him to better understand how his hypertension impacted upon his kidney function, talking about the missing links in the collaborative medical management of patients with kidney disease, and much more! See omnystudio.com/listener for privacy information.

    25 min
  4. Person Centered Care Planning for People Living with or at Risk for MCCs

    02/28/2025

    Person Centered Care Planning for People Living with or at Risk for MCCs

    Arlene Bierman MD, MS, Brittany Watson MD, MPH and Jane Pederson MD, MS discuss the recent JAMA online publication Person-Centered Care Planning for People Living with or at Risk for Multiple Chronic Conditions. This paper describes a qualitative study using theme analysis from responses following a Request for Information (RFI) published in the Federal Register soliciting input on PCCP, posted by the Agency for Healthcare Research and Quality (AHRQ) in 2022. Responses were analyzed between January 2023 and February 2024. The researchers identified 9 themes: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. The information collected from this study are used to gain momentum in the AHRQ’s initiative on Person-Centered Care Planning for People with MCC. This data was used to solicit input from multidisciplinary experts, patients and policy stakeholders at the recent AHRQ Summit to determine next steps in promoting comprehensive care for the nation’s largest patient population – those living with MCC. LINK TO FULL ARTICLE: https://www.nursingoutlook.org/article/S0029-6554(24)00166-0/abstract?dgcid=raven_jbs_etoc_email See omnystudio.com/listener for privacy information.

    35 min
  5. WEBINAR - Medication Safety: Knowledge is Power

    12/20/2024

    WEBINAR - Medication Safety: Knowledge is Power

    A link to the slides mentioned in the podcast: https://hcanys.org/doclink/kuebler-medication-safety/eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWIiOiJrdWVibGVyLW1lZGljYXRpb24tc2FmZXR5IiwiaWF0IjoxNzMzNDIwOTE0LCJleHAiOjE3MzM1MDczMTR9.Xg5H1OS1UAio4gUrdriWHmecDx9uMOC-ZmB2Y-Rv9I8 See omnystudio.com/listener for privacy information.

    49 min
  6. Multiple Chronic Conditions vs Chronic Conditions - Dr. Eduardo Bruera

    12/06/2024

    Multiple Chronic Conditions vs Chronic Conditions - Dr. Eduardo Bruera

    In the sixth edition of the MCCRC Podcast, Dr Kim Kuebler sits down with Dr. Eduardo Bruera to discuss palliative care in and how it is being used in the primary care setting for those patients living with non-reversible, symptomatic chronic conditions. Here is a link to the reference Dr. Bruera used in this podcast: https://www.nursingoutlook.org/article/S0029-6554(24)00166-0/abstract?dgcid=raven_jbs_etoc_email  See omnystudio.com/listener for privacy information.

    36 min
  7. Dr. Paul Ciechanowski discusses the benefits of integrated behavioral health models in primary care

    10/28/2024

    Dr. Paul Ciechanowski discusses the benefits of integrated behavioral health models in primary care

    In the fifth edition of the MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Paul Ciechanowski talks about the benefits of integrated behavioral health models in primary care, why integrated care is a preferable model to hiring psychiatrists or social workers as part of a co-located model, and much more. Here are links to the references Dr. Ciechanowski used in the podcast: Clinical inertia: https://escholarship.org/content/qt7fd7r9r5/qt7fd7r9r5.pdf Two clinical trials that support collaborative care by research groups: https://jamanetwork.com/journals/jama/fullarticle/198486 https://www.nejm.org/doi/full/10.1056/NEJMoa1003955 See omnystudio.com/listener for privacy information.

    38 min
  8. Dr. Irina Koyfman discusses Chronic Care Management - Do’s, Don’ts, and Everything in Between.

    10/16/2024

    Dr. Irina Koyfman discusses Chronic Care Management - Do’s, Don’ts, and Everything in Between.

    In the fourth edition of the MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Irina Koyfman to talk about Chronic Care Management (CCM), getting in depth on what CCM really is, why specialists should consider doing CCM, and the future of CCM. Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/ See omnystudio.com/listener for privacy information.

    39 min
  9. Dr. Matthew Sorenson discusses how the human immune system relates to Multiple Chronic Conditions

    08/16/2024

    Dr. Matthew Sorenson discusses how the human immune system relates to Multiple Chronic Conditions

    In the third edition of The MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Matthew Sorenson to talk about how the human body is impacted by chronic conditions, the different types of cells in the immune system, and the factors impacting immune health. Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/ See omnystudio.com/listener for privacy information.

    33 min
  10. Dr. Glenna Crooks discusses her research on helping overloaded people remaining in the workforce

    06/03/2024

    Dr. Glenna Crooks discusses her research on helping overloaded people remaining in the workforce

    In this second edition of The MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Glenna Crooks to talk about her most recent research on helping overloaded people remaining in the workforce, along with her most recent book "The NetworkSage: Realize Your Network Superpower." Order "The NetworkSage: Realize Your Network Superpower" here: https://www.amazon.com/NetworkSage-Realize-Your-Network-Superpower/dp/1532029624 The MCCRC Podcast EP #2: Dr. Glenna Crooks, PhD Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/ See omnystudio.com/listener for privacy information.

    26 min
  11. Dr Julian L. Gallegos discusses the link between diabetes and low testosterone in men

    05/14/2024

    Dr Julian L. Gallegos discusses the link between diabetes and low testosterone in men

    In this first edition of The MCCRC Podcast, Dr. Kim Kuebler sits down with Dr. Julian L. Gallegos to talk about T2DM, Obesity, and Hypogonadism. Visit The Multiple Chronic Conditions Website here: https://multiplechronicconditions.org/ The MCCRC Podcast EP #1: Dr. Julian L. Gallegos, PhD, MBA, FNP-BC, CNL, CMHE, FAUNA See omnystudio.com/listener for privacy information.

    28 min
  • 11 Episodes

About

Multiple Chronic Conditions (MCC) means that a person is living with two or more chronic conditions at the same time. Currently, 1 out of 3 adult Americans have MCCs and for persons 65 and older 4 out of 5 Medicare Beneficiaries and a growing number of children have MCCs. This is the largest patient population and users of healthcare resources accounting for 64% of all clinician visits, 70% of all inpatient stays, 83% of all prescriptions, 71% of all healthcare spending, and 93% of Medicare spending. https://multiplechronicconditions.org/

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