In general, Americans are not a healthy people.

Among adults, 42% have two or more chronic conditions, according to a 2024 CDC report; 12% have at least five of these conditions, which include heart disease, cancer, diabetes, obesity and hypertension.

These conditions — known as comorbidities when they exist alongside other, shorter-term health concerns — afflict at least 129 million Americans, and they make treating these other health concerns more complex.

Doctors treating patients with comorbidities should work together across specialties to ensure patients receive accurate diagnoses and adequate care. The additional required coordination can open physicians up to an increased risk of something going awry during treatment and resulting in medical malpractice litigation.

“If the physician is not addressing the complexities and the different comorbidities that arise, then it can absolutely increase the risk of complications,” said Anne Marie Lyddy, MHA, CPHRM, senior risk management consultant, West region, ProAssurance.

Fortunately, there are a number of risk management strategies that can help address the risks posed by comorbidities. Let’s take a look at five ways physicians can manage comorbidities, reduce their risk and drive better patient outcomes.

1) Collaborate with Other Health Care Professionals

Anne Marie Lyddy, MHA, CPHRM, Senior Risk Management Consultant, West Region, ProAssurance

Effective communication between physicians and other health care professionals is paramount in managing patient comorbidities. Collaborative interactions facilitate the exchange of crucial information, treatment plans and insights, enabling a comprehensive approach to patient care. Clear and open communication fosters a coordinated effort among health care teams, leading to optimized strategies for addressing the complex needs of patients with multiple medical conditions. When different physicians communicate with one another and work together to coordinate a patient’s care, it can reduce the risk of comorbidities interfering with the treatment of other conditions.

“By fostering clear and open communication with their patients and among themselves, physicians can collaborate more effectively to address the complex needs of patients with multiple medical conditions, ultimately improving patient safety and outcomes,” said Lyddy. “That can help to reduce misadventures in general and errors in, say, medication management because they have access to and utilize critical patient information.”

2) Optimize Electronic Health Records to Better Manage Treatment

By their nature, comorbidities make patient treatment more complex. A patient with diabetes or heart disease might be taking medications to manage their condition, which could have adverse interactions with the drugs they need to treat a different injury or illness.

Further, patients may not be the best keepers of their own medical history. They might not remember a particular drug or treatment they’ve undertaken to manage comorbidities with prior physicians. In these cases, electronic health records (EHR) can step in to help doctors make sure they’re treating a patient appropriately. EHRs can help track treatment, record progress and document any concerns a treating physician may want to follow up on. Good documentation can also help in the defense of a physician in the event of an unanticipated outcome that leads to litigation.

“If the EHR is being used and optimized, then there are flags, alerts and aids that would help the physician as they work through a disease process,” Lyddy said. “There are still some physician practices that use paper rather than transitioning to an EHR system. This is especially true in smaller practices where it can be a challenge to invest in new technologies.”

Larger health systems might see small hospitals and physician practices struggle with EHR during mergers and acquisitions — which are once again rising in the health care space after slowing for two years during the pandemic. In order to reduce medical malpractice risk in cases with comorbidities, when merging systems, hospitals need to prioritize and understand the criticality of data migration. They should also focus on system interoperability, data security and training, and must keep good digital records to ensure the entities they acquire are practicing good EHR hygiene.

“If you’re lucky, they’re on the same EHR,” Lyddy said. “But they’re probably not, especially if they’re acquiring a series of smaller practices, which may not have an EHR at all or, if they do, it may not be compatible.”

3) Use Medication Reconciliation Programs to Reduce Errors

Communication and collaboration among providers can result in better managed care, especially when it comes to prescribing. Patients with comorbidities might be taking a number of different medications, and it’s important to monitor them to ensure there are no negative interactions between any of the drugs.

“At every care transition that patient has, someone should be looking at the med list, because that’s where medication errors, drug interactions and adverse drug events happen— which can open a physician up to medical malpractice risks,” Lyddy said.

“With patients with comorbidities, it’s even more important because they’re on more medications.”

 4) Make Sure Patients Are Involved in Their Care

 Doctors collaborating with one another and documenting care processes in EHR systems is only one part of what is needed to ensure treatment success and reduce medical liability exposures; patients also need to be invested in their care to ensure success.

“The more patients are involved in their care, are educated and help themselves, the better off they will be in improving their outcomes,” Lyddy said.

In cases with comorbidities, this is especially important. A patient’s diet, exercise and other factors can play a major role in managing their long-term conditions and can encourage healthy recovery from shorter-term ailments. Doctors treating patients with comorbidities should talk with them to make sure they’re investing in their health.

“The medications they’re taking, the diet they’re consuming — all of it plays a role,” Lyddy said.

“The more that we can educate patients — whether it be via face to face communication, written educational materials or videos that can help the patient be informed about their disease processes and things that they can do to help with their own care — the better the outcomes will be. That empowers the patient and hopefully helps them to take an active role in their care. The hope is that it would ultimately help to reduce the risk of untoward events.”

 5) Partner with a Malpractice Carrier that Regularly Monitors Performance and Conducts Quality Improvement Initiatives

 Managing comorbidities can be tricky, but with the right systems in place, physicians can reduce their exposure to medical malpractice suits even in the most complex cases. Insurance carriers are there to aid hospitals and private practices in implementing the right risk management tools.

ProAssurance has developed a number of risk management resources to help its insureds reduce the risk of litigation in cases where comorbidities are involved. The risk management team educates physicians on the importance of assessing and managing the risks associated with comorbidities, encourages a collaborative approach among providers and analyzes a practitioner’s approach to see where they might be exposing themselves to additional risk.

ProAssurance insureds can take a self-assessment to see where that exposure might lie as they treat patients with comorbidities. The assessment then generates a report with suggestions for improvement.

“We give them an opportunity to answer survey questions that are basically a practice self-assessment,” Lyddy said. “They go through a series of questions that will help to identify gaps in their processes or opportunities for improvement.”

ProAssurance risk management consultants can also visit a practice and make suggestions for how to improve communication and collaboration, better facilitate coordination of care and reduce the risk of medical malpractice claims.

“We can go in and identify the areas that are causing breakdowns,” Lyddy said, “and then work with them on system improvements; actions that help to improve processes that can enhance the patient’s experience and ultimately optimize treatment plans.”

The risk management team can also conduct an assessment of medical records and staff note-taking processes. They assess whether the EHR is being used correctly, and include documentation of informed consent and other aspects of care. The review process can help improve consistency within the practice and reduce opportunities for error that could result in litigation.

“Ultimately, it takes an integrated approach that not only elevates patient safety and satisfaction but also aids physicians in effectively managing patient comorbidities. By fostering clear communication, refining processes and optimizing systems, health care providers can create a supportive environment that enables them to address the complex needs of patients with multiple medical conditions.”

A cohesive strategy can go a long way to not only enhance the overall patient experience but also empower physicians to manage the challenges posed by comorbidities more effectively, leading to improved patient outcomes.

To learn more, visit:  https://riskmanagement.proassurance.com/.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with ProAssurance. The editorial staff of Risk & Insurance had no role in its preparation.