Chronic diseases are almost as costly as they are common. According to the Centers for Disease Control and Prevention (CDC), half of U.S. adults have at least one chronic condition, while almost one-third have two or more. And treatment of those conditions accounts for more than 80 percent of our health care spending.
“These conditions are some of the most costly causes of death in this country, but many are very preventable,” says Veronica Hawkins, Medical Mutual vice president of Government Accounts. “Fortunately, there are plenty of programs consumers can use that give them the tools, the education and the encouragement they need to really improve their quality of life.”
Smart Business spoke with Hawkins about the types of programs being offered in the market to help people manage their chronic health conditions, and how organizations can benefit as well — by increasing productivity in the workplace and reducing their health care costs.
What types of conditions are considered ‘chronic’?
The basic definition focuses on non-contagious diseases that have a long duration and generally slow progression. Some examples are cardiovascular diseases, diabetes and chronic respiratory diseases like chronic obstructed pulmonary disease (COPD) and asthma. In most cases, depression also falls into this category.
What is disease management?
It refers to ongoing care to help people with one or more chronic conditions. The idea is to prevent or minimize their effects through integrated care.
Many organizations today offer some type of disease management program to help their employees have a better quality of life. Plus, when employees don’t need to visit the emergency room or be admitted to the hospital as often, health care costs go down and productivity goes up.
How do the programs work?
Disease management is included with most fully insured plans. Self-funded employers, which pay their own claims, would likely have to buy into it. The cost structure, obviously, varies among carriers, but it is usually built in to either the employer’s premium or administrative costs.
In most cases, insurance carriers work with an outside vendor that uses claims information to identify members who might benefit from the program. They do outreach to identify members who want to participate, and those who do are usually assigned a health coach. The health coach educates the member on his or her condition and develops a plan to make changes that will improve their overall health.
The programs send educational materials to members even if they haven’t opted in — unless, of course, they decline to participate.
What else might be involved?
A member might use the program to better understand his or her medications or get counseling to quit smoking or lose weight. Depression screening is also very common.
Depending on the needs of the members, many programs offer counseling, home visits, 24-hour call centers and appointment reminder systems. Others allow members to receive their diabetic testing supplies, like a diabetes monitor or test strips, for no additional out-of-pocket cost. There is usually quite a bit of customization, so each member gets the help that he or she needs.
How can organizations get more employees to participate?
Engagement is obviously the most important part of a disease management program — and the biggest challenge. Monetary incentives are relatively common, depending on how the program is set up, either by the carrier, employer or program vendor. For example, participants might get a gift card for completing their first year in a program.
Obviously, each organization is different and the needs of individual members will vary. It takes time and expertise to find the right approach. But it can definitely be worthwhile.
Organization leaders should talk to their insurance carrier if they are interested in implementing a disease management program, or simply want to get more of their employees to participate in the one they already have.
Insights Health Care is brought to you by Medical Mutual
