Many employers who are watching their group health insurance premiums increase are asking obvious “what if” questions: What if my healthy employees could stay healthy? What if my unhealthy employees didn’t get sicker?
And health care professionals are asking, “Why not?” says Dr. John Wallendjack, vice president of Medical Affairs for HealthAmerica. “Why not change the focus of health care from illness to wellness, from high-cost treatment to low- or no-cost prevention, from passive patient to self-care participant? The health care approach that resulted from this questioning is called disease management.”
Smart Business spoke with Wallendjack about how employers can use disease management to address cost and quality concerns.
What is disease management, and how does it affect the cost of health care?
Disease management is the process of reducing health care costs and improving quality of life for individuals by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care.
What has driven the increasing interest in disease management?
Two developments have served as catalysts for the increased interest: the unsustainable rise in health care spending and advances in information technology.
The numbers help explain why early prevention and disease management are necessary. Health care costs have been rising for years and will continue to do so. The Office of the Actuary in the Centers for Medicare & Medicaid Services projects that from 2009 to 2019, average annual health spending growth, at 6.1 percent, is anticipated to outpace average annual growth in the overall economy, at 4.4 percent. By 2019, national health spending is expected to reach $4.5 trillion and comprise 19.3 percent of the nation’s Gross Domestic Product.
The nature of health care in the U.S. has changed dramatically over the past century, with longer life spans and greater prevalence of chronic illnesses. The Centers for Disease Control and Prevention estimates that health care costs for chronic disease treatment account for more than 75 percent of national health expenditures. As the baby-boom generation ages and develops chronic illnesses, boomers will use more health care services.
Second, technological advances are making the disease management concept more achievable. The ability to collect and analyze patient data using information technology has resulted in major improvements to the health care delivery system. This has allowed for significant strides in the creation of effective disease-management programs. IT makes it possible to determine the health risks of individuals, as well as of entire populations, and track treatment, outcomes and costs.
Once a patient’s information is in the system, it can be accessed by health care providers to coordinate care and avoid medical errors. IT helps identify health care best practices and monitor their use, and it’s behind many of the quality comparisons consumers can access to evaluate health care providers and hospitals.
