If an employee is diagnosed with a
chronic condition, it can create anxiety
for an employer. Often, a number of issues arise concerning the health, well-being and productivity of the employee.
For employers, this may mean the possibility of a complex, long-running illness
that could result in higher premium costs
for the company.
In a delicate situation such as this, an
employer must look at the needs of the
employee and demonstrate patience and
understanding. With chronic care management, available through the employer
group’s health plan, the illness can be
managed so the employee can lead the
healthiest, most productive life possible.
Chronic care management can benefit
both the employee and employer.
“An employer needs to understand the
chronicity of the disease,” says S.
Ramalingam, M.D., MBA, the senior medical director for UPMC Health Plan. “You
won’t see results right away from an effective chronic care management plan. First,
one must invest in the plan; the payoff
sometimes comes years later in terms of
improved health and productivity from an
employee who has learned how to live
with a chronic illness.”
Smart Business spoke with Ramalingam
about chronic care management and what
employers should know about it.
What is chronic care management, and how
does it differ from other care?
Unlike care for acute illnesses, chronic
care requires planned, regular visits with
caregivers and special emphasis on preventive measures. Care should be clinically grounded and tailored to an individual’s
needs. Treating chronic illness effectively
usually means the use of personal care
managers. These managers (trained nurses employed by a patient’s health plan)
can identify problems and work with the
patient’s physician to develop treatment
plans based on specific medical needs.
The care manager can also provide educational materials through periodic mailings, online resources and regular follow-up phone calls. One of the most important
things that care managers do is what a physician often cannot do, which is to
identify and remove any barriers to care.
With the personal attention, the care
manager may be able to answer important
questions such as: Why isn’t a patient taking his or her medicine? Why isn’t a
patient going to see the doctor as scheduled? A care manager may find that medication is too expensive and may be able
to recommend a more affordable generic
alternative. Maybe the patient can’t get to
a doctor’s office because of transportation
issues or conflicts at work. The care manager can help the employee find another
doctor who is more accessible. Care managers help patients receive the best treatment possible.
Why is it necessary to invest in the help of a
care manager when dealing with a chronic
illness?
Chronic disease is not only the major
cause of disability, it is the main reason
people seek health care, and it accounts
for more than 70 percent of all health care
spending. Employers need to invest in the
proper treatment. One area that is overlooked is the behavioral health element.
In recovering from a chronic disease, the
mindset of the individual plays an important role. The biggest danger with many
patients who have a chronic disease is
depression. A care manager can see to it
that the employee receives the behavioral
health care that might be needed.
What role should an employer play when
dealing with an employee who has a chronic
illness?
If an employer has employees with
chronic conditions, it must understand
how important it is to make time available
for the patients to do the things needed to
manage their condition. An employee
needs to feel comfortable and not
ashamed for having a chronic condition. It
is a fine balance because it is important
not to foster a sense of unfairness among
employees who see one of their colleagues missing work to treat their condition. Employers should work with their
health plan provider to learn methods to
keep things positive for everyone.
Flexibility is most important for an
employer.
What should an employer understand about
treating a chronic condition?
One of the biggest things for an employer to understand is, with chronic care, you
do not see the results instantaneously.
Both the person with the condition and
the employer should understand the
chronicity of the disease. Chronic care
management is an investment for an
employer. If a chronic condition is treated
aggressively through a disease management program, an employer gains an
employee who will be more productive
through the years and who is more likely
to avoid more costly procedures in the
future. The employer should also understand that caring for a chronic condition
does not mean finding a cure for that condition but rather improvement in the person’s quality of life.
S. RAMALINGAM, M.D., MBA, is the senior medical director for UPMC Health Plan. Reach him at [email protected] or
(412) 454-5702.
