Can Chronic Disease Management Really Work?

With the Centers for Disease Control and Prevention projecting that 83 million people will soon have three or more chronic diseases, the number of employers working to manage chronic conditions like diabetes, high blood pressure and coronary artery disease is staggering.

Not only do the average medical costs for a diabetic exceed $16,000 per year, but the loss of productivity is estimated to add an additional $1,700. How can your health plan cope?

Begin with Good Information
Reviewing claims data, diagnostic tests and prescription drug data is a critical starting point. Once plan members with chronic illnesses are identified, care managers, nurse navigators or health coaches can talk with them to learn about their lifestyle, ask about medications, nutrition, their family situation and other factors that may be impacting their condition.

Chronic disease management is not a one-step process. It involves partnering with a member’s physician and other professionals to understand the patient’s needs and develop a personalized care plan. This level of personal involvement will not only help the member receive the care they need but also help them better understand how to use their health plan to their benefit.

Experience shows that 80% of a company’s healthcare spend is often attributed to 20% of plan members. Chronic illness is likely the reason, making disease management a critical part of high-quality healthcare plans.

Is Self-Funding Right for Small Groups?

Self-FundingAs the number of stop loss insurance products offering quick reimbursement of large claims continues to increase, more and more small groups (those with 50 to 150 employees) continue to transition to partial self-funding. The ability to identify how claim funds are being spent is one important reason. Claims data, seldom made available to small groups in a fully insured environment, can help pinpoint where health care dollars are going and the impact of strategies such as disease management, care management or wellness programs. Continue reading