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WHAT IS CHRONIC CONDITION MANAGEMENT? 

Chronic Condition Management programs can go by many names. Disease management, condition management, and medical management are all terms commonly used. Regardless of what you call it, these programs offer more personalization to the member and generally more varied methods of communion.

This patient-focused, high-touch approach helps participants manage chronic conditions, which in turn drives down costs and improves compliance with their physician’s care plan. 

 

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How is Chronic Condition Management different from Health Coaching?

 

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One of the big differences between chronic care management and health coaching is the clinical nature of the program. Chronic condition management is generally provided by a nurse, whereas health coaching is provided by someone with a health, but not necessary clinical, background.

 

According to Employee Benefit News, “A good condition management program includes guidance on nutrition, exercise, sleep and stress management, but how those areas are prioritized should depend on the individual.” For example, if a participant’s poor nutrition habits are a result of their stress levels, tackling their stress and offering stress management tools is prioritized first.

 

The last key difference between coaching and chronic care management is a lot of times, chronic care management is offered only to members who have certain chronic conditions. Health coaching is generally available to all members or those who have one or more significant health risks but haven’t developed a diagnosed condition.

 

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What conditions are supported?

 

 

 

 

 

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This list isn’t all-inclusive, but many times chronic condition management programs cover:

 

• Diabetes
• Heart Failure
• High Blood Pressure
• High Cholesterol
• Ischemic Heart Disease
• Asthma
• COPD
• Chronic Kidney Disease
• Pregnancy

 

 

 

 

 

 

 

 

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What are the goals of a chronic condition management program?

 

 

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Success and good health for the member are the top goals of a chronic condition management program. Keep these 5 tenants in mind when evaluating a chronic condition management program:

    

 

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SUPPORT

Supporting the relationship with the member’s physician and their plan of care.

 

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REDUCE

Monitoring claims and health data to reduce gaps in care

 

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PERSONAL

Focusing on behavior change personalized to the individual

 

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ACHIEVE

Educating and motivating the member to achieve health improvement

 

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PREVENTION

Preventing medical complications due to the condition by using evidence-based care guidelines

 

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Can you use incentives with chronic condition management programs?

 

 

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Deciding to incentivize your chronic condition management program has a lot to do with your company’s goals. If you’re seeing skyrocketing health care costs due to hospital admissions or emergency care related to chronic conditions, it might be worthwhile to provide members with incentives for participating in a chronic condition management program or complying with recommended care. If you’re looking to enhance your benefits, just having a chronic condition management program and advocate available to the members can be incentive enough.

 

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How are members identified?

 

 

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Many times members are identified though medical and pharmacy claims. We like to take things a step further and identify members though self-reported data on the annual health survey and potential members though biometric screenings.

 

Make sure you’re informed an aware of the process for enrollment to be sure you’re not missing eligible members. Unmanaged conditions can cost more than $2,000 per patient in avoidable treatment each year.

 

 

 

    

 

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What types of outreach methods are used?

 

 

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Most chronic condition management programs are telephonic. This allows your members to connect with a clinical expert at a time and place that is convenient and confidential for them.

 

Outreaches are good, but we believe in creating a two-way conversation with our members. We use technology to help get in touch with members. A continual flow of data from biometric devices also allows our nurses to support participants when they need it.

 

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What kind of results should we expect?

 

 

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Some programs only measure the number of letters sent or calls received. While communication is important and shows activity, what you need are true health and cost results. The national average for chronic care management program compliance rates hovers around 30 – 40%. This should be the minimum benchmark for your company in determining if your program is successful.

 

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OUR PROGRAM COMPLIANCE

Rates compared to National Average

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What about people without chronic conditions?

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Providing support for members with chronic conditions is incredibly important and successful at moving the needle on health and claims costs. But what about clinical support and care recommendations for employees without chronic conditions? We all know that prevention is important and helping people understand what preventative exams they need at certain points in their life is key to managing long-term health.

 

Supporting employees without chronic conditions can take many forms from education and support about preventative visits, to specific coaching programs like weight management or nicotine cessation, to general lifestyle coaching for healthy habits. We recommend supporting your employees without chronic conditions with health coaching.

 

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