TABLE OF CONTENTS
01 Chronic Care Management vs. health coaching | 02 Supported conditions | 03 Employer needs | 04 Goals of Chronic Care Management | 05 Incentivizing Chronic Care Management | 06 Member identification | 07 Outreach methods | 08 Results | 09 Supporting those without chronic conditions | 10 Population health strategy
Chronic Care 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 patient-focused, high-touch interventions helps individuals manage chronic conditions, which in turn drives down costs and improves compliance with their physician’s care plan.
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 that chronic care programs are 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.
Many employers are looking for cost-control and tech solutions to help their population manage chronic conditions like diabetes and high blood pressure.
IMPROVING HEALTH TO MANAGE COSTS
Today's leaders understand the value of a wellness program, but are continuing to look for ways to control costs and improve the health of their population. According to a survey by Willis Towers Watson, 80% of employers are planning to sponsor programs targeting health conditions or high-cost cases by 2021 and 65% of employers will emphasize diabetes over the next three years. Targeting the population with the highest health risks and those with chronic conditions is a smart strategy. Unmanaged conditions can cost more than $2,000 per patient in avoidable treatment each year.
To target this population effectively, companies are looking for tech solutions:
WHY TECH MATTERS
Technology is increasingly important in our daily lives. So it's only natural that this evolves into health management. Navigating a chronic condition takes a lot of time and effort on the member's part, and technology offers accessibility and support to users at a time and place that is convenient for them. Most companies recognize that their employees can't access doctors and nurses at any time of the day or night, but they can access resources on their smartphones.
Technology also offers members an enhanced user experience because it's personalized to them. From reminders about upcoming appointments and recommended care, to details about program requirements and covered physicians, a customized user experience takes the guess-work out of managing a chronic condition.
Success and good health for the member are the top goals of a chronic care management program. Keep these 5 tenants in mind when evaluating a chronic care management program:
Supporting the relationship with the member’s physician and their plan of care. See what types of programs can support employees with diabetes or pre-diabetes.
Monitoring claims and health data to reduce gaps in care and costs. Discover how your chronic care management program saves you money here.
Deciding to incentivize your chronic care 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 care management program or complying with recommended care. If you’re looking to enhance your benefits, just having a chronic care management program and advocate available to the members can be incentive enough.
Many times members are identified though medical and pharmacy claims. At HealthCheck360, 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 members participate in as part of the wellness program.
When evaluating a chronic care management program, make sure you’re informed and aware of the process for enrollment. You want to be sure you’re not missing eligible members. Unmanaged conditions can cost more than $2,000 per patient in avoidable treatment each year.
Most chronic care 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.
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.
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.
Learn more about Health Coaching.
Determining if a chronic care management program fits into your company's overall population health strategy is no small task.
Here are a few questions to consider when starting this process:
1. WHAT ARE YOUR GOALS?
2. WHAT IS YOUR BUDGET?
3. WHAT IS YOUR COMPANY CULTURE?
4. WHAT DO YOU NEED IN A PARTNER?
Learn more about why these questions are important and get help determining your population health strategy with this free checklist!